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Bean-shaped ring segments in 'bag-in-the-lens' surgery as an augmentation tool in complex capsule cases

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Session Details

Session Title: Combined Cataract Surgery Techniques. Surgical Devices

Session Date/Time: Saturday 05/09/2015 | 08:30-10:30

Paper Time: 09:52

Venue: Main Auditorium

First Author: : A.Altenburg BELGIUM

Co Author(s): :    S. Ni Dhubhghaill   M. Tassignon                 

Abstract Details


The Bag-in-the-lens (BIL) cataract surgery technique is a validated approach, where an intraocular lens is centrally placed and supported by the anterior and posterior capsulorhexes which are both placed in the inter-haptic lens groove. This method of lens placement provides a high degree of centration and stability but also largely dependents on capsular and zonular integrity. In cases of significant zonular loss and capsular instability, Bean-Shaped Ring Segments (BSRS) can be used to reinforce the capsule and facilitate BIL placement. The aim of this study is to report the application of this new tool in BIL surgery.


The study is a retrospective observational study of all cases where BSRS were implanted in combination with BIL implantation in Antwerp University Hospital, Belgium.


In this novel technique the inner semicircles of the BSRS slot into the inter-haptic groove of the BIL while the outer semicircles are placed in either the sulcus or the residual capsular bag to confer additional support. The records of all patients that underwent BIL implantation augmented with BSRS from the first case in May 2011 and most recent in March 2015 were included. The surgical indications, preoperative and postoperative vision, complications and additional interventions were noted. There were no exclusion criteria implemented.


A total of 56 eyes in 52 patients underwent BIL implantation with BSRS support. Twenty-three eyes were IOL exchanges, where standard lenses was replaced with BILs. Eleven eyes were cases of traumatic cataract, 9 eyes were complex surgeries, 8 were due to luxations and 5 were miscellaneous causes. In 84% of cases, two BSRS were used, in the other 16% one was used. The majority (89%) were sulcus positioned, the others in the capsule. Thirty six of 56 cases had a visual acuity of 0.5 (decimal Snellen) or better at last follow up. Three had worse vision postoperatively than preoperatively.


The data shows that the BSRS can be used to widen the indications for BIL surgery. In this institution, the technique is most frequently used to reconstruct the capsular bag support during IOL exchange procedures. The cases where the technique was least successful were phakic lens luxations associated with Marfan's and Homocystinuria, where even with bean support the capsule was too fragile to sustain a BIL. This is the first report of the outcomes of this novel surgical device. Although it is associated with a learning curve, the visual outcomes in many cases, particularly in IOL-exchanges were encouraging.

Financial Interest:

One of the authors gains financially from product or procedure presented

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