Intraoperative Posterior Capsule Folds with Foldable Acrylic Intraocular Lenses

Abstract

Abstract: : Purpose: Posterior capsule folds have been noted after intraocular lens (IOL) implantation in the capsular bag at the time of cataract surgery. Recently it has been suggested that the appearance of posterior capsule folds (the "longitudinal striae sign") indicates complete removal of ophthalmic viscoelastic device (OVD), but no formal study supporting this relationship has been reported. I investigated the relationship between posterior capsule folds and OVD during small incision cataract surgery with foldable acrylic IOLs. Methods: A prospective observational study of 155 consecutive uncomplicated cataract extractions using phacoemulsification was performed. A MA60BM, SA30AL or SA60AT foldable acrylic AcrySof IOL (Alcon Laboratories, Fort Worth, TX) was implanted after filling the capsular bag with sodium hyaluronate 1%, a cohesive OVD. The presence or absence of posterior capsule folds was noted immediately after IOL implantation and after removal of OVD. Results: Posterior capsule folds were present in 21 of 49 cases (43%) implanted with a MA60BM lens, 4 of 64 cases (6%) implanted with a SA60AT lens, and in only one case of 42 (2%) implanted with a SA30AL lens. For the MA60BM cases with folds, 14 cases had folds noted prior to removal of OVD and 16 cases had folds noted after OVD removal. For the SA60AT cases with folds, 2 of the 4 cases had folds noted prior to as well as after OVD removal. The single case with a fold noted with the SA30AL developed the fold after IOL implantation. Folds were found more frequently with the MA series IOL than the SA series IOLs (p < 0.0001, Fisher exact test). There was no significant difference noted in age, sex, race, axial length, horizontal corneal diameter, or power of IOL implanted between groups with and without posterior capsule folds. Conclusion: Lens design and haptic material may have more to do with the formation of posterior capsule striae than removal of OVD for the AcrySof IOLs studied. Posterior capsule folds occur even in the presence of OVD. Contrary to previously published observations, the presence of posterior capsule folds does not reliably signify the complete removal of OVD.

Keywords: 582 small incision cataract surgery