To evaluate the use of a capsule anchor to reposition and fixate the capsular bag to the scleral wall in eyes with subluxation of the crystalline lens. Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel. This study evaluated a 1-plane poly(methyl methacrylate) intraocular implant (Capsular Anchor) that is clipped to the anterior capsule to support it. The device is composed of a central rod located in front of the anterior capsule and 2 lateral arms positioned behind the anterior capsule. The anchor is secured to the sclera with a single 9-0 or 10-0 polypropylene suture. A capsular tension ring (CTR) can be implanted in conjunction with the anchor. The anchor was implanted in eyes with subluxated cataractous lenses. After surgery, intraocular lens (IOL) centration and corrected distance visual acuity (CDVA) were monitored for 12 months. The anchor was successfully implanted in 2 patients with traumatic subluxated lenses and 2 patients with Marfan syndrome. In 1 eye, 2 anchors were used because of zonular dehiscence that extended during surgery. In 3 eyes, an IOL was implanted in the bag and in 1 eye, in the sulcus. A CTR was additionally implanted in 3 eyes. During the 12-month follow-up, the IOLs remained well centered and stable. The CDVA improved to 20/20 to 20/25 in all cases. The capsule anchor was effective in fixating the lens capsule to the scleral wall in cases of significant zonular dehiscence.

PURPOSE: To evaluate different calculation approaches for toric intraocular lens (IOL) calculation in cases with high posterior corneal astigmatism (PCA). METHODS: Consecutive patients who underwent cataract extraction with implantation of toric IOLs by a single surgeon were reviewed. Eyes with measured PCA of 0.80 diopters (D) or greater were included. Errors in the predicted postoperative refractive astigmatism were calculated for the Abulafia-Koch formula, vector summation of anterior keratometry with posterior tomography, and the Barrett toric calculator using predicted and measured PCA. RESULTS: One hundred seventy-three consecutive cases of toric IOL implantation were reviewed. Seventeen eyes (10%) had PCA of 0.80 D or greater and were investigated. The mean absolute error was the lowest with Barrett's measured PCA (0.55 ± 0.38) followed by Barrett's predicted PCA mean absolute error (0.65 ± 0.31), vector summation (0.69 ± 0.33), and the Abulafia-Koch formula (0.80 ± 0.36). The rate of eyes with prediction errors within 0.25 D or less was the highest for Barrett's measured PCA (29.4%) followed by Barrett's predicted PCA (5.9%) and no eyes for the Abulafia-Koch formula and vector summation. The mean centroid prediction errors were lowest for Barrett's measured PCA and Barrett's predicted PCA (0.14 ± 0.66 @70, 0.14 ± 0.73 @179, respectively), followed by vector summation (0.35 ± 0.70 @5), and the Abulafia-Koch formula (0.39 ± 0.80 @179). CONCLUSIONS: The results suggest that in cases of high PCA, the Barrett toric calculator using direct measurements of PCA may have a potential advantage over predicted PCA in toric IOL calculations and vector summation of the anterior and posterior corneal astigmatism. [ J Refract Surg . 2020;36(12):820–825.]

The effect of posterior chamber intraocular lens (IOL) dimensions, design, style, loop fixation, and anterior capsular tears on decentration were investigated in an experimental model. Nine posterior chamber IOLs of various designs and styles with loop diameters between 12.0 and 14.0 mm and optic diameters between 5.0 and 7.0 mm were implanted in human eyes obtained post mortem. Symmetrical and asymmetrical fixation were investigated in eyes with and without radial tears using the Miyake posterior view technique. Location of IOL loops proved to be the most significant factor in IOL decentration. Decentration was least with symmetrical bag/bag fixation and no radial tears (mean = 0.20 +/- 0.05 mm). Asymmetrical bag/sulcus fixation in the presence of anterior capsular tears was associated with the highest decentration rate (mean 0.68 +/- 0.28 mm). Optic size and total loop diameter had no apparent effect on IOL centration in the immediate postoperative period.