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Decentered capsulotomy contributes to risk of vault after accommodating IOL implantation
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LOS ANGELES — A decentered or irregular capsulotomy can increase the risk of postoperative vaulting in patients implanted with an accommodating IOL, a study found.
“The overall incidence of vault was very low, but several factors seem to increase the risk,” Timothy Page, MD, said at the American Society of Cataract and Refractive Surgery meeting.
Timothy Page
In the study, a retrospective chart review identified cases of postoperative vault in patients implanted with accommodating IOLs as well as a demographically similar control group. Detailed questionnaires were sent to the surgeons in those cases, yielding 103 cases in the vault group and 100 in the control group.
“We wanted to know if femto had an effect,” Page said. “It turned out to be a nonsignificant factor. Whether it was used for incisions or capsulotomy or fragmentation, there was no statistical significance between these two groups.”
Neither did diameter size less than the size of the optic have a significant effect between the groups. However, a significantly decentered or non-circular capsulotomy significantly increased the risk of postoperative vault, Page said. Failure to polish the anterior and posterior capsule, incomplete removal of the cortex, and damage to the iris, capsule, zonules or IOL are other risk factors.
Conversely, placement of a capsular tension ring at the time of surgery may have a protective effect in preventing vault, he said. – by Patricia Nale, ELS
Reference:
Page T. Surgical technique and intraoperative events associated with vaulting of accommodative intraocular lens. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 5-9, 2017; Los Angeles.
Disclosure: Page reports he is on the speakers bureau for Alcon and Bausch + Lomb and is a consultant for Johnson & Johnson Vision.