RESULTS OF 87 CASES OF INTRAOCULAR-LENS IMPLANTATION AT THE FRONT OF THE WHOLE CAPSULAR BAG

To prevent or delay Elschnig pearl formation, we performed an unusual surgical technique on 87 patients: intraocular lens implantation at the front of the whole capsular bag. We tried to obtain tight adhesion between the anterior and posterior capsules so the lens epithelial cells could not proliferate and form Elschnig pearls. In fact, the patients exhibited no Elschnig pearls or Soemmering's ring, but developed large anterior capsular folds and a multilayer cell membrane between both capsules after two (three cases), six (19 cases), and 12 months (14 cases). This led to a decrease in visual acuity, and a Nd:YAG laser anterior and posterior capsulotomy was required in most cases (83%). Several months later, these eyes developed enormous Elschnig pearls emanating centrifugally from the laser opening, strongly suggesting that lens epithelial cells require aqueous humor for Elschnig pearl transformation. Since it is not yet possible to obtain perfect adhesion between anterior and posterior capsules, our results confirm the need to remove the anterior capsule after extracapsular cataract extraction.