Thorough capsule peeling improves lens stability, quality of vision in IOL exchange

COPENHAGEN, Denmark — Capsule peeling is a challenging but mandatory maneuver for quality of vision in the course of IOL exchange, according to one specialist.

Explantation has become a relatively frequent event with first-generation multifocal IOLs. The most common indications, including opacification, decentration and dislocation, are related to capsular problems such as contraction and tissue proliferation, which make the lens unstable, Marie-José Tassignon, MD, said at the meeting of the European Society of Ophthalmology.

Marie-José Tassignon

"In some cases we removed multifocal lenses where the concentric rings had become oval because the capsule contracted and bent the lens, causing huge visual issues," she said.

Thorough cleaning of the inner side of the anterior capsule and capsule periphery is mandatory.

"Scrape it all off using a hook-shaped instrument; otherwise, you won’t be able to provide a stable fixation of the haptics and a good visual quality," Tassignon recommended.

"In some cases, do only the peeling and leave the lens there. This is easier with silicone lenses that produce less proliferation," she said.

Posterior capsule peeling is also performed by Tassignon for IOL exchange with bag-in-the-lens (BIL) implantation before performing a posterior capsulorrhexis. She recommended using a bimanual technique, which helps manipulate and move the lens within a capsular bag that is full of thin and thick fibrotic tissue.

"Bimanual helps, so I can move the lens gently, with no stress on the zonules, peel, perform a [posterior continuous curvilinear capsulorrhexis] and place BIL," she said.

Disclosure: Tassignon has a proprietary interest in bag-in-the-lens (Morcher).