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Huang F, Tong W, Wang D, Guan W, Zhang Z, Zhao YE. Impact of anterior capsule polishing on capsule opacification and capsule bend after age-related cataract surgery. J Cataract Refract Surg 2024; 50:599-604. [PMID: 38270489 DOI: 10.1097/j.jcrs.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE To investigate the effect of anterior capsule polishing on postoperative capsule opacification and capsular bend in patients with age-related cataract displaying normal axial length. SETTING Eye Hospital of Wenzhou Medical University at Hangzhou. DESIGN Prospective self-controlled trial. METHODS Patients with age-related cataracts aged 56 to 84 years displaying normal axial length were enrolled. Before surgery, a coin-toss method was used to randomly select 1 eye for intraoperative 360 degrees anterior capsule polishing (polishing group); the contralateral eye received no treatment (control group). Capsular bend index (CBI), anterior capsule opacification (ACO), posterior capsule opacification (PCO), and anterior capsule opening area (ACOA) were recorded at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively using swept-source optical coherence tomography and slitlamp examination. RESULTS 21 patients (42 eyes) were enrolled. Within-group comparisons showed that both groups had significant differences in CBI between 1 week and 1 month postoperatively, and between 6 months and 12 months postoperatively ( P < .05). Between-group comparisons revealed a significant difference in CBI at 1 week postoperatively ( P < .05); at 12 months postoperatively, there was a significant difference in ACOA ( P < .05). There were no significant between-group differences regarding ACO or PCO at any timepoint ( P > .05). CONCLUSIONS For patients with age-related cataracts and normal axial length, 360 degrees anterior capsule polishing can delay early capsular bag deformation without increasing the risks of ACO and PCO. This approach can also limit contraction of the anterior capsule opening.
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Affiliation(s)
- Feng Huang
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
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Lin X, Ma D, Yang J. Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches. Front Med (Lausanne) 2024; 11:1366576. [PMID: 38439904 PMCID: PMC10911763 DOI: 10.3389/fmed.2024.1366576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.
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Affiliation(s)
- Xuanqiao Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Dongmei Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Lens Epithelial Cell Removal in Routine Phacoemulsification: Is It Worth the Bother? Am J Ophthalmol 2022; 239:1-10. [PMID: 35081415 DOI: 10.1016/j.ajo.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To review the literature on crystalline lens epithelial cell (LEC) removal in routine phacoemulsification and determine whether it should be incorporated as part of a surgeon's standard technique. DESIGN Perspective. METHODS Expert commentary with video demonstrations on techniques of removal of LECs and associated potential complications. Discussion incorporates the importance of LEC removal, a review of techniques to prevent posterior capsular opacification (PCO), and the effects of intraocular lens design on LEC proliferation and PCO. RESULTS The evidence suggests that LEC removal should be routinely performed as it can be carried out safely and with considerable short- and long-term benefits for patients. With effective cleanup, there is reduced anterior capsule opacification, fibrosis, and decentration of the capsular bag as well as reduced rates of posterior capsular opacification. Techniques for removal are easy to learn, with very low complication rates, and can reduce the risk of the long-term need for technically complex procedures such as intraocular lens explantation. CONCLUSIONS LEC removal from both the anterior and posterior capsule is part of a continuous, incremental improvement of cataract surgery and should be introduced to ophthalmology trainees during their formative years as part of their regular cataract surgery armamentarium.
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Recalde PL, Larco C, Torres D, Larco P. Femtosecond laser assisted capsulotomy in the treatment of capsule contraction case report. Am J Ophthalmol Case Rep 2020; 20:100893. [PMID: 32913925 PMCID: PMC7472803 DOI: 10.1016/j.ajoc.2020.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/28/2020] [Accepted: 08/16/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To present the surgical value of femtosecond laser capsulotomy in the treatment of capsular contraction. Observations The clinical case of a 63-year-old male patient with single eye who, two months after cataract surgery without complications, presented a significant dislocation of the secondary intraocular lens due to a capsule contraction and epithelial metaplasia that covered the lens optics and caused low vision. Conclusions The femtosecond laser-assisted capsulotomy proved to be effective and safe with minimal traction on the zonule and no IOL damage, in this patient with a follow-up of 29 months.
