Sir,

This is the first reported case of cataract surgery where the empty capsular bag is sealed with PerfectCapsule® (Milvella Limited) and then irrigated with 5-fluorouracil (5-FU) for 3 min using a concentration of 50 mg/ml.1 A hydrophilic acrylic intraocular lens (IOL; Bausch & Lomb (B&L) Akreos Adapt) was implanted into the capsular bag. The surgery and follow-up for 1 year have been uneventful. The lens capsule centrally and peripherally remains very clear.

Case report

A 63-year-old woman underwent right cataract surgery with a hydrophilic acrylic IOL ((B&L Akreos Adapt) implanted into the capsular bag. The capsulorhexis was 4.0 mm diameter. Before the implantation of IOL, and at the conclusion of irrigation/aspiration, PerfectCapsule was inserted into the anterior chamber filled with Provisc (Alcon Laboratories) and located over the capsulorhexis.2 Suction through a syringe was applied, and the seal was tested for integrity using balanced salt with fluorescein. With the completion of sealing, 10 ml of 5-FU in a concentration of 50 mg/ml was irrigated through the capsular bag. The solution of 5-FU was stained with fluorescein to detect any leakage. After irrigation for 3 min with 5-FU, the capsular bag was flushed with 2 ml of balanced salt. The suction was then released and PerfectCapsule removed from the anterior capsule by simply pulling on the external tubing. The capsular bag was then filled with OVD and the B&L Akreos Adapt IOL inserted, using an injector, into the capsular bag. The entire procedure was uneventful.

The visual acuity is 20/20 corrected (−1.25 DS). The endothelial cell count postoperatively shows little reduction compared with the unoperated left eye of the patient.3, 4

Clinical photographs are shown at 3 months (Figure 1) and 12 months (Figure 2). An ultrasound biomicroscope (UBM) image at 12 months is shown (Figure 3).

Figure 1
figure 1

Three-month post-op. The anterior and posterior capsules are fused at the IOL periphery, and the overall capsule is clear.

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Figure 2
figure 2

Twelve-month post-op. Note the clear posterior capsule centrally and peripherally. There is minimal fibrosis in the anterior capsule. The peppering on the anterior capsule inferiorly, over the IOL optic, was present at 3 months and remains unchanged.

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Figure 3
figure 3

UBM image at 12-month post-op. Note the fused peripheral anterior and posterior lens capsules with no inclusions.

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Comment

The ‘specialised’ IOLs under development will require changes in surgical technique to effect complete evacuation of lens epithelial cells from the capsular bag to ensure low posterior capsule opacification levels and a flexible capsular bag.5