PURPOSE: Posterior chamber foldable silicone intraocular lenses (IOLs) are becoming increasingly prevalent in patients undergoing a pars plana vitrectomy with fluid-air exchange. The authors report an important limitation of foldable silicone IOLs during fluid-air exchanges in pars plana vitrectomies. METHODS: The charts of 18 pseudophakic patients with foldable silicone IOLs who underwent vitrectomy with fluid-air exchange by the authors were reviewed. RESULTS: There was a statistically significant difference in the occurrence of condensation during fluid-air exchange between the group of patients with a capsulotomy versus those that did not have a capsulotomy (P = 0.003). Condensation limiting the view of the retina occurred during fluid-air exchange in 11 of 11 of the patients with foldable silicone lenses and a capsulotomy. Attempts to remove the condensation with a soft-tipped aspiration cannula resulted in limited view of the retina for 1 to 2 minutes in 6 of 11 patients. Use of a thin film of silicone oil restored the view in one patient. In the presence of an intact posterior capsule, condensation did not occur on identical foldable silicone IOLs in seven of seven patients. CONCLUSION: Recognition of the presence of a foldable silicone lens is important when an air-fluid exchange is anticipated. If a capsulotomy is present, the surgeon must be aware that condensation may limit the view of the retina severely during and after surgery. Intraoperatively, the view of the retina usually can be restored in short surgeries by wiping the posterior lens surface with a soft-tipped cannula, and in more complex surgeries by applying a thin film of silicone oil on the posterior surface of the lens.
PURPOSE: Posterior chamber foldable silicone intraocular lenses (IOLs) are becoming increasingly prevalent in patients undergoing a pars plana vitrectomy with fluid-air exchange. The authors report an important limitation of foldable silicone IOLs during fluid-air exchanges in pars plana vitrectomies. METHODS: The charts of 18 pseudophakic patients with foldable silicone IOLs who underwent vitrectomy with fluid-air exchange by the authors were reviewed. RESULTS: There was a statistically significant difference in the occurrence of condensation during fluid-air exchange between the group of patients with a capsulotomy versus those that did not have a capsulotomy (P = 0.003). Condensation limiting the view of the retina occurred during fluid-air exchange in 11 of 11 of the patients with foldable silicone lenses and a capsulotomy. Attempts to remove the condensation with a soft-tipped aspiration cannula resulted in limited view of the retina for 1 to 2 minutes in 6 of 11 patients. Use of a thin film of silicone oil restored the view in one patient. In the presence of an intact posterior capsule, condensation did not occur on identical foldable silicone IOLs in seven of seven patients. CONCLUSION: Recognition of the presence of a foldable silicone lens is important when an air-fluid exchange is anticipated. If a capsulotomy is present, the surgeon must be aware that condensation may limit the view of the retina severely during and after surgery. Intraoperatively, the view of the retina usually can be restored in short surgeries by wiping the posterior lens surface with a soft-tipped cannula, and in more complex surgeries by applying a thin film of silicone oil on the posterior surface of the lens.