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Combined BIL and Vitrectomy

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Innovative Implantation Technique

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Abstract

The “bag in the lens” (BIL) IOL is a very good option in combined phacoemulsification and vitrectomy. Based on the experience of more than 3000 implantations of the BIL since 2009, necessary modifications of the primary posterior continuous curvilinear capsulorhexis (PPCCC) and other critical steps during phacovitrectomy are discussed: In the eyes with a poor or absent red reflex, the PPCCC can be performed with intracameral illumination. During a fluid-air exchange, a marked condensation of water on the posterior surface of the BIL will occur which can be eliminated with hydroxypropylmethylcellulose. Postoperatively, there is a risk of pupillary capture in gas-filled eyes. Mydriatics in the first postoperative days should be avoided. Pupillary capture can be managed easily. The BIL offers excellent intraoperative stability and postoperative centration. Other advantages are the complete absence of posterior capsular opacification or anterior capsule contraction, a good intraoperative and postoperative view on the fundus, and the lack of posterior synechiae even after heavy postoperative inflammation or in uveitis.

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Abbreviations

AC:

anterior chamber

ACCC:

anterior continuous curvilinear capsulorhexis

BIL:

“bag in the lens” foldable IOL

BSS:

balanced salt solution

CTR:

capsular tension ring

HPMC:

hydroxypropylmethylcellulose

I/A:

irrigation and aspiration

IOFB:

intraocular foreign body, -ies

IOL:

intraocular lens

OVD:

ophthalmic viscoelastic device

PDR:

proliferative diabetic retinopathy

PPCCC:

primary posterior continuous curvilinear capsulorhexis

PPV:

pars plana vitrectomy

PVR:

proliferative vitreoretinopathy

RD:

retinal detachment

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Financial Disclosure

The author has no financial interest in any material or method mentioned.

Author information

Authors and Affiliations

  1. Eye Clinic, Klinikum Frankfurt Hoechst, Frankfurt am Main, Germany

    Tillmann P. Eckert

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  1. Tillmann P. Eckert
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Corresponding author

Correspondence to Tillmann P. Eckert .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Antwerp University, University Hospital, Edegem, Belgium

    Marie-José Tassignon

  2. Department of Ophthalmology, Antwerp University, University Hospital, Edegem, Belgium

    Sorcha Ní Dhubhghaill

  3. Department of Ophthalmology, Antwerp University, University Hospital, Edegem, Belgium

    Luc Van Os

1 Electronic Supplementary Material

Implantation of a capsular tension ring before PPCCC (MP4 122583 kb)

PCCC in a silicone oil-filled eye before aspiration of the oil via the pars plana (MP4 142343 kb)

Enlargement of a small PPCCC with end-gripping forceps via the pars plana (MP4 231968 kb)

Intracameral illumination-assisted PPCCC in an eye with a vitreous hemorrhage in PDR (MP4 299056 kb)

PPCCC after core vitrectomy in an eye with a vitreous hemorrhage in PDR (MP4 74914 kb)

Removal of IOFBs through the capsulotomies before implantation (MP4 125607 kb)

Implantation of a BIL in two eyes with intraoperative posterior capsule rupture (MP4 252976 kb)

Bimanual technique of implantation of the BIL in eyes with weakened zonules (MP4 387575 kb)

Reposition of the incarcerated iris in pupillary capture: partial pupillary capture and circumferential pupillary capture (MP4 150644 kb)

Phacovitrectomy with BIL in retinal detachment. Condensation on posterior surface of BIL can be managed with HPMC (MP4 123502 kb)

Phacovitrectomy in an eye with syphilitic panuveitis. Pupillary dilation with five iris retractors (MP4 280070 kb)

BIL in penetrating injury with traumatic cataract (MP4 171849 kb)

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Eckert, T.P. (2019). Combined BIL and Vitrectomy. In: Tassignon, MJ., Ní Dhubhghaill, S., Van Os, L. (eds) Innovative Implantation Technique. Springer, Cham. https://doi.org/10.1007/978-3-030-03086-5_19

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  • DOI: https://doi.org/10.1007/978-3-030-03086-5_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03085-8

  • Online ISBN: 978-3-030-03086-5

  • eBook Packages: MedicineMedicine (R0)

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