Reverse optic capture allows adequate IOL stability
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Capsulorrhexis is an essential aspect of and a prerequisite for performing phacoemulsification surgery.
Gimbel and colleagues described an ideal capsulorrhexis and advantages of having a tear-resistant opening Enclaving the optic of an IOL into the margins of a capsulorrhexis is known as optic capture and provides stability and centration in complicated scenarios. In 1991, Neuhann described the method of engaging the optic of an IOL through the margins of an anterior capsulorrhexis while the haptics were placed in the sulcus. Gimbel and DeBroff were the first to describe the concept of optic capture in pediatric cataract surgery in which the optic is captured into the margins of the posterior rhexis while the haptics lay in the capsular bag.
Source: Ashvin Agarwal, MS, Rhea Narang and Amar Agarwal, MS, FRCS, FRCOphth
For performing an optic capture, the ideal capsular opening should be around 4 mm to 5 mm in primary surgery, and it should be at least 1 mm or 2 mm smaller than the optic diameter so that the optic of the IOL can adequately be supported upon it.
Depending upon the placement of the haptics and the positioning of the IOL optic, six variations have been described for performing an optic capture:
- haptics in sulcus and optic capture through anterior rhexis;
- haptics in sulcus and optic capture through anterior and posterior rhexis;
- haptics in capsular bag and optic capture through anterior rhexis (reverse optic capture, or ROC);
- haptics in capsular bag and optic capture through posterior rhexis;
- haptics in sulcus and optic capture through capsular membrane opening; and
- haptics behind the capsular bag and optic capture through capsular membrane opening.
For performing an optic capture, it is easy to use a three-piece IOL as it allows better enclavation of an IOL optic into the capsulorrhexis margin. However, ROC is specifically performed when the surgeon needs to use a one-piece IOL in the setting of an open posterior capsule. After performing adequate vitrectomy, a one-piece IOL is injected into the capsular bag followed by placement of a spatula behind the optic of the IOL that eventually helps to push or elevate the optic out of the capsular bag and engages it around the rim of anterior capsulorrhexis (Figures 1 to 8). Thus, performing an ROC allows adequate IOL stability, although surgeons need to adjust the IOL power as the optic moves anteriorly and is not lying in the capsular bag. Surgeons also need to follow the cases for development of uveitis-glaucoma-hyphema syndrome, which can occur due to proximity of the IOL optic with the uveal tissue.
- References:
- Gimbel HV, et al. J Cataract Refract Surg. 1990;doi:10.1016/s0886-3350(13)80870-x.
- Gimbel HV, et al. J Cataract Refract Surg. 1991;doi:10.1016/s0886-3350(13)81001-2.
- Gimbel HV, et al. J Cataract Refract Surg. 1994;doi:10.1016/s0886-3350(13)80659-1.
- Gimbel HV, et al. J Cataract Refract Surg. 2004;doi:10.1016/j.jcrs.2003.11.035.
- Neuhann T, et al. The rhexis-fixated lens. Presented at: American Society of Cataract and Refractive Surgery meeting; April 7-10, 1991; Boston.
- For more information:
- Amar Agarwal, MS, FRCS, FRCOphth, director of Dr. Agarwal’s Eye Hospital and Eye Research Centre, is the author of several books published by SLACK Books, sister company of Healio publisher Ocular Surgery News, including Phaco Nightmares: Conquering Cataract Catastrophes, Bimanual Phaco: Mastering the Phakonit/MICS Technique, Dry Eye: A Practical Guide to Ocular Surface Disorders and Stem Cell Surgery and Presbyopia: A Surgical Textbook. He can be reached at aehl19c@gmail.com; website: www.dragarwal.com.
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