Plate-haptic Intraocular Lens Research Articles

Image Contrast and Spectral Transmission of Presbyopia-Correcting Intraocular Lenses: Evaluating the Impact of Nd:YAG Laser Associated Defects

Purpose Neodymium yttrium aluminum garnet (Nd:YAG) laser capsulotomy is considered gold standard in the treatment of posterior capsule opacification (PCO). In this laboratory study, we measured spectral transmission to evaluate the image contrast and analyze the impact of Nd:YAG associated defects in presbyopia-correcting intraocular lenses (IOLs). Methods Two hydrophobic, acrylic IOLs as classic multifocal lenses with diffractive ring segments and different amount of near addition (A, B), one hydrophilic, trifocal IOL (C), one sector-shaped, plate haptic IOL (D) and one hydrophobic, enhanced depth of focus (EDOF) IOL (E) were studied. Measurements included surface topography characterization, United States Air Force resolution test chart (USAF) analysis, spectral transmittance measurements and through focus contrast measurement. Measurements were done with unaltered samples, damages (n = 7) were intentionally created in the central 3.5 mm zone using a photodisruption laser (2.0 mJ) and measurements were repeated. Results Significant differences were shown between unmodified samples and samples with YAG pits. The YAG-pits decreased the image contrast and spectral transmission and changed results of USAF test images. The imaging contrast decreased to 66%, 64%, 60%, 52% and 59% with the YAG shots in samples (A-E). The light transmission decreased to 88%, 87%, 92%, 79% and 91% (A-E) on average between 400 nm to 800 nm. In all IOLs a reduction of the relative intensity of transmitted light was observed. Conclusion The image performance of all tested presbyopia-correcting IOLs is significantly influenced and disturbed by YAG-pits. The intensity of transmitted light is reduced in the wavelength between 450–800 nm. USAF test targets show worse results compared to unmodified samples and contrast is significantly deteriorated. No ranking/rating among tested IOLs should be made as many other factors play a role in real world scenario. High care should be taken when performing Nd:YAG capsulotomy on premium IOLs to avoid any damages.

Accuracy of Modern Intraocular Lens Formulas in Highly Myopic Eyes Implanted With Plate‐Haptic Intraocular Lenses

To evaluate the predictive accuracy of modern intraocular lens (IOL) formulas and axial length (AL) adjusted traditional IOL formulas, including Wang-Koch and Cooke-modified AL (CMAL) method, in long eyes with plate-haptic IOLs, and to compare refractive prediction error variances with C-loop IOLs. Retrospective consecutive case series study. Data from 391 eyes with Zeiss 509 M and 302 eyes with Alcon SN6CWS implants in highly myopic patients, following cataract surgery from January 2019 to November 2023, were collected. One eye per patient was selected. Predictive outcomes of 15 modern formulas (Barrett Universal II (BU II), Cooke K6 (K6), Emmetropia Verifying Optical (EVO) 2.0, Hoffer-QST, Kane, Karmona, Ladas AI, Naeser 2, Olsen, Pearl-DGS, Radial Basis Function (RBF) 3.0, T2, VRF-G, Zhu-Lu, and Z-Calc) and 4 traditional IOL formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T) with AL adjusted methods, were evaluated. The mean prediction error, mean absolute prediction error (MAE), root-mean-square absolute prediction error (RMSAE) and the proportions of eyes with PEs within ±0.25 Diopter (D), ±0.50 D, ±0.75 D, and ±1.00 D were analyzed. Top 10 RMSAE-ranked formulas underwent further subgroup analysis based on AL, anterior chamber depth (ACD), and keratometry (K). For the 509 M group, RMSAE ranking for the top 10 IOL formulas were the RBF 3.0 (0.432), Zhu-Lu (0.436), Olsen (0.436), EVO 2.0 (0.437), Pearl-DGS (0.447), K6 (0.452), VRF-G (0.454), Naeser 2 (0.464), Haigis-CMAL (0.465) and Karmona (0.477). Karmona and Naeser 2 showed poorer performance in the extremely long AL and steep K subgroups, respectively (p ≤ 0.042). Haigis-CMAL accuracy was significantly lower in shallow ACD and flat K subgroups (P ≤ .045). The SN6CWS group showed significantly lower MAE and RMSAE compared to the 509 M group for the BU II, EVO 2.0, Hoffer-QST, Kane, Pearl-DGS, and Zhu-Lu formulas (P ≤ .024). In long eyes with plate-haptic IOLs, RBF 3.0 performed best, closely followed by Zhu-Lu, Olsen, and EVO 2.0; Karmona and Naeser 2 are discouraged for extreme AL and steep K conditions, respectively; Haigis-CMAL is not suggested for shallow ACD and flat K cases. Refractive outcomes in eyes implanted with a C-loop design IOL were more accurate than for those implanted with a plate-haptic design, for most tested formulas.

