Systematic surgical procedures to secure more stable in-the-bag intraocular lens fixation

Several conditions have to be fulfilled to retain the integrity of the capsular bag for a long period after intraocular lens fixation: (1) The anterior capsular window should be small (5 mm) and round, with no radial tears; (2) the equator of the capsular bag should be almost circular; (3) the retained capsular wall should be transparent and (4) it should have no deformity. To meet these conditions, systematization of several innovative procedures is required. The system that we propose comprises continuous circular capsulorhexis (Neuhann and Gimbel), hydrodelamination (Brint), roundel phacoemulsification (Hara and Hara), new IOL designs, and intraoperative extensive lens epithelial cell removal. A description of each procedure is presented.