New bag refilling procedure comes closer to restoring accommodation

BERLIN — The implantation of a 0.1-mm accommodative membrane IOL at the opposite sides of the capsular bag enhances results of the bag refilling procedure, preventing silicone leakage and posterior capsular opacification formation, according to a study presented here.

Okihiro Nishi

This new method presented by Okihiro Nishi, MD, the Ridley Medal lecturer at the European Society of Cataract and Refractive Surgeons meeting, consists of in-the-bag implantation of a thin diaphragm similar to an IOL but with no refractive power to seal the anterior capsulorrhexis. The lens is kept in place by the pressure of the injected high molecular weight silicone polymer that refills the bag. A second lens can be implanted after performing a posterior continuous curvilinear capsulorrhexis to prevent PCO.

Monkey experiments demonstrated the presence of 2 D to 3 D accommodation after 4% pilocarpine application.

"Since the accommodative IOL has no refractive power, refraction changes may arise, not from the forward movement of the IOL but from an actual curvature change of the anterior membrane," Dr. Nishi said.

Surgery required 20 to 30 minutes and was found to be highly reproducible.

"This new procedure solves two of the persisting problems of lens refilling, namely leakage of the injectable silicone and capsular opacification. The data clearly showed that some clinically useful accommodation can be obtained by this refilling technique. So although achieving emmetropia is still an issue to be solved, we are two steps closer to a possible clinical application for restoring accommodation," Dr. Nishi said.