Dr. Hoffman noted that the Cataract Clinical Committee of the American Society of Cataract and Refractive Surgery has emphasized that single-piece IOLs should not be implanted into the ciliary sulcus without fixation because of the risk of pigment dispersion, glaucoma, uveitis, and recurrent vitreous hemorrhages.
“However, it may be OK to put single-piece IOLs in the bag and perform reverse optic capture,” said Dr. Hoffman, recounting a recent study of the procedure performed in 16 eyes, with 12 of the fellow eyes serving as controls (Ophthalmic Surg Lasers Imaging 2012;43:480-8).
The authors reported that patients achieved 20/25 or better vision in 94% of the eyes in which the reverse optic capture was performed compared to 92% in the control eyes. In both groups, 94% and 100%, respectively, were within 1 D of the intended correction. The IOLs in all eyes that underwent reverse optic capture remained centered, and no vision-threatening complications occurred after 19 months of follow-up.
The study concluded that reverse optic capture of a single-piece acrylic IOL through an anterior capsulorhexis merits consideration for IOL placement in selected cases of insufficient posterior capsule support.