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Purpose: To evaluate the use of the second-generation capsular anchor in the treatment of subluxated crystalline and synthetic intraocular lenses., Setting: Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel., Design: Prospective interventional study., Methods: This study evaluated the second-generation capsular anchor, a 3D poly(methyl methacrylate) intraocular implant designed to anchor the lens capsule to the sclera. All surgeries were performed by a single surgeon. Intraoperative and postoperative complications were recorded. Corrected distance visual acuity, lens centration, and lens tilt were assessed at the final follow-up of 3 months., Results: 10 eyes of 10 patients were included in this study. Mean age was 56.2 (22 to 87) years. The reasons for the lack of zonular support were pseudoexfoliation in 3 cases, trauma in 3 cases, and Marfan, ectopia lentis, and pathologic myopia (1 case each). In 1 case, pseudoexfoliation and a history of recent trauma coexisted. 8 of the 10 surgeries were due to subluxation of crystalline lenses and 2 due to subluxation of intraocular lenses. Vision improved in all patients after surgery. Centration of the IOLs was excellent in all patients at the third postoperative month. One patient developed a retinal detachment at the third postoperative week and underwent successful surgery, and 1 patient developed macular edema at the fifth postoperative month, which resolved with topical medication., Conclusions: The second-generation capsular anchor, designed to provide significant improvements over the first-generation device, is effective in fixating the capsular bag to the scleral wall in cases with inadequate capsular support., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To describe and discuss the presentation and management of 4 cases of late (17 to 20 years) postoperative spontaneous posterior capsule rupture (PCR) and intraocular lens (IOL) subluxation in eyes implanted with the same hydrophilic 1-piece IOL., Setting: Center for Applied Eye Research, Meir Medical Center and the Ein-Tal Eye Center, Israel., Design: Case series., Methods: Four patients presented with spontaneous rupture and posterior dislocation of the same design IOL (B-Lens) 17 to 20 years after implantation. No trauma or any other direct causative factor was identified in any of the cases., Results: Of the 4 cases reported, the IOLs were successfully repositioned to the ciliary sulcus and sutured to the scleral wall (1 case) or the iris (2 cases), and the IOL was stable in the sulcus without the need for further sutured fixation in 1 case, with effective vision restored in all cases., Conclusions: Spontaneous PCR is a rare postoperative complication and has not been reported, to the authors' knowledge, in cases without predisposing factors. A mechanism of late capsular tear was not confirmed, but the specific design of the IOL might have been a contributing factor., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)