Endocapsular Phacoemulsification Research Articles

Evaluation of Nd:YAG laser capsulotomy results in patients who underwent cataract extraction and intraocular lens implantation with the endocapsular phacoemulsification method

Background/Aim: Posterior capsular opacification (PCO) is a common complication that develops after cataract surgery, and it can be treated neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. In this study, we aimed to investigate the effects of different intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO), to determine the time between surgery and Nd:YAG laser capsulotomy, and to evaluate the efficacy, effectiveness, and complications of capsulotomy in patients who underwent cataract surgery with the phacoemulsification method and subsequently developed PCO. Methods: The cohort study included one eye of each of 153 cases (63 males, 90 females) who underwent cataract surgery with the phacoemulsification method in our clinic from August 1, 2006, through August 1, 2008, and subsequently developed PCO. According to the type of IOL implanted, the cases were divided into three groups: polymethylmethacrylate IOL (Group 1), hydrophilic acrylic IOL (Group 2), and hydrophobic acrylic IOL (Group 3). The control examinations of the patients who underwent Nd:YAG laser capsulotomy were undertaken before capsulotomy and at the first week, first month, and third month after capsulotomy. Results: Visual acuity improvement was detected in 96.7% of the 153 cases. It was determined that 9.1% of the cases had an intraocular pressure (IOP) increase of more than 5 mmHg at the third hour after capsulotomy and approached baseline values at the end of 1 week. The mean total energy used in all the cases was 37.20 (14.70) mjl. The mean total energy used in 14 patients with an IOP elevation of above 5 mmHg was 71.07 (10.59) mjl. Nd:YAG laser capsulotomy was performed at an average of 6.29 (4.91) months in Group 1, 7.81 (4.35) months in Group 2, and 17.7 (12.35) months in Group 3. After capsulotomy, clinically significant cystoid macular edema was observed in 1.9% of the cases, IOL damage in 3.9%, and vitreous hemorrhage in 0.6%. Conclusion: In this study, the incidence of PCO development was found to be lower in the patients who underwent hydrophobic acrylic IOL implantation; therefore, this type of lens should be preferred for implantation. Although Nd:YAG laser capsulotomy is an outpatient treatment method that can be applied quickly and can increase visual acuity, it can also lead to complications. To eliminate most of these complications, it would be beneficial to minimize the energy used during the laser procedure.

Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial.

Subluxation techniques are superior to divide-and-conquer in procedure duration, pain, and ultrasound quantity, but their safety in endothelial cell loss (ECL) is unclear. This randomized single-blind noninferiority clinical trial aimed to determine whether subluxation supracapsular phacoemulsification techniques are inferior to a reference endocapsular technique (divide-and-conquer) regarding postoperative corneal ECL. Patients (aged18 years or older) with greater than +0.2 logarithm of the minimum angle of resolution best spectacle-corrected visual acuity and normal to severe density cataract were randomized to subluxation or divide-and-conquer phacoemulsification in 2015 to 2016. Follow-up with ophthalmic tests was conducted on day 4 and months 1, 3, and 12. The primary study outcome was ECL at all time points. Secondary study end points were operative variables, including effective phaco time and procedure duration. A clinically relevant noninferiority ECL limit was established on the basis of the literature. In total, 292 patients (mean age, 73 yrs; 59% female) were randomized and underwent subluxation (n = 148) or divide-and-conquer (n = 144). Day 4 and month 1, 3, and 12 data were available for 243, 270, 275, and 198 patients, respectively. The unexpectedly high dropout at 12 months meant that the 12-month ECL data could only be assessed qualitatively. Surgery was successful in all patients. Subluxation was noninferior to divide-and-conquer in ECL. Effective phaco times were similar, but subluxation associated with shorter procedure duration. The subluxation technique was noninferior to divide-and-conquer regarding postoperative ECL, at least in the first 3 months, and associated with reduced intervention time. Subluxation techniques may be suitable alternatives to endocapsular techniques.Clinical Trial Registration-URL: ClinicalTrials.gov. Unique identifier: NCT02535819.

