Results of implantation in the capsular bag. A short term review of 1,588 cases.
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Biomedical subjects
Publications and source records attributed to A Galand.
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Direct measurement of the capsular bag was performed after extracapsular cataract extraction on 49 cadaver eyes. These lenses had a collapsed bag size of 10.32 +/- 0.42 mm.
We describe a new method of implantation in the capsular bag. The initial anterior capsulotomy incision is limited to a linear opening from 10 o'clock to 2 o'clock. The nucleus is expressed and the cortical remnants are removed. An implant, specially designed for this technique, is introduced vertically between anterior and posterior capsules and then rotated to a horizontal position entirely within the capsular bag. Finally, a central piece of anterior capsule is excised.
Modifications have been applied to the method of anterior capsulotomy presented by Baïkoff in 1981. Conservation of the anterior capsule during extracapsular cataract extraction facilitates insertion of an implant into the capsular bag. Moreover, this method affords protection to the corneal endothelium. In the new procedure, the initial capsulotomy is limited to a linear opening from 10 to 2 o'clock. After extracapsular extraction and implantation in the capsular bag, a central piece of anterior capsule is excised. An implant specifically designed for this operative technique is used, resulting in a pure capsular fixation.
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We operated on 55 eyes with secondary-cataract following implantation of a Binkhorst's irido-capsular lens. The procedure was through the limbus in 27 cases and via pars plana in 28 cases. For the limbus approach, we made a discission ("membranotomy") in all cases. By pars plana approach, we made a discission in 6 cases and an excision ("membranectomy") by means of phacophage (lensectomy instrument) in 22 cases. We observed that discission frequently yields deceptive or transitory results, requiring one or more reinterventions, while excision of the pupillary membrane by means of phacophage always results in a broad and definitive opening Pars plana approach has the advantage that it facilitates transformation of membranotomy to membranectomy. None of the 55 cases has presented retinal detachment.
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A combined operation a) keratoplasty; b) cataract extraction; c) iridocapsular implant must be advised when a corneal opacity and a cataract require both a surgical treatment. Six months after surgery, functional results are good in 4 cases/5.