Early central posterior capsular fibrosis in sulcus-fixated biconvex intraocular lenses

A series of 228 eyes implanted with one-piece all poly(methyl methacrylate) (PMMA) biconvex posterior chamber intraocular lenses was examined for posterior capsule opacification. One hundred forty-one eyes (61.8%) had opacification at an average postoperative period of 19.7 months. Seventy eyes (30.7%) developed an unusual form of early central posterior capsular fibrosis (ECPCF), which was confined to the capsulorhexis opening, sparing the peripheral aspect of the anterior and posterior capsules. Risk factors for developing this form of opacification were close apposition of peripheral anterior and posterior capsules caused by placing a posteriorly vaulted biconvex optic anterior to a capsulorhexis opening smaller than the optic diameter. This opacification occurred most often in cases of haptic fixation in the ciliary sulcus. The cumulative capsulotomy rate in this series was 5.26% at three months, 9.1% at 12 months, and 13.2% at 20 months. Of the ECPCF cases, 34.3% eventually required neodymium: YAG (Nd:YAG) laser capsulotomy; the capsulotomy rate for ECPCF was 4.8 times higher than that for Elschnig pearls. Early onset of ECPCF (average onset = 19.4 weeks) resulted in early Nd:YAG capsulotomy (average = 8.0 months after surgery). One-piece all-PMMA biconvex intraocular lenses may promote early central fibrosis of the posterior capsule if the lens optic is anterior to a capsulorhexis opening smaller than the optic diameter. The early onset of this form of opacification predisposes to earlier Nd:YAG capsulotomy with a higher risk of complications.