Endocapsular deep-wedge-removal phacofracture

We present a nucleus disassembly technique that allows safe debulking of two thirds of the nucleus by removal of a deep, central, equilateral triangular wedge of nucleus with no manipulation or rotation. The resulting equilateral triangular wedge-shaped cavity yields 3 points of weakness at each corner that facilitate cracking the remaining peripheral nuclear rim into 3 equal segments. Each segment is easily gripped by short bursts of phaco power and pulled into the central cavity for safe endocapsular phacoemulsification, an approach that protects the cornea. This technique is applicable to most cataracts regardless of consistency. It prevents zonular stress by avoiding manipulation or rotation of the nucleus in cases in which zonular weakness is a concern. The technique was used in 95 consecutive eyes, with no posterior capsule tears, vitreous loss, or zonule disturbance.

Comparison of posterior capsule opacification in rabbits receiving either mitomycin‐C or distilled water for sealed‐capsule irrigation during cataract surgery

To compare posterior capsule opacification (PCO) in rabbits who undergo cataract surgery and receive either mitomycin-C (MMC) or distilled water (DW) during sealed-capsule irrigation (SCI). In addition, we examined the toxicity of DW and MMC. Twenty-four eyes from 12 rabbits were divided into three groups. Balanced salt solution (BSS), DW, MMC 0.4 mg/mL was injected into the capsular bag for 2 min after endocapsular phacoemulsification and insertion of a SCI device. The degree of PCO was assessed by POCOman software at 3 months post surgery. Central corneal thickness, anterior chamber inflammation were assessed 1 day, 1 week, 2 weeks, 3 weeks, 1 month and 3 months postoperatively. A statistically significant difference in PCO scores was noted between the control and study groups (P < 0.05). The PCO scores of the MMC group were significantly lower than those of the DW group (P < 0.05). The MMC and DW groups did not show significant toxicity compared with the BSS group. MMC is more effective in reducing PCO than DW; the SCI device can protect the surrounding ocular tissue from MMC toxicity in rabbit eyes.

Modified extracapsular extraction versus endocapsular phacoemulsification: intraoperative and immediate postoperative events

The clinical events and variations in intraocular pressure (IOP) that occur in endocapsular phacoemulsification technique were compared to the modified extracapsular extraction technique during the intraoperative and immediate postoperative periods. Phacoemulsification technique caused less corneal edema, less ocular discomfort and fewer postoperative complications than the modified extracapsular extraction technique. The observed increase in postoperative IOP, especially in the case of phacoemulsification, makes pressure monitoring mandatory, as well as the use of ocular hypotensive agents when the IOP exceeds acceptable limits.

Biomatériaux et implants intraoculaires, techniques chirurgicales d'implantation

La technique de phacoémulsification dans la chirurgie de la cataracte chez le chien a permis de régler un grand nombre de problèmes et de rendre routinier un acte considéré comme problématique. L’étude approfondie de la réfraction chez le chien, l’avènement de matériaux biotechnologiques de pointe et la collaboration des laboratoires spécialisés, ont ouvert la voie de la correction de l’aphakie post-opératoire. La mise à disposition des chirurgiens ophtalmologiques vétérinaires d’implants intra-oculaires fiables et parfaitement tolérés par les milieux oculaires, justifie le développement de la technique d’implantation. Ces implants rigides ou souples, pliables et/ou injectables font l’objet à l’heure actuelle de codifications opératoires précises. Mais la plus grande qualité des implants de dernière génération est de pouvoir être introduit par une ouverture réduite et de conserver ainsi tout le bénéfice de la petite incision cornéenne utilisée dans la technique de phacoémulsification endocapsulaire.

Intraoperative management of iris prolapse using iris hooks

Iris prolapse has become an unusual and generally benign event in routine cataract surgery using endocapsular phacoemulsification techniques. We operated on the second eye of a patient with hyperopia whose first eye surgery in our care had been uneventful. In the second eye, as soon as the phaco incision was made and hydrodissection begun through the primary incision, the iris repeatedly prolapsed through the incision. This was managed definitively by applying iris hooks, 1 at each side of the primary incision, to the pupillary border so the prolapsing iris was held peripherally in the anterior chamber and under modest tension.

