title: Clinical and histopathologic evaluation of six human eyes implanted with the bag-in-the-lens.
abstract: OBJECTIVE
  To describe the clinical and histopathologic features of eyes implanted with the bag-in-the-lens (BIL), which involves the use of a twin capsulorhexis lens design, and performance of anterior and posterior capsulorhexes.
  
  
  METHODS
  Case series with clinicopathologic correlation.
  
  
  METHODS
  Six eyes implanted with the foldable, hydrophilic acrylic BIL, obtained postmortem at different postoperative times, from 4 patients were studied.
  
  
  METHODS
  On the patients' death, the eyes were enucleated, immersed in fixative, and submitted for analyses under a high-frequency ultrasound unit (Artemis, Ultralink, St. Petersburg, FL; 50 MHz), gross analyses, and histopathologic analyses. Clinical data in each case were obtained by chart review.
  
  
  METHODS
  Clinical data obtained included patient demographics, preoperative evaluation, description of surgical implantation procedure, and postoperative outcomes. The postmortem evaluation included analyses of lens fixation and centration, as well as gross and histopathologic analyses of postoperative capsular bag opacification.
  
  
  RESULTS
  The patients were aged 74.6+/-12.6 years at implantation. The postoperative time in this series ranged from 4 to 39 months. In all eyes for which the surgical implantation was uneventful (N = 5), postoperative BIL decentration was insignificant. In 1 eye, the anterior capsulorhexis was torn off, and although BIL implantation was still possible, a relative lens decentration was observed postoperatively, but without clinical significance. Although progressively larger amounts of Soemmering's ring formation were observed in the specimens with larger follow-up, the central area delimitated by the rhexis openings remained perfectly clear in all 6 eyes.
  
  
  CONCLUSIONS
  This is the first series of human eyes implanted with the BIL, obtained postmortem at different postoperative times. BIL centration depends on the performance of centered capsulorhexes of appropriate size. The results confirm the concept of the lens design in that any proliferative/regenerative material remains confined to the intercapsular space of the capsular bag remnant outside the optic rim.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors.affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA. liliana.werner@hsc.utah.edu
authors.forename: Liliana
authors.initials: L
authors.lastname: Werner
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Tassignon
authors.forename: Brian E
authors.initials: BE
authors.lastname: Zaugg
authors.forename: Veva
authors.initials: V
authors.lastname: De Groot
authors.forename: Jos
authors.initials: J
authors.lastname: Rozema
mesh_terms: D000180:Acrylic Resins; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D019923:Capsulorhexis / Q000379:methods*; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D019591:Pseudophakia / Q000473:pathology*
chemical_list: D000180:Acrylic Resins; D001672:Biocompatible Materials