SCLERAL SUTURE FIXATION FOR DISLOCATED SILICONE PLATE HAPTIC INTRAOCULAR LENS.

To describe results in two cases of a dislocated silicone plate haptic intraocular lens managed with vitrectomy and repositioning with scleral suture fixation. Small case series. Two patients presenting with dislocated silicone plate haptic intraocular lens underwent a 23-gauge vitrectomy with a "handshake" maneuver to pass a 9-0 prolene suture through the positioning holes to allow scleral fixation. Best-corrected visual acuity was returned to predislocation Level 2 and 8 months after the vitrectomy. Silicone plate haptic intraocular lens can be managed with scleral suture fixation using this adapted technique, avoiding removal and exchange techniques. These are the first reported cases of silicone plate haptic intraocular lens managed with scleral suture repositioning.

Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial

PurposeTo evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt and axial stability of a 11.0mm plate haptic intraocular lens (IOL) DesignIntraindividual, randomized, double masked, controlled, clinical trial. ParticipantsPatients scheduled for sequential same day bilateral cataract surgery. MethodsAll patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. IOL axis assessment was performed at the end of surgery (EOS), 1 hour (1h), 1 week (1w), 1 month (1m) and 6 months (6m) using a high precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed preoperatively, at 1w and 6m using an anterior segment OCT (AS-OCT). Main outcome measuresRotational stability from EOS to 6m and at all follow up visits. Decentration and tilt at 6m. Differences in axial shift between 1w and 6m. ResultsOne hundred and thirty eyes of 65 patients were included in the study. Absolute rotation from EOS to 6m was 2.8°±3.9° and 3.2°±5.3° for the CTR and control groups, respectively (p=0.613). IOL decentration and IOL tilt at 6m were 0.29±0.1mm and 0.24±0.1mm and 6.7°±2.8° and 5.6°±1.6° for the CTR and control groups, respectively (p=0.058, p<0.01). A posterior IOL shift of 0.31±0.31 mm and 0.19±0.14 mm was observed in the CTR and control groups, respectively. ConclusionsConcomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared to the control group. A negative effect of the CTR on decentration, tilt and axial stability was observed. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution.

Endoscopic Visualization for Atypical Uveitis Glaucoma Hyphema Syndrome Management.

We discuss how ophthalmic endoscopy was used in the management of 6 cases with atypical uveitis glaucoma hyphema syndrome. For case 1, the endoscope was used to remove a retained haptic foreign body after an intraocular lens (IOL) exchange with an iris-sutured IOL for a complete capsular bag-IOL complex dislocation. In case 2, the endoscope was key in identifying the presence and location of vascular lesions at the site of previous pars plana sclerotomies. In case 3, the endoscope enabled visualization of a large segmental Soemmering's Ring pushing a 3-piece IOL haptic into the posterior iris. For case 4, the endoscope allowed viewing of the sharp edge of the optic where the haptic of a one-piece lens had been amputated, and the sharp edge of the cut optic was anteriorly oriented and continuing to rub the posterior iris. In case 5, the endoscope confirmed the presence of 1 haptic of a 1-piece lens out of the capsular bag and in the sulcus space. Also, it showed that the capsular bag had inadequate zonular support to attempt repositioning the haptic into the bag. In case 6, the endoscope was helpful in identifying a 1-piece plate haptic IOL in the sulcus, with synechiae and anterior location causing iris bulging inferiorly.

Case series: \u201cDouble arch\u201d changes caused by capsule contraction syndrome after cataract surgery in highly myopic eyes

BackgroundCapsule contraction syndrome (CCS) after cataract surgery causes intraocular lens (IOL) haptic flexion and IOL optic displacement in most former reports. However, there are few reports on CCS-induced deformation of the IOL optic. We report two cases of CCS after cataract surgery in highly myopic eyes and describe a previously unreported “double arch” complication.Case presentationTwo patients with history of high myopia had cataract surgery with hydrophilic acrylic plate haptic IOLs implanted in their eyes. CCS with arch shape deformation of the pupil as well as the optic of the IOL were noticed in both cases after three months, which induced refractive changes and corrected distance visual acuity (CDVA) deterioration. Visual acuity of the patients was restored by replacing the IOL from the capsular bag to the ciliary sulcus and the following neodymium: YAG (Nd:YAG) laser capsulotomy. We propose that such “double arch” change brought by CCS is related to the plate-haptic design of the IOL and the incomplete overlap between the capsular opening and the IOL optic.ConclusionsWe recommend careful IOL selection and proper capsulorhexis in patients with high myopia or with other risk factors of CCS. Early diagnosis and timely treatment of CCS are critical to prevent visual symptoms and further ocular complications.

