Evaluation of the first 100 consecutive PhacoFlex silicone lenses implanted in the bag through a self-sealing tunnel incision using the Prodigy inserter.

We evaluated the performance of the PhacoFlex silicone lens with open polypropylene loops and the disposable Prodigy inserter in a series of 100 consecutive no-stitch cases. Loading the lens into the PRO-1A inserter model was easy, as was inserting it through a 4 x 4 mm self-sealing sclerocorneal tunnel incision. If the chamber was deep and the capsular fornix expanded, unfolding the polypropylene loops was safe and direct bag placement was always possible. If the capsular bag was insufficiently distended, however, the posterior loop tended to entangle with wrinkles in the posterior capsule, jeopardizing the capsule's integrity. With a round and well-centered 4 mm to 5 mm capsulorhexis, centration was good provided the lens was completely within the bag. Even with proper bag placement of the haptics, however, the optic occasionally decentered slightly and tilted because of secondary capture in the capsulorhexis opening. With an incomplete capsulorhexis or a jagged-edged capsulotomy, malpositioning was not uncommon. This was due to secondary displacement of one haptic into the sulcus or partial capture of the optic by the anterior capsule leaf. Because of the flexibility of the polypropylene loops, the lenses tended to decenter and tilt following capsular shrinkage.