|Year : 1989 | Volume
| Issue : 4 | Page : 161
Decentering of I.O.L
CBM Oph. Institute, Little Flower Hospital, Angamally-683 572 Kerala, India
S T Fernandez
CBM Oph. Institute, Little Flower Hospital, Angamally-683 572 Kerala
|How to cite this article:|
Fernandez S T. Decentering of I.O.L. Indian J Ophthalmol 1989;37:161
Intra ocular lens implantation surgery still remains a relevant subject in any national and international meeting in ophthslmlogy.
Even though it is universally accepted now, as a safe and useful mode of treatment to regain high quality of vision, this surgery still has not reached a state of accepted perfectness. It is therefore, natural that every day new lens designs come out tagged after the name of different surgeons who makes small changes of their own. The mode of surgery is also changing so frequently, confusing the common practicing surgeon.
Lens inserted in the capsular bag is being accepted as more anatomical and safe way of doing the surgery. But inspite of this anatomical position, lenses with soft loops are pushed by the thickened and fibrosed capsule either making it decentered or even giving rise to pupillary capture. In many cases such decentered lenses do not make much of a problem except the change in the refraction and bad appearances.But still this occurs in a small percentage of cases. Surgeons who do not undertake I.O.L. surgery may even frighten the patients about such decentering. Therefore newer methods of lenses and surgery has been thought of to overcome this problem.
The causating factors for such decentering have been thought of as :
a) The epithelisation of the capsule due to the remnant of epithelial cells left behind.
b) Small optics and large loops which when pushed aside make refractive changes.
c) Capsular tear due to irregular edges of the anterior capsulotomy.
To prevent this is to clean the capsule of all the epithelial cells. Ultrasonic cleaning, use of chemicals and mechanical cleaning of the capsule with sand blast cannulas or similar instruments have been advised.
Large disc lenses with the convexity placed posteriorly touching the capsule has been found to be a preventive factor. Large disc lens of 9 to 9.5 mm optics or large lens with the optical diameter of 7 mm and a round flexible loup has been tried in patients with good results.
Capsulorhexis described by Neuhann is now done to get a regular round anterior capsular opening and Lens is removed by phacoemulsification. This will prevent the tearing of the capsule while inserting the lens and hold the lens centered in the middle. But it requires sophisticated and expensive equipments.
The mode of inserting lens in the capsule has also changed. The new method is described as intercapsular or envelop method, making sure that the complete lens and its loop is inside the capsule. In the enveloping method the lens inserted inside the capsule through a linear or slightly curved capsular incision and a capsulorhexis done in the middle of the capsule. This is done for either rigid disc lenses or disc lens as with flexible loops.
Dr.Alberts Galand is one of the earliest originators in describing this method and has written his invited article describing his latest method specially for the readers of the Indian Journal of Ophthalmology. I thank him specially for this gesture.
My first 3 years term as the Editor of the Indian Journal of Ophthalmology is coming to the end. I am grateful to the members for their support. I must take this occasion to thank the Managing Editor, Dr.Rajvardhan Azad,editorial board members, ex-offico members, consultant editors in India and abroad. The staff of Littlle Flower Hospital extended their untiring services for bringing up the journal to the present standard. I also thank the photo typesetters, the press and the advertisers for their cooperation.