Biocompatibility of poloxamer hydrogel as an injectable intraocular lens

To induce irreversible gelation of poloxamer, a thermosensitive polymer hydrogel, by using a photoinitiator and ultraviolet (UV) irradiation and to verify the biocompatibility and use of poloxamer as an injectable intraocular lens (IOL) material. Department of Ophthalmology, Seoul National University College of Medicine, Seoul Artificial Eye Center, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea. In 10 rabbits, endocapsular phacoemulsification was performed and a poloxamer-photoinitiator mixture was injected into the capsular bag through a small capsulorhexis site. In 1 eye, the capsulorhexis site was closed with a small plug and the entire eye was irradiated with UV light for 5 minutes. Postoperatively, poloxamer transparency and effect on the conjunctiva, cornea, iris, vitreous, and retina were observed. A mixture comprising 25% poloxamer and 0.01% photoinitiator produced a poloxamer that remained transparent in the lens capsule for up to 6 months. No inflammatory response or toxicity was observed in the conjunctiva, cornea, iris, vitreous, or retina. Poloxamer is a potentially suitable material for an injectable IOL. Further study is needed.

Estudo comparativo da densidade de células endoteliais da córnea após facoemulsificação pelas técnicas de "dividir e conquistar" e "quick chop"

Since one of the most implicated factors in corneal endothelial cell loss after phacoemulsification is the ultrasound time, and that the "quick chop" technique utilizes less ultrasound time, the objective of this study was to compare and analyze the reduction of the central corneal endothelial cell density between the patients submitted to the "divide and conquer" and "quick chop" techniques.Fifty-six patients with grade 3 senile cataract were prospectively selected and submitted to endocapsular phacoemulsification by the "divide and conquer" (28 patients, group 1) and "quick chop" (28 patients, group 2) techniques. The non-contact corneal central specular microscopy performed pre- and postoperatively at one month, 3 months and 6 months, and the ultrasound time used for each surgery, were verified.We observed that the "divide and conquer" technique spent an average of 2.0 minutes of ultrasound time and the "quick chop", 1.1 minute; that the reduction of the central corneal endothelial cell density was significant for both techniques in the first postoperative month (16.5% in group 1 and 19.4% in group 2) and that the variations in central corneal endothelial cell density that followed, at the 3rd and 6th month were not significant. There was no statistically significant difference between the variation of the central corneal endothelial cell density that occurred with both techniques (Student's "t" test p=0.334; in the 1st postoperative month).We concluded that the reduction of central corneal endothelial cell density was not statistically different between the two techniques.

Acute haptic-induced pigmentary glaucoma with an AcrySof intraocular lens

A 49-year-old man had uneventful endocapsular phacoemulsification with in-the-bag implantation of an AcrySof ® SA60AT single-piece intraocular lens (IOL) (Alcon) in the right eye. Twenty-seven days postoperatively, he presented with ocular pain, intraocular pressure of 48 mm Hg, 360 degrees of hyperpigmentation of the trabecular meshwork, and iris pigment epithelial atrophy in the region of the upper temporal haptic, which had dislocated into the sulcus. The patient made an excellent recovery following IOL removal and exchange. Scanning electron microscopy of the explanted IOL demonstrated that the haptic had a rough lateral surface and anterolateral edge. We do not think this IOL should be implanted in the sulcus

The Effect of Photodynamic Therapy with Rose Bengal on Posterior Capsule Opacification in Rabbit Eyes

We investigated the in vivo effect of photodynamic therapy (PDT) using rose bengal on the development of posterior capsule opacification (PCO). Endocapsular phacoemulsification was performed on white rabbits, which were divided into 4 groups: control group; group 1, treated with visible light only; group 2, treated with rose bengal only, and group 3, treated with PDT. In the case of the PDT group, rose bengal dissolved in sodium hyaluronate was injected into the empty capsular bag and treated with visible light. Three months after surgery, the rabbits were sacrificed and the eyeballs enucleated. The obstruction rate of visible light caused by PCO was measured with an optical powermeter. The mean obstruction rate was 30.6% in the control group, 28.3% in group 1, 19.3% in group 2, and 14.3% in group 3. Group 3 showed a statistically significant decrease in PCO compared with the control group and group 1 (p = 0.0014). Our results suggest that PDT using rose bengal effectively decreased PCO in rabbit eyes.

