New IOL safe, effective in pediatric cataract cases

HONG KONG — A specially designed "bag-in-the-lens" IOL is safe and effective in pediatric cataract cases due to its minimal contact with biomaterial, the lens' developer said in a presentation here.

Marie-Jose Tassignon

Marie-Jose Tassignon, MD, said the new IOL was developed specifically for children to minimize contact with biomaterial that can cause lens epithelial cell damage and the resulting loss of elasticity in the capsular bag. Dr. Tassignon said she performs this implantation primarily for pediatric cataracts, which is what she encounters in European children.

The three pieces of the lens create a groove around the optic and between the haptics where the IOL can secure the edges of both the anterior and posterior capsulorrhexis, leaving the only contact of the lens with the capsular bag edges.

The surgical procedure to implant the lens consists of standard cataract removal with the exception of her technique for anterior and posterior capsulorrhexis, which she performs with the aid of a specially designed tension ring, she said. Dr. Tassignon described the unique aspects of the procedure. She admitted that the procedure required more skill and was more difficult than standard cataract removal procedures.

After removing the cataract, Dr. Tassignon said she does not fill the capsular bag with viscoelastic, but instead she places viscoelastic in front of the anterior capsule to force the anterior and posterior portions of the bag together and then she cleans the bag with both capsules touching.

Dr. Tassignon performs her anterior chamber capsulorrhexis with the aid of the ring and then uses the anterior chamber capsulorrhexis outline to guide her creation of a posterior capsulorrhexis of the same size.

"The vitreous body behind the capsule is very important because it is the space used to implant the posterior part of the haptic," she said.

"The posterior capsule comes out more anteriorly and close to the border," she said.

The lens size is selected based on preoperative biometry using the lens sizing formula of Abhay R. Vasavada, MD, she said.

Dr. Tassignon said that in almost all cases she has implanted, at postop follow-up, the axis remains clear, provided both capsules are in the groove.

"I had one case where I didn't look carefully enough to ensure the anterior and posterior portions were in the groove, and an opacification of the lens developed," she said.

The advantage of using this IOL is that the capsular bag remains flexible and the lens can be reimplanted, she said.

"The technique doesn't allow epithelial cells to migrate into the capsule, which is sealed and within the lens haptic," she said.