Current concepts in posterior chamber lens technology

Although extracapsular cataract extraction and posterior chamber lens technology is of unrivaled safety and efficacy, the following aspects command considerable attention: chronic postoperative inflammation, inhibition of posterior capsular opacification, facilitation of YAG-laser posterior capsulectomy, prevention of ultraviolet radiation exposure, and sulcus versus capsular-bag fixation of posterior chamber lenses. The differential diagnosis of lens-induced and intraocular-lens-induced inflammation is presented, along with recommendations for the treatment and management of the second eye. Use of the complete laser-ridge lens to create a barrier for migrating cells capable of causing posterior capsular opacification is discussed. Using it to create a space between the posterior surface of the optic and the posterior capsule to facilitate YAG-laser posterior capsulectomy is also described. The status of ultraviolet blockers in intraocular lenses is discussed. The transition to capsular-bag fixation is recommended based on the following problems with sulcus-fixated lenses: mechanical disruption of the blood-aqueous barrier with release of inflammatory mediators, hemorrhage from or obstruction in the major arterial circle, the danger of polypropylene in metabolically active tissue, and the posterior iris chafing syndromes.