I read with great interest the report by Kelkar et al. on the rare complication of late posterior subluxation of a rollable intraocular lens (IOL) following YAG laser posterior capsulotomy after an uneventful previous microphacoemulsification cataract surgery. Following YAG laser posterior capsulotomy, shrinkage and contracture of the anterior capsule can expel out an IOL from the bag into the vitreous and such events have been reported since many years.[2–4] Hence, since the past 11 years, I have been following a standard protocol of always giving three to four relaxing radial YAG laser cuts on the opening of the anterior capsule – capsulorhexis rim, in addition to, and after doing the YAG laser posterior capsulotomy. This is of greater importance now with the advent of foldable and rollable IOLs. Another important point is to do all YAG capsulotomies with well-dilated pupils so that the anterior capsule rim can be seen and cut properly. Furthermore, I always do a large posterior capsulotomy, yet I have never faced subluxation/dislocation of IOL. A large opening enables a comfortably clear view of the posterior segment and facilitates laser procedures for the retina and also reduces haloes and glare for the patient. Analyzing my personal patients' data of the past 11 years during the period from 03 May 1999 to 01 September 2010, I have done a total of 398 YAG laser capsulotomies using the technique described and not a single IOL has dislocated or subluxated. I feel these tips could help prevent such unfortunate events from occurring in patients who have previously undergone good uneventful surgery and recovered clear vision.
1. Kelkar A, Kelkar J, Kelkar S, Shaikh A. Late posterior subluxation of rollable intraocular lens after an uneventful microphacoemulsification cataract surgery Indian J Ophthalmol. 2010;58:350–1
2. Framme C, Hoerauf H, Roider J, Laqua H. Delayed intraocular lens dislocation after neodymium: YAG capsulotomy J Cataract Refract Surg. 1998;24:1541–3
3. Dahlhauser KF, Wroblewski KJ, Mader TH. Anterior capsule contraction with foldable silicone intraocular lenses J Cataract Refract Surg. 1998;24:1216–9
4. Joo CK, Shin JA, Kim JH. Capsular opening contraction after continuous curvilinear capsulorhexis and intraocular lens implantation J Cataract Refract Surg. 1996;22:585–90
5. Hayashi K, Nakao F, Hayashi H. Influence of size of neodymium: Yttrium-aluminium-garnet laser posterior capsulotomy on visual function Eye (Lond). 2010;24:101–6