Lens refilling and endocapsular polymerization of an injectable intraocular lens: In vitro and in vivo study of potential risks and benefits

Endocapsular cataract removal and injection of a liquid artificial lens has several advantages, including restitution of accommodation, small comeoscleral incision, a more physiological position of the intraocular lens, and a reduced rate of secondary opacification. Our technique consists of bimanual phacofragmentation followed by injection of a fluid monomeric material that can be polymerized inside the capsular bag by short light exposure. Our study assessed the potential risks of the technique (e.g., heat damage to ocular tissue, light damage to the retina) and investigated the technique in vivo. We performed in vitro experiments on porcine cadaver eyes and an in vivo study on 15 rabbits. After a clinical follow-up of at least 12 weeks, the eyes were investigated histopathologically. During the polymerization process, the highest temperature measured at the posterior lens capsule was 45.1 degrees Celsius for a few seconds. The measured irradiance (0.065 watts per cm²) and the risk of photochemical damage to the retina during 20 seconds of polymerization were comparable to that caused by 1.5 minutes of standard coaxial illumination with the operating microscope. In vivo there were no serious inflammatory reactions except in four cases in which there had been intraoperative problems. The rate of secondary opacification appeared less than in conventional intraocular lens implantation in rabbits, especially when the capsule refilled completely. Retinal damage could not be detected histopathologically. In conclusion, refilling techniques may be successful once appropriate refilling materials become available.