Early capsular bag contraction with haptic dislocation following implantation of a flexible hydrophilic acrylic

1
Early capsular bag contraction with haptic
dislocation following implantation of a flexible
hydrophilic acrylic psuedoaccomodating IOL

• Nigel Morlet
• FRACS FRANZCO
• The author has no financial interest in the
  subject matter of this e-poster

2
The Tetraflex Lens

• Not FDA approved but available in Canada, Europe,
  Australia
• Single piece, hydrophilic, with square edge
  optic, and flexible closed loop haptics.

3
Outcomes Audit

• Review of 151 eyes (79 patients) implanted with a
  Tetraflex IOL after cataract extraction or
  refractive lens exchange over 24 month period.
• Outcomes assessed were
• Useful near vision (N10 or J5 or better)
• Posterior capsule opacification
• Need for lens repositioning

4
Near Vision Results

• Failure to achieve useful near vision occurred in
  13 (16.5) patients.
• Of the remaining, 41 (51.9) had a refraction of
  gt0.50 Dioptres minus spherical equivalent in at
  least one eye.

Comment Near vision was easier to achieve with
those who were originally myopic (thinner IOL).
Targeting mini-monovision of -0.75 in the
non-dominant eye improved the near vision
capability. Pushup exercises were useful in the
near term, but had little effect once capsular
fibrosis was well established
5
Posterior Capsule Opacification

• YAG laser capsulotomy was required for 37 eyes
  (24.5) within the maximum of 33 months
  follow-up.

Comment Capsular fibrosis was common, as
expected with hydrophilic acrylic IOLs. The rate
of early capsular fibrosis suggests that more
than 50 will ultimately require YAG laser
capsulotomy.
6
IOL or Haptic Dislocation

• IOL repositioning was required in 15 eyes (13
  patients, 16.5).
• The bag was opened and stabilized with the
  insertion of a capsular tension ring after the
  lens was repositioned.

Comment The soft haptics were easily
compressed, bending inwards along the horizontal
part, migrating centrally, often under the optic,
causing lens tilt and occasionally pushing the
optic out of the capsular bag. Vision was
degraded by induced astigmatism as well as by
capsular opacity. All cases responded well to
surgery and, to date, have remained well
positioned with a satisfactory return of vision.
7
Haptic Dislocation Case

• Capsular bag fibrosis compressed the soft haptics
  deforming them into a loop that was pushed under
  the optic (associated video file shows
  repositioning and insertion of tension ring)

8
Conclusions

• The near vision outcomes were mostly acceptable,
  but mini-monovision had a part to play.
• Capsular opacification was very common as with
  other hydrophilic IOLs.
• The capsular bag fibrosis along with soft haptics
  produced the frequent IOL dislocation.

Comment I no longer offer this IOL to my
patients because any benefit of near vision now
seems overwhelmed by the possible need for
revision surgery.