Posterior optic buttonholing prevents intraocular pressure peaks after cataract surgery with primary posterior capsulorhexis

Impact of primary posterior capsulorhexis on regeneratory after-cataract and YAG laser rates with an acrylic micro-incision intraocular lens with plate haptics: 1-year and 3-year results

Purpose

To evaluate the posterior capsule opacification (PCO) and YAG laser capsulotomy (YAG‐LCT) rates with a plate‐haptic acrylic micro‐incision intraocular lens (IOL) and the impact of primary posterior capsulorhexis.

Methods

A total of 97 patients scheduled for immediate sequential bilateral cataract surgery underwent a randomized, prospective intraindividual comparison with the ZEISS Asphina 409MV plate‐haptic acrylic IOL with the eyes receiving an additional primary posterior capsulorhexis (PPCR) or not. YAG‐LCT and PCO rates were evaluated at 1 and 3 years. Three‐year PCO rates were calculated with a 3‐scenario method for eyes that underwent YAG‐LCT between 1 and 3 years.

Results

A total of 56 patients were seen at 1 year, and 57 at 3 years. For the eyes without and with PPCR, YAG‐LCT rates were 14.3% and 0% at 1 year, and 59.7% and 3.5% at 3 years, respectively. Opacification rates at 1 year were 0.55 ± 0.99 and 0.05 ± 0.21 for the central 2‐mm optic zone. A total of 42 patients completed both the 1‐ and 3‐year follow‐up. Three‐year opacification rates for the group without PPCR were 1.99 ± 2.20, 2.26 ± 2.66 and 3.66 ± 3.61 for the central 2‐mm zone and 2.57 ± 2.07, 3.13 ± 3.03 and 4.09 ± 3.34 for the 4.5‐mm zone for the best, extrapolated and worst‐case scenarios, respectively.

Conclusion

The ZEISS Asphina 409MV plate‐haptic acrylic IOL exhibited unusually high YAG‐LCT and PCO rates with standard in‐the‐bag implantation. PPCR was safe and effective in preventing central opacification and the need for YAG laser treatment.

Effect of primary posterior continuous curvilinear capsulorrhexis with posterior optic buttonholing on pilocarpine-induced IOL shift

PURPOSE

To assess intraocular lens (IOL) shift along the visual axis induced by ciliary muscle contraction with pilocarpine after cataract surgery and to compare primary posterior continuous curvilinear capsulorrhexis (CCC) and posterior optic buttonholing with IOLs implanted in the bag.

SETTING

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

DESIGN

Clinical trial.

METHODS

Eyes with age-related cataract had cataract surgery with implantation of a nonaccommodating IOL (AF-1 YA-60BB). Surgery was performed with primary posterior CCC and posterior buttonholing in 1 eye (study eyes) and with conventional in-the-bag implantation in the contralateral eye (control eyes). After a minimum of 6 months postoperatively, the anterior chamber depth was assessed with partial coherence interferometry before and after application of pilocarpine 2.0% and, after a washout interval of 1 week, before and after the application of cyclopentolate 1.0%.

RESULTS

Forty eyes of 20 patients were enrolled. A slight backward shift of the IOL (+78 μm) in study eyes and in control eyes (+118 μm) was detected after pilocarpine application (both P<.05). No significant difference in IOL shift was found between study eyes and control eyes (P=.19).

CONCLUSIONS

Combined primary posterior CCC and posterior optic buttonholing did not affect IOL shift during pharmacologically stimulated ciliary muscle contraction compared with in-the-bag implanted IOLs. Capsule fibrosis diminished with primary posterior CCC but did not seem to be the only limiting factor in the accommodative IOL shift.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.