Longitudinal folds in the posterior capsule

Abstract

We commend Durak and Oner1 for their astute observation and reporting of an interesting intraoperative finding during phacoemulsification. They describe the occurrence of folds in the posterior capsule along the longitudinal axis of the intraocular lens (IOL) and indicate that this signifies complete removal of ophthalmic viscoelastic devices (OVDs) from the capsular bag. They hypothesize that these folds are probably due to the stretch of a collapsed capsular bag by the haptics of the IOL. The location of the folds stretching from the ends of the IOL haptics and their disappearance after fluid injection into the anterior chamber distends the capsular bag indicate that their surmise is correct. We would like to add that the appearance of these folds after IOL insertion also indicates the anatomic location of the lens in the posterior chamber. Particularly in eyes with pupillary miosis during the surgical procedure, the surgeon sometimes finds it hard to ensure that the IOL is completely within the capsular bag. In such instances, we have found the folds to be a useful sign confirming in-the-bag location of the IOL. Recognizing this sign would help the surgeon avoid unnecessary manipulation of the iris to confirm the IOL's location. The longitudinal folds are, however, not observed in all eyes, indicating the role of other factors in this phenomenon. We believe that the relationship between the diameter of the IOL and the capsular bag is also important, since it is the stretch of the capsular bag by the IOL that results in these folds. This indicates a slight (possibly desirable) oversizing of the IOL in relation to the capsular bag. If the IOL diameter were smaller than that of the capsular bag, these folds would not occur. Similarly, it is conceivable that the configuration of the IOL haptic may influence the occurrence of these folds. Longer C-shaped haptics that produce a more uniform stretch of a larger area of the equator of the capsular bag may not produce these folds. An important limitation of the “longitudinal striae” sign is, therefore, that posterior capsule folds do not occur in all eyes. Failure to see these folds should not be construed to indicate the presence of a bolus of OVD in the bag or sulcus placement of the IOL. Srinivas K. Rao DO Prema Padmanabhan MS aChennai, India