Phacoemulsification in the anterior chamber

Purpose: To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. Setting: Instituto Oftalmológico de Alicante, Alicante, Spain. Methods: In this prospective randomized masked clinical trial, 60 eyes of 30 patients had cataract extraction by phacoemulsification. A conventional stop-and-chop technique was used in 30 eyes; the other 30 had surgery by the phaco-out technique in which the nucleus was prolapsed into the anterior chamber using extensive hydrodissection. Copious sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat®) and hydroxypropyl methylcellulose were used to protect the cornea and iris. The phaco time and power, postoperative inflammation, corneal edema (clinically and by pachymetry), and endothelial cell count between groups preoperatively and postoperatively were compared. All patients completed a 3-month follow-up. Postoperative examinations were at 3 days, 2 weeks, and 1 and 3 months. Results: The mean nuclear hardness was 2.67 ± 0.61 (SD) in the stop-and-chop group and 2.65 ± 0.71 in the phaco-out group. The power-to-time ratio was 18.47 and 18.80, respectively. The mean endothelial cell loss was 11.18% ± 4.24% in the stop-and-chop group and 11.20% ± 5.60% in the phaco-out group. There were no significant differences between groups in any parameter ( P > .05, independent-sample t test). Conclusion: Phacoemulsification in the anterior chamber was as safe as endocapsular phacoemulsification using a stop-and-chop technique. This technique is fast and easier to learn than endocapsular phacoemulsification.

Phacoemulsification in Indian eyes with pseudoexfoliation syndrome

Purpose: To evaluate the intraoperative and postoperative behavior after phacoemulsification in Indian eyes with pseudoexfoliation syndrome. Setting: Iladevi Cataract & Intraocular Lens Research Centre, Ahmedabad, India. Method: Ninety eyes were prospectively evaluated. Group 1 (cohort) comprised 45 consecutive eyes with pseudoexfoliation and coexisting cataract and Group 2 (control), 45 consecutive normal eyes with senile cataract only. Phacoemulsification was performed by a single surgeon using a step-by-step, chop in situ, and lateral separation technique. An AcrySof® intraocular lens was implanted in the bag in all eyes. Intraoperative observations included pupil size after maximal mydriasis, phakodonesis, zonular dehiscence, grade of cataract, and capsule tear/rupture. Postoperatively, intraocular pressure (IOP), best corrected visual acuity, aqueous flare/cell response, and the presence of posterior synechias were evaluated at 1 day and 1 month. A chi-square test was used for statistical analyses. Results: The mean pupil size was significantly smaller in Group 1 ( P = .0000). No eye in either group had phakodonesis. Sixty percent of eyes in Group 1 and 31% in Group 2 had a hard cataract ( P = .008). Endocapsular phacoemulsification was performed in 82% of eyes in Group 1 and 84% of eyes in Group 2. Intraoperative complications such as zonular or capsular dehiscence were not seen in any eye. Postoperatively, IOP and aqueous cell response were comparable between groups ( P = .11 and P = 0.81, respectively). A significantly higher flare response was observed in Group 1 ( P = .000). The visual outcome at 1 month was similar between groups. Conclusions: The intraoperative performance of Indian eyes with pseudoexfoliation was comparable to that in normal eyes. A good surgical outcome is ensured by using an appropriate surgical technique. Apart from a higher flare response, the postoperative outcomes in eyes with pseudoexfoliation were within normal limits, and the outcome at 1 month was satisfactory.

Ketorolac-Tobramycin Combination vs Fluorometholone-Tobramycin Combination in Reducing Inflammation Following Phacoemulsification Cataract Extraction With Scleral Tunnel Incision

The objective of this study was to compare the efficacy of ketorolac-tobramycin combination with fluorometholone-tobramycin combination in the control of ocular inflammation after endocapsular phacoemulsification cataract surgery with scleral tunnel incision. This was a prospective, randomized, investigator masked, 2-week, single-center study. Ocular examinations were carried out preoperatively and postoperatively on days 1 (baseline), 2, 3, 7, and 14. There were 60 patients (30 in each treatment group) undergoing uncomplicated cataract-lens implant surgery enrolled and randomized in the study. The baseline parameters were similar in the two study groups. At each visit comprehensive ocular examinations were performed and a 4-point (0 to 3) grading system was used to record findings of the burning/stinging sensation, blurred vision, ocular discomfort, conjunctival hyperemia, anterior chamber flare, and anterior chamber cells. There was no statistically significant difference between the treatment groups in the findings of the ocular inflammation at any of the postoperative visits. Both treatments were equally well tolerated. This study suggests that ketorolac may be an alternative to some corticosteroids (fluorometholone). It is generally accepted that fluorometholone is not as potent an anti-inflammatory as prednisolone the most commonly used steroid following cataract extraction.

