Posterior Capsule Opacification with Microincision (MICS) IOLs

Abstract

The history of cataract has been of continual evolution towards smaller and smaller incision sizes, but there is, however, little point in reducing incision size unless intraocular lenses (IOLs) can be designed to be inserted without the need to enlarge the incision. The demands are great because the microincision cataract surgery (MICS) IOLs must perform as well as a conventional IOL. They must be able to withstand the pressures and forces required to compress it enough to withstand the trauma of injection. They must also be rigid enough to withstand the forces of postoperative bag contraction. IOL design and materials, as well as inserter technology, using coatings to facilitate injection, have advanced so that IOLs can now be inserted through 1.8 mm incisions or even 1.4 mm using wound-assisted techniques. Early MICS IOLs used hydrophilic polymers as these are more compressible and have a plate-haptic configuration, but clinical experience has shown these suffered from high rates of posterior capsule opacification (PCO). More recently hydrophobic materials and open-loop haptic designs have become available but still have increased PCO compared to conventional IOLs, possibly due to their reduced thickness.

MICS IOL design continues to advance and the importance of objective comparable fellow-eye-controlled PCO studies cannot be overemphasized if we are to achieve a good MICS IOL design.