[Current state of implantation of flexible intraocular lenses].

Abstract

Two main arguments have stimulated the development of hydrogel and silicone lenses: flexibility allows folding and thus insertion through a small incision, and inertness promises excellent biocompatibility, possibly surpassing that of PMMA. However, as long-term performance remains to be established, these implants cannot yet be considered a routine alternative. Clinical studies are mandatory to document their advantages and any disadvantages, especially as few of the reports already published on experience with such lenses do not give an objective picture of the current status: the surgical techniques used and the observation criteria applied differ and were sometimes inappropriate. In addition, the series are too small and the follow-up studies too short to allow valid conclusions. In this paper, following the description of the materials and designs and of the implantation techniques available for flexible lenses, a review of the pertinent literature and the author's own experiences is reported. This is based on 800 implantations performed over a period of 4 years. Monobloc designs with flange haptics (IOGEL, STAAR) have been found to perform best. The Faulkner folder has proved to be optimal, allowing for easy and atraumatic folding and insertion. Within the eye, the lens is safely guided and released. Bag placement of appropriately styled lens models is strongly recommended, since sulcus-placed lenses have sometimes shown either iris bulging or decentration and windshield-wiper or propeller phenomena. The capsular edge should be smooth and the capsular opening well centered and round in order to guarantee stable fixation and symmetrical compression.(ABSTRACT TRUNCATED AT 250 WORDS)