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EW SHOW DAILY
Wednesday, May 11, 2016
The capsular bag was spread in
the anterior chamber using visco-
elastic and fixated in the posterior
chamber with iris retractors. A
capsular tension ring was inserted,
and the bag was sutured to the sclera
using a capsule fixation device.
The patient's early results
included good visual acuity and a
smooth postop period. EW
Editors' note: Dr. Osher has financial
interests with Abbott Medical Optics
(Abbott Park, Illinois), Alcon (Fort
Worth, Texas), and Bausch + Lomb
(Bridgewater, New Jersey), among other
companies.
Replacing haptics within the eye: Strange but true
by Rich Daly EyeWorld Contributing Writer
Dr. Osher said the cases were
further examples of the "personali-
ties" of 3-piece lenses, which emerge
from injectors backward about half
the time.
Transplanting a capsular bag
A video by Yuriy Kondratenko,
MD, demonstrated the unusual
strategy of transplanting a donor
capsular bag to replace 1 lost during
cataract surgery.
Key points included that the
procedure could succeed with either
the use of a vacuum system or a
push technique to place the do-
nor capsular bag into the anterior
chamber.
The surgeon opted to "harvest"
a fresh haptic from another identical
lens, according to a video displayed
at the session. The approach was en-
couraged by the knowledge that the
haptics "have excellent memory."
The replacement haptic easily
went into the empty haptic tunnel
in the lens but when the surgeon
rotated the eye, it came out again.
The haptic was reinserted into the
IOL and the lens was centered with-
in the capsular bag without further
incident.
Robert Osher, MD, Cincinnati,
said he has seen at least 2 other vid-
eos that documented incidences of
haptics that came out or broke and
required replacement.
S
urgeons were able to suc-
cessfully replace dislodged
and broken haptics from
3-piece IOLs within the
eye on 2 separate occa-
sions. The cases from Partha
Biswas MD, Arnab Biswas, MD,
Subharangshu Sengupta, MD, and
Ajoy Paul, MD, all of India, were
presented during the "Strange but
True" symposium at the ASCRS•
ASOA Symposium & Congress.
The first case involved the im-
plantation of an acrylic hydrophobic
IOL with an injector. However, the
trailing haptic became dislodged and
remained in the injector.
The surgeon considered seg-
menting the IOL and removing it
through the incision and replacing it
or enlarging the incision to remove
the IOL and replacing it.
Instead, the surgeon opted to
try reinserting the haptic into the
tunnel of the optic. The process
involved enlarging the side port to
hold the optic firmly with a pair of
phakic IOL forceps, while another
set of forceps was used to reinsert
the haptic into the lens. After 3 at-
tempts, the haptic was maneuvered
into the end of the tunnel.
The optics were dialed into the
bag and the lens centered without
incident.
A year later, another acrylic
hydrophobic IOL was being inject-
ed into the eye, and after injection
the surgeon realized that most of
the trailing haptic was broken off
and remained in the injector. The
surgeon used lens holding forceps,
which have duck-billed ends, to pull
out the broken haptic from the optic
and explant it.
Dr. Osher speaks at the "Strange but True" symposium.
