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Watermark on anterior capsule: a result of excessive irrigation through the central hole of ICL V4c with CentraFLOW

Poster Details

First Author: S.Chaudhary INDIA

Co Author(s):                        

Abstract Details


A diffuse, light grey patch is seen to develop on the central part of the anterior capsule of the crystalline lens, which lightens towards the periphery, during profuse and forced irrigation through the central hole of an ICL with a central hole. Irrigation through the central hole is recommended in centraflow ICL to remove the visco-elastic thoroughly from under the lens because now there are now no peripheral iridectomies to me made. We observed this grey staining of the anterior capsule in several cases and called it the 'Watermark on anterior capsule'.


Eye7 hospitals, New Delhi, India


Bi-manual 22g irrigation aspiration cannula is used. One opening of irrigation tip is placed over the central hole of the ICL, facing the hole. The second opening, facing the opposite direction, is covered with the shaft of the aspiration cannula, to force irrigating BSS fluid down the central hole, in the space between the ICL and the crystalline lens, so as to displace the visco-elastic from this space. A light grey stain on the anterior capsule is seen to develop with over 10 seconds of irrigation. We followed up these cases for two weeks to evaluate the watermark.


Watermark on the anterior capsule is a new situation seen when profuse irrigation under forced pressure is done through the central hole of the ICL. The watermark is densest under the cental hole, and fades towards the periphery. It was a cause of concern when noticed the first time, as the surgeon had no knowledge whether this mark will persist, and if so, for how long. The surgeon was also concerned whether this watermark would have effect on the visual acuity of the patient. The watermark became lighter when seen after three hours postop, and had dissipated on the third day followup. It had no effect on the visual acuity at two weeks postop.


It may be concluded that profuse forced irrigation of the anterior capsule of the crystalline lens with BSS results in temporary hydration of the anterior capsule which appears as a light diffuse hazy grey watermark. The watermark disappears within 48 hours postop. and has no effect on the visual acuity as seen at 2 weeks postop. However, long term effects still need to be evaluated. The area of concern could be whether these patients would develop an early anterior sub capsular cataract or an early anterior capsular opacity.

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