Capsulotomy, myopia, and unexpected intraocular pressure rise

Posterior capsule opacification

A complication of extracapsular cataract extraction with or without posterior chamber intraocular lens (PC-IOL) implantation is posterior capsule opacification. This condition is usually secondary to a proliferation and migration of residual lens epithelial cells. Opacification may be reduced by atraumatic surgery and thorough cortical clean-up. Clinical, pathological and experimental studies have shown that use of hydrodissection, the continuous curvilinear capsulorhexis and specific IOL designs may help reduce the incidence of this complication. Capsular-fixated, one-piece all-polymethylmethacrylate PC-IOLs with a C-shaped loop configuration and a posterior convexity of the optic are effective. Polymethylmethacrylate loops that retain "memory" create a symmetric, radial stretch on the posterior capsule after in-the-bag placement, leading to a more complete contact between the posterior surface of the IOL optic and the taut capsule. This may help form a barrier against central migration of epithelial cells into the visual axis. Various pharmacological and immunological methods are being investigated but conclusive data on these modalities are not yet available.

Clear lens extraction for axial myopia. An appraisal

Optional surgery requires a higher degree of safety than that performed for medical necessity. This ethical principle is particularly applicable to axial myopes, who have higher-than-normal rates of operative and postoperative complications if they undergo lens extraction. Moreover, several noninvasive, extraocular, and reversible techniques now exist for the correction of myopia. Currently, it would appear that the possible optical benefits of clear lens extraction in axial myopia are usually outweighed by the severity of the risks and by the availability of safer alternatives.