|Year : 2006 | Volume
| Issue : 4 | Page : 277-278
Probable edge defect in Acrysof single-piece intraocular lens
Cornea and Anterior Segment Consultant, The Eye Super Specialties, Mumbai, India
The Eye Super Specialties, An L. V.Prasad Eye Institute Collaborating Center, Punit Plaza, 2nd Floor, Next to Rajawadi Post Office, Ghatkopar (East), Mumbai - 400 077
Source of Support: None, Conflict of Interest: None
The purpose of this article is to report an edge defect in single-piece hydrophobic acrylic intraocular lens (IOL) observed during a routine phacoemulsification procedure. The chip was successfully removed intraoperatively with a McPherson's forceps. However, six months postoperatively patient complained of a disturbing glare due to posterior capsular folds originating from the site of IOL defect. Patient was advised, however refused to undergo Nd:Yag laser capsulotomy to relieve the symptoms. This case highlights the necessity to check each foldable IOL under the microscope before loading it into the cartridge, for possible edge defects.
Keywords: Edge defect, foldable intraocular lens
|How to cite this article:|
Shah U. Probable edge defect in Acrysof single-piece intraocular lens. Indian J Ophthalmol 2006;54:277-8
Intraoperative problems with insertion of foldable intraocular lens (IOL) have been rarely reported., The purpose of this article is to highlight the rare possibility of an edge defect in single-piece hydrophobic acrylic IOL observed during a routine phacoemulsification procedure and to suggest remedial measures for the same.
| Case Report|| |
The problem was encountered with an Acrysof Natural (SN60AT, Alcon laboratories, Inc.) IOL insertion after an uneventful temporal clear corneal phacoemulsification (stop and chop technique) procedure in the right eye of a 59-year-old female patient. The IOL was injected after an uneventful loading of the IOL. After placement of the IOL in the bag, the supero-temporal edge of the optic was seen to have a full thickness edge chip and the fragment was hanging loose from the edge [Figure - 1]. Since it was in the periphery without any fracture extending centrally, this chipped fragment was detached from the optic with a gentle pull with the help of a McPherson's forceps and removed so as to avoid floating of the IOL fragment postoperatively. The edge being superior and extremely peripheral it was thought to have no optical effect postoperatively. The loading was monitored and re-checked on the surgical video recording as well.
Until the six-month postoperative visit the patient had maintained 20/20 vision (uncorrected) in that eye, but had a complaint of glare. Examination at this stage [Figure - 2] showed folds in posterior capsule originating from the area of the defect traversing centripetally. The posterior capsule was otherwise clear. The patient was offered Nd:Yag laser capsulotomy to relieve the complaint, which she declined. The left eye, operated similarly three months prior, had a best corrected visual acuity of 20/20 with no visual complaints until nine-month postoperative visit.
The Acrysof Natural IOL has been widely used globally. As per the product information from Alcon, the cartridge is filled with an ocular viscosurgical device and the IOL is held with a McPherson's forceps parallel to the plane of the optic under microscopic visualization. The leading haptic is in the same plane as the optic and the trailing haptic is placed above the optic with the loading forceps provided with the Acrysof IOL. The Monarch II (B) delivery system is used to insert the lens into the capsular bag.
Our surgical protocol requires the operating surgeon himself to load the foldable IOL in the cartridge. At no point is any toothed forceps used to hold or manipulate the IOL.
| Discussion|| |
Prior report of IOL cracking in an acrylic single-piece lens has been described due to malfunction of a cross-action IOL forceps. There is another report of an Acrysof IOL undergoing a stress fracture intraoperatively along the fold line.  This case differs from the above two due to the defect being preexistent and not iatrogenic or instrument-induced. The posterior capsule known to adhere to the IOL surface took the shape of the edge defect causing radial folds extending into the visual axis.
The above case highlights the possibility of edge defects in a foldable IOL and the necessity to check each IOL under the microscope before loading it into the cartridge. If left undetected it can cause intraoperative tissue damage, postoperative loose fragment or optical aberration secondary to capsular changes.
| References|| |
Pfister DR. Stress fractures after folding an acrylic intraocular lens. Am J Ophthalmol
Balasubramanya R, Rani A, Dada T. Forceps-induced cracking of a single-piece acrylic foldable intraocular lens. Ophthalmic Surg Lasers Imaging
Koch PS, Katzen LE. Stop and chop phacoemulsitication. J Cataract Retract Surg.
[Figure - 1], [Figure - 2]