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Combined BIL and Vitrectomy

  • Tillmann P. EckertEmail author
Chapter

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.

Keywords

Phacovitrectomy Bag in the lens Morcher Type 89F Primary posterior curvilinear capsulorhexis Vitreous hemorrhage Intracameral illumination Pupillary capture Condensation 

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

Notes

Financial Disclosure

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

Supplementary material

Video 19.1

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

Video 19.2

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

Video 19.3

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

Video 19.4

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

Video 19.5

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

Video 19.6

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

Video 19.7

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

Video 19.8

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

Video 19.9

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

Video 19.10

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

Video 19.11

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

Video 19.12

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

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Eye Clinic, Klinikum Frankfurt HoechstFrankfurt am MainGermany

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