Effect of continuous circular capsulorhexis and intraocular lens fixation on the blood-aqueous barrier.

Permeability across the blood-aqueous barrier to fluorescein was estimated fluorophotometrically in pseudophakic eyes for which a continuous circular capsulorhexis was performed. The permeability index was significantly higher in the in-the-bag fixations than in the out-of-the-bag fixations at 3 and 6 months after surgery, when only bilateral cases were enrolled. Damage to the barrier in eyes with the in-the-bag fixations was attributable to the broad attachment of optics to the anterior capsule, because a positive linear regression was obtained between the permeability index and the doughnut-shaped contact area in eyes with the in-the-bag fixations. The permeability index in eyes with the in-the-bag fixations was as low as that in eyes with the out-of-the-bag fixations when the contact area was small. These results indicate an unfavorable effect of the in-the-bag fixation with broad contact of the optics with the anterior capsule and, thus, suggest either an in-the-bag fixation with a large capsulorhexis or an out-of-the-bag fixation.