Alternative IOL in combined surgery

Bag-in-the-lens approach works well for combined phaco-vitrectomy.

Dermot McGrath

Posted: Thursday, August 15, 2019

Using a bag-in-the-lens (BIL) technique offers surgeons a safe and effective means of greatly reducing the risk of posterior synechiae in combined phaco-vitrectomy procedures, according to a French study.

“In our experience, the BIL technique results in the absence of posterior synechiae postoperatively, which also means better visibility of the retina for the ophthalmologist,” said Clément Auchere-Lavayssiere MD at the annual congress of the French Implant and Refractive Surgery Association (SAFIR) in Paris, France.

While the BIL technique requires additional surgical steps, notably a primary posterior continuous curvilinear capsulorhexis, it also confers other advantages compared to conventional intracapsular IOL implantation, said Dr Auchere-Lavayssiere.

“There is now considerable evidence in the literature of the various benefits of using BIL including a total absence of posterior capsule opacification or phimosis, and therefore no need for Nd:YAG laser capsulotomy. It is also perfectly adapted to paediatric cataract with less requirement for reintervention, and also works well with toric implants as there are no issues of decentration or rotation,” he said.

Posterior iris synechiae is one of the more frequent complications of phaco-vitrectomy procedures, noted Dr Auchere-Lavayssiere, with an estimated incidence of between 20% and 30%.

“It can be the origin of reduced visual acuity and light sensitivity, difficulty to examine the peripheral retina, and increased risk of acute hypertonia due to pupillary block,” he said.

Dr Auchere-Lavayssiere’s retrospective study at the University Hospital in Caen included more than 100 successive phaco-vitrectomy procedures for all indications over a 38-month period. Patients were divided into two groups: standard implant (IS) and bag in the lens implant (BIL), with both groups assessed for the presence of posterior iris synechiae postoperatively.

The BIL IOL, also known as the Tassignon lens (Morcher GmbH) after its inventor, Prof Marie-José Tassignon MD, is made of hydrophilic acrylic and has a 5mm optic that is surrounded by a groove running 360° around the rim of the lens and elliptical haptics. The BIL requires both an anterior and a posterior capsulorhexis, the edges of which are captured in the 360° groove, explained Dr Auchere-Lavayssiere.

In the IS group of 55 patients, significant posterior synechiae was detected in 22 cases (40%) compared to just one case of 45 bag-in-lens patients (2%). In multivariate analysis, only use of a BIL implantation (p=0.004) was associated with absence of posterior synechiae.

“The results were pretty conclusive and confirmed the advantages of adopting a bag-in-the-lens approach for combined phaco-vitrectomy procedures. The key advantage of this approach is the absence of synechiae, and the resulting optimal pupillary dilation. It resulted in better vision, avoiding the need for laser capsulotomy and also the risk of acute hypertony as a result of pupillary block,” he concluded.