Stability of Intraocular Lens With Different Haptic Design: A Swept-Source Optical Coherence Tomography Study.

Purpose: To investigate the stability of intraocular lens (IOLs) with different haptics by swept-source anterior-segment optical coherence tomography (AS-OCT).Methods: Sixty-eight eyes from 55 patients received the implantation of Rayner 920H (Closed C-loop Group), Zeiss 509M (Plate Group) or Lenstec SOFTEC HD (C-loop Group) IOLs. The tilt and decentration of IOLs were evaluated using AS-OCT at least 1 month postoperatively.Results: Mean decentration and tilt of IOLs were 0.18 ± 0.12 mm (range 0.02 to 0.59 mm) and 5.63 ± 1.65° (range 2.2 to 9.6°) respectively. Decentration was significantly smaller in the plate haptic group (0.12 ± 0.06 mm) as compared to the C-loop group (0.22 ± 0.13 mm, P = 0.02). The tilt of IOL was also significantly smaller in the plate haptic group (4.96 ± 0.89°) as compared to the C-loop group (6.28 ± 1.83°, P = 0.01). There was marginal difference between the Closed C-loop group (5.52 ± 1.74°) and C-loop group (6.28 ± 1.83°, P = 0.07).Conclusions: The Plate-haptic IOLs should have better stability for the decentration and tilt than the C-loop design IOLs.

Visual Performance of Two Diffractive Trifocal Intraocular Lenses: A Randomized Trial.

To compare two trifocal intraocular lenses (IOLs), the RayOne Trifocal RAO603F IOL (closed-loop haptic IOL; Rayner Intraocular Lenses Limited) and the AT Lisa tri 839 MP IOL (plate-haptic IOL; Carl Zeiss Meditec AG), concerning optical and capsular bag performance. Patients scheduled for cataract surgery received either a closed-loop haptic IOL or a plate-haptic IOL in the first eye and the other IOL in the second eye. Three months postoperatively, autorefraction and subjective refraction, uncorrected and corrected distance visual acuity at 4 m, 80 cm, and 40 cm, an objective reading test (Salzburg Reading Desk; SRD Vision), a defocus curve, IOL tilt and decentration, a questionnaire about dysphotopsia, and grading of halos with a halometer were performed. Eighty-eight eyes of 44 patients were included. Visual acuity was comparable between both IOLs. The closed-loop haptic IOL performed better in the defocus curve at -1.50 diopters (D) (0.08 ± 0.10 vs 0.12 ± 0.09 logMAR; P < .01). The plate-haptic IOL had better contrast sensitivity without glare under mesopic and photopic conditions in miosis (P = .0018 and .002, respectively) and mydriasis (P = .017 and .003, respectively). Significant differences were found for less overall subjective disturbance (P = .047) and starbursts (P = .039) for the plate-haptic IOL, but not for the other positive dysphotopsia symptoms. Both trifocal IOLs delivered good and comparable visual function with low degrees of disturbing dysphotopsia. The closed-loop haptic IOL was slightly superior in the defocus curve, whereas the plate-haptic IOL was slightly superior concerning contrast sensitivity and positive dysphotopsia. [J Refract Surg. 2021;37(7):460-465.].

Capsular Bag Distension Syndrome Following Phacoemulsification with Implantation of Intraocular Lens

Capsular bag distension syndrome is a rare complication following phacoemulsification with posterior chamber intraocular lens implantation. We describe the case of a middle-age male, who developed early onset capsular bag distension syndrome of the right eye after phacoemulsification with implantation of plate haptic posterior chamber intraocular lens (Zeiss CT ASPHINA 509MP). There was persistent poor vision during follow up at 1 week and 5 weeks post-surgery with a myopic shift of 2.5 diopters sphere (DS). The intraocular pressure was only elevated at 2 hours post-operative and was normal during the subsequent followup. Distension of capsular bag was confirmed with the IOP Master 700 which showed abnormal separation of posterior capsule from the intraocular lens. He was diagnosed with capsular bag distension syndrome secondary to retention of viscoelastic. Right eye removal of retained viscoelastic was performed and the capsular bag distension syndrome resolved successfully with best corrected visual acuity at 6/6. Hence, complete clearance of viscoelastic during phacoemulsification with plate haptic intraocular lens is important in order to prevent capsular bag distension syndrome.

