The anatomy of the anterior interface revisited

Abstract

With the advent of the intraoperative OCT in 2015, the anterior interface could be visualized during cataract surgery. This technology allowed better understanding of the anterior interface that was considered for so many years as being virtual. Based on the intraoperative OCT device, we were able to describe a new type of congenital cataract based on a dysgenesis of the anterior interface which we called AVLID: anterior vitreo‐lenticular interface dysgenesis. This type of congenital cataract is responsible for about one third of the newborn cataract in developed countries. It also allowed us to observe that the anterior interface was not large enough to accommodate the bag‐in‐the‐lens in some eyes with childhood cataract. We then developed a new capsule stretching technique to enlarge the anterior interface per operatively. In addition, we observed the presence of anterior vitreous detachment (AVD) in adults starting from 45 years on. We found an incidence of 60% AVD in adult eyes and were able to study the consequences on accommodation of AVD. The anterior interface was given the name of Berger, an Austrian anatomist from Graz (1887). However, the most important structure of the anterior interface is the ligament of Wieger. Wieger was an ophthalmologist and described the hyaloidal‐capsular ligament in his thesis which he defended in Strassbourg (1884). It is this ligament that influences accommodation and as a result the name of Wieger should be recognized as such.