Long-term decentration of intraocular lenses implanted with envelope capsulotomy and continuous curvilinear capsulotomy: A comparative study

Abstract

Intraocular lens (IOL) decentration was studied in a series of 569 consecutive eyes that had extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation. In 383 of the eyes, an envelope capsulotomy (EC) was performed; in 186, a continuous curvilinear capsulotomy (CCC). In 33 eyes, the anterior capsule had one radial tear that reached the lens equator. In all eyes, IOL decentration was determined more than six months after surgery. Mean IOL decentration was 0.42 +/- 0.02 mm in the EC eyes and 0.27 +/- 0.01 mm in the CCC eyes (P < .001). In the CCC eyes, mean IOL decentration was 0.23 +/- 0.02 mm when the anterior capsule had no tears and 0.42 +/- 0.06 mm when it had one radial tear (P < .01). In the EC eyes, mean decentration was less with lenses with a total diameter of 11.0 mm or less and 360 degree circular loops (compressible disc and circular open-loop lenses) than with C- and J-loop lenses with a total length of 13.5 mm to 14.0 mm. With the C- and J-loop lenses in all three capsulotomy groups, mean decentration was related to the presence and number of tears in the anterior capsule: 0.58 mm in the EC eyes, 0.41 mm in the CCC with tear eyes, and 0.23 mm in the CCC without tear eyes. A similar relationship was seen with the bag-implanted lenses: 0.48 mm in the EC eyes, 0.28 mm in the CCC with tear eyes; 0.22 mm in the CCC without tear eyes.

Comparison of IOL Power Calculation and Refractive Outcome After Laser Refractive Cataract Surgery With a Femtosecond Laser Versus Conventional Phacoemulsification

“…Conventional CCC was shown to be safer and less likely to be associated with anterior capsular tears than a can opener or linear capsulotomy, 18 and showed less IOL decentration and tilt. [19][20][21] Even with an intact CCC, asymmetric capsular shrinkage, which is affected by capsulotomy shape, increases IOL decentration. 22 Furthermore, the size of the capsulotomy and the area and regularity of anterior capsule-IOL overlap infl uence the IOL position.…”

A Survey of Intraocular Lens Explantation: A Retrospective Analysis of 23 IOLs Explanted during 2005

“…Centration of the IOL is considered to be related to many lens characteristics including design, total length, and optic and haptic materials (18). Several studies reported that an asymmetric capsulorhexis or any radial tear of anterior capsule possibly cause IOL decentration (19)(20)(21). Asymmetric bag-sulcus lens fixation (22) or broken haptics also lead to severe IOL dislocation.…”

Causes of severe decentration and subluxation of intraocular lenses

“…Asymmetric shrinkage can be prevented with newer techniques such as continuous curvilinear capsulotomy [4] or high-frequency diathermy of the anterior capsule. When recognised early, extended shrinkage of the anterior capsulorhexis can managed relatively easily by making incomplete radial incisions in the anterior capsule with the Nd:YAG laser.…”