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Confirming lens position
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In routine cataract surgery, it is important to ensure that the lens is completely within the capsular bag. Leaving a lens haptic outside of the capsular bag can lead to decentration, capsular phimosis and poor vision.
 The trailing haptic is outside of the capsular bag and in the sulcus, with subsequent capsular phimosis and decentration of the optic. |
In my blog entry from March 15, 2010, I showed a case where once both IOL haptics were placed within the capsular bag, excellent centration and visual results were achieved.
Today I saw a patient who had surgery a year ago. It was a routine surgery with no evidence of other ocular conditions such as pseudoexfoliation. The patient received a three-piece silicone IOL that was only partially placed in the capsular bag. The trailing haptic missed the capsular bag and ended up in the ciliary sulcus. This led to asymmetric capsular bag contraction, capsular phimosis and decentration of the optic. While it is hard to say the exact cause of any late complication, the misplacement of the lens haptic may have contributed to this condition.
While sulcus fixation of an IOL is a valuable option in certain cases, routine cataract surgery is best done by placing the lens implant completely within the capsular bag.
See Dr. Devgan share more expert insight live at OSN New York 2010, to be held November 19-21, 2010 at the Sheraton New York Hotel & Towers. Learn more at OSNNY.com.