Benefits and barriers of accommodating intraocular lenses

Curr Opin Ophthalmol 2017, 28:3–8

• An accommodating IOL by definition is associated with a dynamic increase in dioptric power with an effort to focus from distance to intermediate or near vergence.
• Measured amount of accommodation may be influenced by binocularity, target nature, interest, stimulus, instrument myopia, fatigue, and illumination.
• Pseudoaccommodative mechanisms include the induction of higher order aberrations, lens tilt, and miosis.
• Dynamic pseudoaccommodative mechanisms could work alone or in concert with some degree of accommodation because of IOL translation in the
  Crystalens IOL.
• Preventing capsular contraction includes a round, central capsulorhexis with anterior capsule haptic coverage, polished anterior capsular leaflets, meticulous cortical cleanup, rotation of IOL vaulted posteriorly along the posterior capsule, and construction of a water-tight wound.
• New technologies for accommodating IOLs include designs utilizing dual optics, shape changing optics, and IOLs with dynamic changes in refractive index.

dynamic pseudoaccommodating mechanisms :  the induction of higher order aberrations, lens tilt, and miosis, could work alone or in concert with some degree of accommodation because of IOL translation to produce the equivalent of approximately 1 diopter of  accommodation in Crystalens and some other
single-optic presbyopia-correcting IOLs.

PREVENTION AND TREATMENT OF CAPSULAR CONTRACTION SYNDROMES

capsular contraction( z-syndrome)

prevetation ;

This includes creating a round, central capsulorhexis with anterior capsule covering plate haptics, polishing the underside of the anterior capsular leaflets, meticulous cortical cleanup, rotation of IOL vaulted posteriorly along the posterior capsule, not implanting the IOL if there is a capsular tear or zonular rupture, and construction of a water-tight wound to prevent a deflation syndrome with flattening of the plate haptic IOL in the bag.

1. Early treatment of capsular fibrosis or striae using a Nd:YAG laser may prevent or treat mild forms of z-syndrome.
2. 2. Moderate z-syndrome may require repositioning and insertion of a capsular tension ring, whereas more severe forms are more suitable to IOL exchange. This complication is unique to hinged plate haptic IOLs.

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