[After-cataract following intraocular lens implantation. Part II: prevention with alternative implants and techniques].

The introduction of sharp-edged optics has drastically reduced, but not fully eradicated, retro-optical after-cataract formation. The effectiveness of capsular bending rings or primary posterior capsulorhexis is also limited, and these have not become widespread because of the demanding surgical technique and the costs associated with an additional implant. Anterior capsule polishing has been found to even increase the need for laser capsulotomy, and rinsing the sealed capsular bag with cell-toxic agents has not yet gained clinical application. Routine posterior optic buttonholing through a well-centered posterior capsulorhexis opening is a promising alternative because it precludes access of lens epithelial cells behind the optic while at the same time counteracting fibrosis of the anterior capsule. Because this effect is independent of optic rim design and lens material, future efforts in lens refinement may concentrate on reducing the reflectivity of the optic rim and optimizing the biocompatibility of the lens material.