Clinical and Histopathologic Evaluation of Six Human Eyes Implanted with the Bag-in-the-Lens
Received 11 March 2009; received in revised form 10 June 2009; accepted 12 June 2009. published online 05 November 2009.
Purpose
To describe the clinical and histopathologic features of eyes implanted with the bag-in-the-lens (BIL), which involves the use of a twin capsulorhexis lens design, and performance of anterior and posterior capsulorhexes.
Design
Case series with clinicopathologic correlation.
Participants
Six eyes implanted with the foldable, hydrophilic acrylic BIL, obtained postmortem at different postoperative times, from 4 patients were studied.
Methods
On the patients' death, the eyes were enucleated, immersed in fixative, and submitted for analyses under a high-frequency ultrasound unit (Artemis, Ultralink, St. Petersburg, FL; 50 MHz), gross analyses, and histopathologic analyses. Clinical data in each case were obtained by chart review.
Main Outcome Measures
Clinical data obtained included patient demographics, preoperative evaluation, description of surgical implantation procedure, and postoperative outcomes. The postmortem evaluation included analyses of lens fixation and centration, as well as gross and histopathologic analyses of postoperative capsular bag opacification.
Results
The patients were aged 74.6±12.6 years at implantation. The postoperative time in this series ranged from 4 to 39 months. In all eyes for which the surgical implantation was uneventful (N = 5), postoperative BIL decentration was insignificant. In 1 eye, the anterior capsulorhexis was torn off, and although BIL implantation was still possible, a relative lens decentration was observed postoperatively, but without clinical significance. Although progressively larger amounts of Soemmering's ring formation were observed in the specimens with larger follow-up, the central area delimitated by the rhexis openings remained perfectly clear in all 6 eyes.
Conclusions
This is the first series of human eyes implanted with the BIL, obtained postmortem at different postoperative times. BIL centration depends on the performance of centered capsulorhexes of appropriate size. The results confirm the concept of the lens design in that any proliferative/regenerative material remains confined to the intercapsular space of the capsular bag remnant outside the optic rim.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found after the references.
Available online: November 5, 2009.
1John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
2Department of Ophthalmology, Antwerp University Hospital, Belgium
Correspondence: Liliana Werner, MD, PhD, John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT 84132
Manuscript no. 2009-342.
Financial Disclosure(s): The author(s) have made the following disclosure(s): Dr Tassignon is the inventor of the BIL IOL. The other authors have no financial or proprietary interest in any product mentioned in this article.
Supported in part by the Research to Prevent Blindness Olga Keith Wiess Scholar Award, a Funding Incentive Seed Grant of the University of Utah Research Foundation (Liliana Werner, MD, PhD), and Funds for Research in Ophthalmology, Belgium (Marie-José Tassignon, MD, PhD, FEBO).
ABSTRACT