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Reasons for Explantation of Silicone Multifocal Intraocular Lenses (Allergan SA 40 N)

Schmack I., Becker K. A., Auffarth G. U.,
Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)

Purpose: Despite of new intraocular lens designs and IOL materials the anterior capsule fibrosis (ACF) is still a common problem in modern cataract surgery. Especially silicone lenses tend to induce the development of ACF and shrinkage of the anterior capsulorhexis (ACR), leading in some cases to IOL dislocation. We report on four patients who developed early decentration of silicone MIOL after uneventful phacoemulsification with consecutive IOL exchange.
Patients and methods: Between 01.01.2000 and 31.12.2001 75 patients received MIOLs (Allergan SA 40 N) after uneventful phacoemusification. In 4 of these patients an IOL explantation or IOL reposition became necessary because of IOL dislocation by ACF.
Results: In all cases we found a extensive fibrosis of the anterior capsule and shrinkage of the ACR with superior IOL decentration. The patients complained about monocular diplopia and decreased vision. The best corrected distance acuity was between 0.25 and 0.8. In one case an IOL reposition was performed while in the other patients an IOL exchange (one-piece PMMA) has been necessary. During and after surgery no complications occurred and visual acuity ranged between 0.3 to 1.0.
Conclusions: Silicone IOLs tend to induce an extensive fibrosis of the ACR if capsulorhexis size is below 4.5 mm. To prevent MIOL decentration a large capsulorhexis of 5.5 mm and anterior capsule polishing is recommended.