Pilot evaluation of refractive prediction errors associated with a new method for ray-tracing–based intraocular lens power calculation

To investigate the accuracy of a new ray-tracing-based intraocular lens (IOL) power calculation method and to compare the outcomes with different IOL calculation formulas. Hanusch Hospital, Vienna, Austria. Theoretical prospective monocentric study. Monofocal aspheric plate haptic IOL (CT Asphina 409M/MP) implantation was performed in 40 cataractous eyes. At 1month postoperatively, manifest refraction and optical coherence tomography-based biometry (IOLMaster 700) was conducted. The refractive spherical equivalent absolute error of the ray-tracing IOL power calculation method, based on individualized eye model data, a physical lens position predictor, retinal image quality metrics criteria for IOL power selection, and exact IOL design information was calculated and compared with the outcomes using the Barrett Universal II, Hill-RBF, SRK/T, and Haigis formulas. There was no significant difference in absolute errorbetween ray tracing and the Barrett Universal II (0.37 diopter [D]±0.29 [SD]; P=.601) or Hill-RBF (0.39±0.31 D; P=.170). However, the absolute error was significantly lower compared with the Haigis formula (0.42±0.36 D; P=.029) and SRK/T (0.52±0.39 D; P=.020). The refractive prediction of absolute error within ±0.25 D and within ±0.50 D ranged between 48% (ray tracing) and 25% (SRK/T), and between 80% (ray tracing) and 55% (SRK/T), respectively. The new ray-tracing-based IOL power calculation method was an accurate procedure and showed promising preliminary results not only for the refractive outcome, but also for surgeon and patient education as well as the management of patient expectations.

The effects of different shapes of capsulorrhexis on postoperative refractive outcomes and the effective position of the intraocular lens in cataract surgery

BackgroundTo evaluate the effects of anterior capsular opening size on deviation from predicted refraction and the effective position of the intraocular lens (ELP) in cataract surgery.MethodsNonrandomized clinical trial. Eighty patients (80 eyes) with simple age-related cataracts were treated from May 2018 to September 2018 at the Fourth Affiliated Hospital of China Medical University. All patients undergoing phacoemulsification received intraocular lens based on the voluntary principle. Forty eyes were implanted with the C-loop haptic intraocular lens (AMO Tecnis ZCB00) while the other 40 eyes were implanted with the plate haptic intraocular lens (CT ASPHINA 509 M). Follow-up visits were conducted postoperatively at 1 week, 1 month, and 3 months during which patients underwent refraction and data collection after pupil dilation, which included anterior segment photography and Scheimpflug imaging by Pentacam. The area, horizontal and vertical diameter of the capsulorrhexis, circularity, decentration, and package were analysed using the image analysis software Image-Pro-Plus 6.0,then evaluated the relationship between the different shapes of capsulorrhexis with deviation from predicted refraction and ELP in cataract surgery.ResultsDeviation from predicted refraction and all of the parameters of capsulorrhexis were not correlative in the 509 M IOL group, however, in the Tecnis IOL group, while the deviation from predicted refraction and all of the capsulorrhexis parameters were not correlative at 1 week, the deviation from predicted refraction did correlate with capsulorrhexis area, horizontal diameter at 1 month (P = 0.029, P = 0.048), and with capsulorrhexis area, vertical diameter at 3 months (P = 0.03, P = 0.017). The ELP correlated with package in both groups postoperatively (r > 0, P < 0.05), but there is no other capsulorrhexis parameters correlated with ELP in the 509 M IOL group (all P > 0.05). For the Tecnis IOL group, the ELP and capsulorrhexis area were correlated at 1 week and 1 month, while the ELP and horizontal diameter, the ELP and vertical diameter were correlated at 1 week, but did not correlate with the other capsulorrhexis parameters in the Tecnis IOL group (all P > 0.05).ConclusionsThe shape of the capsulorrhexis has an effect on postoperative refractive outcomes and the effective position of the intraocular lens in cataract surgery, and plate haptic intraocular lenses have better refractive stability than C-loop haptic intraocular lenses.Trial registrationChiCTR1800015638,2018-04-12.

