Optic Capture vs In-The-Bag IOL

While technically challenging, implanting intraocular lenses (IOLs) using an optic capture through the posterior capsulotomy may help avoid the anterior vitrectomy usually performed using an in-the-bag technique in very young children, recommends Shail A Vasavada DO, DNB, FICO.

“Although there is no literature to suggest that vitrectomy affects x-thing or y-thing, I think if we can avoid disturbing any of the natural structures, particularly in these young-development eyes, I’m sure it should help us in some way or the other in the long run,” Dr Vasavada said.

PROSPECTIVE STUDY

Dr Vasavada based his comments on a prospective randomised clinical trial he and colleagues conducted. It compared five-year outcomes of a conventional in-the-bag IOL implantation— including anterior and posterior capsulorhexes and a limbal anterior vitrectomy—with an optic capture through the posterior capsule without vitrectomy in children four years old or younger.

Thirty eyes were randomised to the in-the-bag group, of which 27 were followed for five years or more, while 31 were assigned to the optic capture group, of which 28 were followed for at least five years. Postoperative outcome measures were significant visual axis opacification (VAO), defined as VAO encroaching on the central visual axis, requiring a secondary vitrectomy or membranectomy; glaucoma development; and significant inflammation markers including large or small cell deposits on IOLs or posterior synechiae—all assessed during the five-year follow-up.

Overall, there were no significant differences in visual outcomes or complications between the two groups within the five-year follow-up period. Visual acuity improved in both groups—0.49 ± 0.19 logMAR for in-the-bag IOLs and 0.66 ± 1.22 logMAR for optic capture—though there was no statistically significant difference between them, Dr Vasavada reported.

Two eyes in the in-the-bag group required a secondary procedure for significant VAO: one at 14 months and one at 16 months after initial surgery. One eye in the optic capture group required a secondary procedure for VAO at 21 months postoperatively. In the in-the-bag group, one child requiring a secondary procedure was under one year old, while the optic capture child was under one year old.

Two eyes in the in-the-bag group and none in the optic capture group developed glaucoma. Both children affected were under one year old at the time of surgery, and symptoms were controlled with topical medications.

CHALLENGING PROCEDURE

A limitation of the study was the skill required to create a posterior capsulotomy and optic capture without disturbing the vitreous face. If the face is disturbed, the surgeon must perform a vitrectomy, Dr Vasavada noted. A small capsulorhexis may also make it difficult to execute the optic capture.

“Serious long-term complications were the same when you do a vitrectomy or don’t do a vitrectomy. … The optic capture of the IOL whenever possible can avoid vitrectomy and yet reduce visual axis obscuration with similar incidence of glaucoma and inflammation postoperatively,” he concluded.

Dr Vasavada presented at the 40th Congress of the ESCRS in Milan.

Shail A Vasavada DO, DNB, FICO is a surgeon and researcher at Raghudeep Eye Hospital and Iladevi Cataract and IOL Research Centre, Amedabad, Jaipur, India. contact@raghudeepeyehospital.com or icirc@abhayvasavada.com