Early capsular bag contraction with haptic dislocation following implantation of a flexible hydrophilic acrylic “psuedoaccomodating” IOL Nigel Morlet FRACS FRANZCO The author has no financial interest in the subject matter of this e-poster

The Tetraflex Lens Not FDA approved but available in Canada, Europe, & Australia Single piece, hydrophilic, with square edge optic, and flexible closed loop haptics.

Outcomes Audit Review of 151 eyes (79 patients) implanted with a Tetraflex IOL after cataract extraction or refractive lens exchange over 24 month period. Outcomes assessed were: Useful near vision (N10 or J5 or better) Posterior capsule opacification Need for lens repositioning

Near Vision Results Failure to achieve useful near vision occurred in 13 (16.5%) patients. Of the remaining, 41 (51.9%) had a refraction of >0.50 Dioptres minus spherical equivalent in at least one eye. Comment: Near vision was easier to achieve with those who were originally myopic (thinner IOL). Targeting mini-monovision of -0.75 in the non-dominant eye improved the near vision capability. Pushup exercises were useful in the near term, but had little effect once capsular fibrosis was well established

Posterior Capsule Opacification YAG laser capsulotomy was required for 37 eyes (24.5%) within the maximum of 33 months follow-up. Comment: Capsular fibrosis was common, as expected with hydrophilic acrylic IOLs. The rate of early capsular fibrosis suggests that more than 50% will ultimately require YAG laser capsulotomy.

IOL or Haptic Dislocation IOL repositioning was required in 15 eyes (13 patients, 16.5%). The bag was opened and stabilized with the insertion of a capsular tension ring after the lens was repositioned. Comment: The soft haptics were easily compressed, bending inwards along the horizontal part, migrating centrally, often under the optic, causing lens tilt and occasionally pushing the optic out of the capsular bag. Vision was degraded by induced astigmatism as well as by capsular opacity. All cases responded well to surgery and, to date, have remained well positioned with a satisfactory return of vision.

Haptic Dislocation Case Capsular bag fibrosis compressed the soft haptics deforming them into a loop that was pushed under the optic (associated video file shows repositioning and insertion of tension ring)

Conclusions The near vision outcomes were mostly acceptable, but mini-monovision had a part to play. Capsular opacification was very common as with other hydrophilic IOLs. The capsular bag fibrosis along with soft haptics produced the frequent IOL dislocation. Comment: I no longer offer this IOL to my patients because any benefit of near vision now seems overwhelmed by the possible need for revision surgery.