Intraoperative optical coherence tomography measurements of aphakic eyes to predict postoperative position of 2 intraocular lens designs

To evaluate intraoperative anterior chamber depth (ACD) measurements of the aphakic eye to predict the postoperative ACD and compare 2 intraocular lens (IOL) designs. Hanusch Hospital, Vienna, Austria. Prospective study. In this prospective study, patients scheduled for cataract surgery received a plate-haptic IOL (Asphina, Carl Zeiss Meditec AG) or an open-loop haptic IOL (ZCB00, Johnson & Johnson). Preoperatively, optical biometry (IOLMaster 700, CZM, or Lenstar, Haag-Streit) was performed. Intraoperatively, a prototype setup was used to perform time-domain OCT scans of the anterior eye segment (Visante connected to OPMI Lumera 200, both CZM). The intraoperative ACD was measured and used to predict the postoperative IOL position. Optical biometry and subjective refraction and autorefraction (RM 8800, Topcon) were performed 2months postoperatively. The study comprised 203 eyes of 203 patients. A partial least-square regression model for ACD generated 2months postoperatively showed that the predictive power of the intraoperative ACD (0.48) was highest followed by the axial eye length (0.45) and then the preoperatively measured ACD (0.30). These findings were confirmed in a bootstrapping model. Regression models combining the preoperative ACD and intraoperative ACD resulted in further significant improvement. Intraoperative ACD measurements predicted the postoperative position of open-loop IOLs and plate-haptic IOLs better than preoperative ACD measurements. Combining preoperative and intraoperative ACD measurements further improved the prediction.

Comparative study of induced changes in effective lens position and refraction after Nd:YAG laser capsulotomy according to intraocular lens design.

PurposeTo evaluate and compare the changes in refraction and effective intraocular lens (IOL) position between a plate-haptic IOL and a c-loop single-piece IOL after neodymium-doped yttrium aluminium garnet (YAG) laser posterior capsulotomy.MethodsIn a prospective study, anterior chamber depth and subjective refraction were measured in 110 pseudophakic eyes from 110 patients, before and 1 month after YAG laser capsulotomy. Patients were divided into 2 groups according to the IOL design: group 1 (plate-haptic acrylic hydrophilic AT LISA tri 839MP®) and group 2 (c-loop acrylic hydrophobic single-piece AcrySof® SA60AT). Lens position was obtained through optical coherence biometry (Biograph WaveLight OB820®).ResultsYAG laser capsulotomy was performed 37.8±9.8 months after surgery in group 1 and 40.6±8.6 months in group 2 (p=0.125). Significant changes were found in the lens effective position after treatment in the 2 groups. The YAG posterior capsulotomy led to a change of anterior chamber depth in group 1 from 4.03±0.32 mm to 3.86±0.34 mm (p=0.02) and in group 2 from 4.03±0.37 mm to 4.14±0.45 mm (p=0.025). After YAG laser posterior capsulotomy, no significant changes were observed in mean spherical equivalent, sphere or cylinder for both groups (p>0.05).ConclusionYAG laser posterior capsulotomy can induce a significant change in the IOL position according to the IOL type; however, the refractive change after treatment is clinically insignificant.

Comparison of Anterior Capsule Stability Following Implantation of Three Single Piece Acrylic Intraocular Lenses with Different Haptic Design.

PurposeTo compare the anterior capsule contraction and intraocular lens (IOL) decentration among three types of IOL to determine the influence of haptic design on anterior capsule stability.MethodsOne hundred fifty patients were enrolled in this prospective, randomized study and 260 eyes underwent implantation of one of the following IOLs: modified L-haptic IOL (n = 74), modified C-haptic IOL (n = 97), or a plate-haptic IOL (n = 89). The area of the anterior capsule opening, IOL decentration, and capsule overlap were measured using retroillumination photospot 1 day and 2 months after cataract surgery.ResultsThe area of capsule opening at postoperative day 1 was significantly different between the three IOLs (p < 0.01). All IOLs showed reduction of the anterior capsule opening from 1 day to 2 months after surgery, and greater reduction was shown in the modified C-haptic IOL (p < 0.001). At postoperative month 2, IOL decentration was significantly different between the IOLs and showed a positive correlation with the mean area reduction during month 2.ConclusionsThe degree of anterior capsule contraction and IOL decentration in modified L-haptic IOLs were less than those in modified C-haptic IOLs and comparable to those in plate-haptic IOLs.