Effect of mitomycin-C on posterior capsule opacification in rabbit eyes

Purpose To determine whether mitomycin-C can inhibit posterior capsule opacification (PCO) without causing ocular toxicity. Setting Yonsei Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. Methods Mitomycin-C dissolved in sodium hyaluronate (0.2 cc of 0.2 mg/mL) was injected into the empty capsular bag for 3 minutes after endocapsular phacoemulsification in rabbit eyes. Three months after surgery, the obstruction rate of visible light caused by PCO was measured using an optical power meter. Results The mean obstruction rate of visible light was 81.0% ± 8.3% (SD) in the control group in which sodium hyaluronate without mitomycin-C was used, 30.5% ± 10.1% in the group in which mitomycin-C was dissolved in sodium hyaluronate, and 71.9% ± 6.8% in the group in which mitomycin-C was dissolved in a balanced salt solution. Statistically significant differences were found among all 3 groups. Conclusion Our results suggest that the application of mitomycin-C dissolved in sodium hyaluronate effectively reduces PCO in rabbit eyes.

Randomized clinical comparison of Healon GV and Viscoat

Purpose To compare the ability of Healon GV® (sodium hyaluronate 1.4%) and Viscoat® (sodium chondroitin sulfate 4.0%–sodium hyaluronate 3.0%) to protect the corneal endothelium during endocapsular phacoemulsification and foldable intraocular lens (IOL) implantation. Setting A small ophthalmology group practice. Methods One hundred forty patients were randomized, 70 per group, in a prospective, partially masked study of cataract surgery using Healon GV or Viscoat. One ophthalmologist performed all surgery. Primary outcome variables were the 2 week postoperative changes in corneal thickness, endothelial cell density, mean endothelial cell size, and endothelial cell hexagonality. Several secondary variables were measured, and an analysis of the statistical power of the study was performed. Results There were no statistically significant differences between groups in terms of age ( P = .856), cataract density ( P = .117), preoperative best corrected visual acuity (BCVA) ( P = .892), postoperative BCVA ( P = .969), amount of viscoelastic material used during surgery ( P = .444), amount of irrigating solution used ( P = .125), or phacoemulsification time ( P = .088). It took longer to remove the Viscoat than the Healon GV ( P < .001), and total operating time for the Viscoat group was longer ( P < .001). Two weeks after surgery, there were no significant differences between groups in corneal thickness ( P = .362), endothelial cell density ( P = .351), or mean endothelial cell size ( P = .610). However, Viscoat preserved the hexagonal shape of endothelial cells slightly better than Healon GV ( P = .043). The study had sufficient power to detect clinically significant differences in corneal thickness, endothelial cell density, and endothelial cell size. Conclusions Healon GV and Viscoat were comparable in their ability to protect the corneal endothelium during endocapsular phacoemulsification and foldable IOL implantation. Results may vary, however, if phacoemulsification is performed anterior to the iris plane.

Artist's impression of endocapsular phacoemulsification surgery

A 77-year-old artist having endocapsular phacoemulsification surgery and intraocular lens implantation illustrated her visual impressions of the procedure in 6 stages, from draping to lens implantation. Her illustrations and commentary indicate that she experienced clear visualization of instruments and colorful abstract imagery. These paintings were shown to 30 consecutive patients to assess their usefulness in preoperatively informing and preparing patients for surgery. With the widespread use of local and topical anesthesia, it is pertinent to the ophthalmic surgeon to understand what patients may see when vision is retained during the procedure.

Accommodation amplitude after lens refilling with injectable silicone by sealing the capsule with a plug in primates.

