The Outcome Of Different Iol Implantation After Posterior Capsule Rupture And Anterior Vitrectomy During Cataract Surgery – A 10 Years Follow-Up

Posterior capsule rapture during cataract surgery with vitreous presentation is a sight threatening intra-surgical complication. The management usually includes anterior vitrectomy and intra-ocular lens (Iol) placement outside the capsule. If possible, 3-piece Iol is inserted into the sulcus, anterior to the capsular bag. In the lack of capsular support, iris-fixed Iol implantation or an anterior chamber Iol (AC-IOL) placement are acceptable solutions. In this study, we examined the effect of the implanted IOL on the long-term complications.

A retrospective 10 year follow-up study.

Department of Ophthalmology, Haifa city, Israel.

Medical files of 9632 patients who went through cataract surgery between 2012-2021 were reviewed for posterior capsule rapture during surgery and anterior vitrectomy. Patients were divided into groups according to the implanted Iol: 3-piece, PMMA sulcus lens (BAL-65, Hanita), iris fixed lens (Artisan, Ophtec) and AC-IOL (Opab 130, Hanita). New onset of glaucoma, macular edema, corneal insufficiency, and retinal detachment were documented for each patient during the follow-up period. The need for another surgery and visual acuity were documented as well. The differences between the 3 groups were analyzed.

247 compatible patients were found. 102,54 and 91 BAL-65 IOL, ARTISAN and AC-IOL respectively. Visual acuity (LogMar) was 1, 0.65 and 1.07, glaucoma appeared in 1.1%, 1.9% and 6.9% (p=0.018), new onset of corneal insufficiency was 4.3%,1.9% and 5.9%, retinal detachment appeared in 2.2%,5.6%,5.9% macular edema was found in 7.6%, 18.5% and 13.7%, and another surgery was required in 9.7%, 9.3 and 10.5% of the patients in the BAL-65, ARTISAN and AC-IOL groups respectively. Comparison of the cumulative risk of any complication showed BAL 65 group with the lowest risk, followed by at ARTISAN group and the AC-IOL group (p=0.001).

Sulcus lens implantation is preferable in terms of long-term complications. In the absence of capsular support Iris fixated Iol was less associated with glaucoma and therefore safer than AC-IOL.