An Aid for achieving the ideal laser posterior capsulotomy

A 2.5- to 4-mm well-centered laser posterior capsulotomy would be ideal. A 2-mm posterior capsulotomy which is well-centered in the pupil region may be adequate. Laser posterior capsulotomies larger than 5 mm is not necessary and if not wellcentered may extend over the optic of intraocular lens risking vitreous coming forward around the optic if the anterior capsulorrhexis does not cover the edge of the optic completely. Too large a posterior capsulotomy may also risk posterior migration of intraocular lens with the plate haptic intraocular lens. ...

Reposition of a Misaligned Zeiss AT TORBI 709M® Intraocular Lens 15 Months after Implantation

To report the treatment of a patient with a misaligned intraocular lens (IOL). We describe a case of a misaligned bitoric single-piece, plate haptic IOL (AT TORBI 709M®, Carl Zeiss Meditec AG, Jena, Germany) 15 months after uneventful phacoemulsification and IOL implantation in the capsular bag. Keratoconus with partly regular astigmatism was preexisting. Thorough examination showed a misalignment of the bitoric IOL of 25 degrees, explaining the patient's symptoms (monocular diplopia). Despite capsular fibrosis, surgical revision with IOL rotation was advised and could be performed without major difficulty. A follow-up visit showed a corrected distance visual acuity of 16/20 and a correctly aligned toric IOL. A long preceding operation should not detain the surgical revision of a misaligned toric IOL in the capsular bag.

Sleeveless-extrusion cannula for levitation of dislocated intraocular lens

Background/aimsTo characterise a sleeveless-extrusion cannula-based suction technique to levitate dislocated intraocular lens (IOLs) and review the surgical outcome.MethodsThis retrospective, non-comparative, single surgeon, interventional, consecutive case series examined 10 patients (10...

Capsular bag stability and posterior capsule opacification of a plate-haptic design microincision cataract surgery intraocular lens: 3-year results of a randomised trial

PurposeTo compare capsular bag stability and posterior capsule opacification (PCO) of a plate-haptic intraocular lens (IOL) and a standard three-piece open-loop-haptic IOL of the same acrylic material.MethodsIn this randomised bilateral...

Angle-closure glaucoma secondary to inflammatory capsular block syndrome following routine cataract surgery

A 78-year-old man had uneventful cataract surgery with implantation of a 1-piece plate-haptic intraocular lens in the capsular bag. Seven weeks later, he presented as an emergency with intense fibrinous uveitis and increased intraocular pressure (IOP). Examination revealed an inflammatory capsular block syndrome (CBS) causing fibrinous anterior uveitis and secondary angle-closure glaucoma. The glaucoma resolved and the patient's vision improved following neodymium:YAG laser posterior capsulotomy. Inflammatory CBS should be considered in pseudophakic patients presenting with fibrinous anterior uveitis, increased IOP, and secondary angle closure.

Impact of intraocular lens haptic design and orientation on decentration and tilt

To assess the effect of intraocular lens (IOL) orientation (vertical versus horizontal) and haptic design (1-piece versus 3-piece) on centration and tilt using a Purkinje meter. Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Randomized pilot study with intrapatient comparison. In part 1 of this study, patients received plate-haptic IOLs (Akreos Adapt) in both eyes that were positioned vertically in 1 eye and horizontally in the other eye. In part 2, patients received a 1-piece IOL (Acrysof SA60AT) in 1 eye and a 3-piece IOL (Acrysof MA60AC) in the contralateral eye. Decentration and tilt were measured 1 month and 3 months postoperatively with a new Purkinje meter. In part 1 (n = 15), the mean decentration of plate-haptic IOLs was 0.4 mm ± 0.2 (SD) with vertical orientation and 0.4 ± 0.2 mm with horizontal orientation and the mean tilt, 1.5 ± 1.1 degrees and 2.9 ± 0.9 degrees, respectively. In part 2 (n = 15), the mean decentration was 0.4 ± 0.3 mm with 1-piece IOLs and 0.6 ± 0.8 mm with 3-piece IOLs and the mean tilt, 2.2 ± 7.2 degrees and 5.3 ± 2.4 degrees, respectively. Three-piece IOLs had a greater tendency toward more decentration than 1-piece IOLs, perhaps because of slight deformation of 1 or both haptics during implantation or inaccuracies in production when the haptics are manually placed into the optic. The IOL orientation for plate-haptic IOLs appeared to have no effect on IOL position. The Purkinje meter was useful in assessing the capsule bag performance of the IOLs. No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.