Unfolding characteristics of a new hydrophobic acrylic intraocular lens, and possible association with complications in triple procedures

Background: To evaluate the relationship between complications observed in triple procedures and the unfolding characteristics of the HOYA AF‐1 lens. Methods: Intraoperative and postoperative complications of 242 eyes undergoing vitrectomy, phacoemulsification and intraocular lens (IOL) implantation were reviewed. Ninety eyes were implanted with the AF‐1 lens (VA60BB), 100 eyes with a polymethylmethacrylate lens (824C) and 52 eyes with an AcrySof lens (SA60AT). The unfolding characteristics of the VA60BB and SA60AT were also experimentally examined. Results: Intraoperative iatrogenic posterior capsular holes caused by the vitreous cutter were observed in two eyes with the VA60BB, in three eyes with the 824C, and in one eye with the SA60AT. Significant rotation of the curled IOL in the capsular bag during implantation, with dislocation of the IOL into the vitreous cavity through the hole occurred in the two eyes with the VA60BB. Postoperatively, posterior synechia of the iris occurred more frequently in the VA60BB group (seven eyes) than in the 824C group (one eye) or the SA60AT group (one eye). In the experimental study, the unfolding time of the VA60BB lens was longer than that of the SA60AT lens. The overall diameter of the VA60BB lens after unfolding remained shorter than that before folding. Conclusion: Incomplete unfolding of the VA60BB appears to cause intraoperative rotation of the IOL in the capsular bag, resulting in IOL dislocation into the vitreous cavity in the presence of a posterior capsular hole. This lens also appears to be associated with higher rate of postoperative complications in triple procedures.