To restore accommodation in primate eyes by refilling the lens capsule with injectable silicone compounds. Eight eyes of 8 monkeys (Macaca fascicularis) were treated by the lens refilling procedure. To prevent leakage of the injected liquid silicone before it polymerized in the capsule in vivo, a silicone plug for sealing the capsular opening was developed. After endocapsular phacoemulsification following an upper minicircular capsulorhexis, the plug was introduced into the capsulorhexis opening. A silicone mixture was injected into the capsular bag through the delivery tube of the plug. Automated refractometry was performed 1 week and 3 months after surgery. Accommodation amplitude was determined as the difference between the refractions before and 1 hour after topical application of 4% pilocarpine chloride. Five of 8 eyes could be refilled. In 4 of 5 eyes, refraction could be measured. Accommodation amplitude ranged from 1.0 to 4.5 diopters, with a mean of 2.3 +/- 1.3 diopters (8.0 +/- 2.0 preoperative values). At 3-month examination, thick posterior capsule opacification precluded refractometry in all eyes. The lens refilling procedure with the use of a silicone plug for sealing the capsular opening was feasible in primate eyes. The accommodation amplitude attained was a small fraction of the value before surgery. This may result from the loss of so-called intracapsular accommodation, ie, active participation of lens fiber cells in accommodation. However, since the obtained accommodation may be sufficient for near vision after cataract surgery, this lens refilling procedure warrants further study. Elucidation of the mechanism of intracapsular accommodation may also be necessary.

Intraoperative complications of 1000 phacoemulsification procedures: A prospective study

Purpose: To determine the frequency and nature of intraoperatlve complications of endocapsular phacoemulsification cataract surgery.Setting: Dalcross Private Hospital and the Departments of Ophthalmology, Concord Hospital and Prince of Wales Hospital, Sydney, Australia.Methods: This prospective study included the first 1000 cases of planned endocapsular phacoemulsification cataract surgery performed by an experienced surgeon. A standardized proforma was completed at the time of surgery. Data recorded included pre-existing ocular abnormalities, duration of surgery, nuclear sclerosis grade, and intraoperative complications.Results: Major complications comprised posterior capsule tears with vitreous loss (1.4%), isolated posterior capsule tears (0.7%), and zonulysis (0.1%). Minor complications included anterior capsule tears (3.8%), iris prolapse (0.6%), and ciliary body incision (0.2%). There was a significant trend toward complications as the nuclear sclerosis grade increased. The incidence of major complications was 9.3% in the first 150 cases and 0.9% in the last 850. This represents a relative risk of 9.9 (95% confidence interval 4.2 to 23.0) of a major complication occurring in the first 150 compared with the later 850 cases.Conclusion: The frequency of major and minor complications fell sharply after the first 150 operations and was maintained. This study may provide a guide for beginning phacoemulsification surgeons and a basis for experienced surgeons to compare their performance outcomes.

Lens refilling with injectable silicone in rabbit eyes

Purpose: To evaluate the technique of refilling the lens capsule with injectable silicone and assess the postoperative findings.Setting: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan.Methods: The lens capsules in the eyes of 16 rabbits weighing 1.5 to 2.0 kg were refilled with 0.2 mL of silicone polymer (about 66% bag volume) after endocapsular phacoemulsification through an upper minicircular capsulorhexis 1.5 to 1.8 mm in diameter. The capsule opening was sealed with a silicone plug to prevent leakage of the injected silicone. Main outcome measures were surgical success rate, inflammation, endothelial cell loss, refractive change after pilocarpine 4% instillation, and capsule opacification.Results: The lens capsule could be refilled in 10 eyes. The failures were caused by capsule rupture during phacoemulsification (n = 3) and profuse leakage of the injected silicone. Silicone that leaked minimally during surgery was easily washed away. Silicone that leaked and polymerized in the anterior chamber postoperatively (n = 3) was easily removed by surgery the following day. Mean endothelial cell loss was 10.2% 1 month after surgery. Aqueous flare intensity was significantly lower on days 2 and 4 than after conventional intraocular lens implantation in a control group. The respective mean preoperative and postoperative refractions were 0.7 diopters (D) ± 1.0 (SD) and 19.1 ± 1.0 D and the mean change (difference between the refractions before and after topical application of pilocarpine 4%), −0.4 ± 0.6 and 1.1 ± 0.4 D (P < .01). Posterior capsule opacification (PCO) was noted after 3 weeks in all eyes.Conclusions: Lens capsule refilling and capsular plug use to prevent silicone leakage was shown to be feasible and avoided complications caused by leakage. Refractive changes suggest that the procedure could yield accommodation in primates. Although neodymium:YAG laser capsulotomy did not cause herniation of the injected silicone, PCO prevention is an essential issue in lens refilling because the capsulotomy may annul the attained accommodation.