Reverse Optic Capture of the Single-Piece Acrylic Intraocular Lens in Eyes With Posterior Capsule Rupture

Introduction

The selection, placement, and implantation technique of an intraocular lens (IOL) in cases of incomplete or insufficient capsule support remains controversial. One implantation technique, optic capture, was first described by Neuhann as rhexis-fixation lens in 1991 (Neuhann T. "The Rhexis-fixated Lens" film presented at the Symposium on Cataract and Refractive Surgery, Boston, Massachusetts, April 1991). With this technique, a three-piece posterior chamber IOL (PC-IOL) is placed in the ciliary sulcus and then the optic is depressed posteriorly beneath the rim of anterior continuous curvilinear capsulorhexis (CCC) to achieve IOL stability. This technique was advocated for cases of posterior capsule rupture (PCR) and is also termed as "anterior capsular support for posterior chamber IOL," ¹ "anterior capsule rhexis fixation,"² or "rhexis IOL fixation."³ This conventional optic capture technique (haptics in the sulcus and optic in the bag using a three-piece PC-IOL) is most often referred to as optic capture or posterior optic capture in the literature.

In contrast, reverse optic capture (ROC) (anterior optic capture or reverse rhexis fixation) is achieved by capture of the optic anteriorly through the anterior capsulorhexis opening (haptics in the bag, optic anterior to rhexis) or both anterior and posterior capsulorhexes (haptics behind the posterior capsule, optic anterior to rhexis). Gimbel and DeBroff ³ proposed this technique of reverse rhexis fixation for cases where a posterior capsule tear occurs after the IOL is placed in the bag or is noticed or extends after IOL placement. Pushker et al.⁴ reported a case in which a three-piece AcrySof IOL (Alcon Laboratories, Inc., Fort Worth, TX) was implanted with anterior optic capture in a patient with isolated traumatic PCR.

ROC has been used for other purposes in cataract surgery. Akaishi et al. presented the results of capturing the IOL optic through anterior CCC in a subsequent surgery to correct the residual refractive error after previous cataract surgery with multifocal IOL implantation. ⁵ Masket and Fram recently reported successful results of 3 cases using ROC to treat patients experiencing negative dysphotopsia.⁶

We prefer the term reverse optic capture because this not only describes the procedure properly but also avoids confusion with the conventional optic capture in the literature. To our knowledge, no peer-reviewed publication detailing results of ROC in...