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Affiliation(s)
| | | | | | - Pablo Larco
- Corresponding author. Larco Visión Clínica y Cirugía de Ojos, Edificio Da Vinci, Pasaje Los Ángeles E4-14 y Alemania, 3rd Floor, Quito, 170135, Ecuador.
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Toto L, Viggiano P, Vecchiarino L, Evangelista F, Borrelli E, Mastropasqua L. Anterior capsule contraction syndrome: a successful multimodal therapeutic approach. Int J Ophthalmol 2019; 12:1356-1358. [PMID: 31456930 DOI: 10.18240/ijo.2019.08.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Luca Vecchiarino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti 66100, Italy
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Gabriel de Figueiredo C, Bordin de Figueiredo G, de Figueiredo J. Aspiration of anterior lens epithelium cells to prevent capsule contraction syndrome in pseudoexfoliation syndrome. J Cataract Refract Surg 2019; 45:523-524. [PMID: 30947855 DOI: 10.1016/j.jcrs.2018.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 10/27/2022]
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Lam J, Sifrig B, Jung H. Rapid Capsular Contraction with Secondary Intraocular Lens Dislocation Associated with Unspecified Rod-Cone Dystrophy: A Case Report. Case Rep Ophthalmol 2018; 9:149-153. [PMID: 29643798 PMCID: PMC5892323 DOI: 10.1159/000486925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose We report an unusual case of rapid and severe anterior capsular contraction associated with secondary intraocular lens (IOL) dislocation following cataract surgery in a patient with unspecified rod-cone dystrophy. Case Report A 68-year-old woman with a history of uncharacterized bilateral rod-cone dystrophy presented with blurry vision 1 month after cataract surgery. Best corrected visual acuity was 20/40 in the operative eye. Slit-lamp exam showed severe anterior capsular phimosis limiting view of the fundus. Our patient underwent 2 sessions of Nd:YAG anterior capsulotomy with limited success. Limited anterior vitrectomy was then performed without success due to densely adherent capsular tissue to the anterior surface of the IOL and additional secondary IOL dislocation. She ultimately underwent pars plana vitrectomy, removal of the capsular bag, and IOL exchange with a scleral fixated IOL. Conclusion Rapid and severe anterior capsular contraction following cataract surgery is rare but appears to be associated with rod-cone dystrophy.
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Affiliation(s)
- Jocelyn Lam
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Bradley Sifrig
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Hoon Jung
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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Takamura Y, Tomomatsu T, Yokota S, Matsumura T, Takihara Y, Inatani M. Large capsulorhexis with implantation of a 7.0 mm optic intraocular lens during cataract surgery in patients with diabetes mellitus. J Cataract Refract Surg 2014; 40:1850-6. [PMID: 25201533 DOI: 10.1016/j.jcrs.2014.02.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/02/2014] [Accepted: 02/08/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the efficacy of a large capsulorhexis and intraocular lens (IOL) in obtaining a larger anterior capsule opening after cataract surgery in patients with diabetes mellitus (DM). SETTING Department of Ophthalmology, University of Fukui, Fukui, Japan. DESIGN Prospective clinical trial. METHODS Patients with DM had bilateral cataract surgery with a 2.8 or 3.0 mm scleral incision, a capsulorhexis with a diameter of approximately 5.0 or 6.0 mm, and implantation of a 6.0 mm optic (Eternity X-60) or 7.0 mm optic (Eternity X-70) IOL. The anterior capsule opening area, aqueous flare intensity, surgically induced astigmatism (SIA), corneal endothelial cell density (ECD), and central corneal thickness (CCT) were measured 1 day, 1 week, and 1, 3, and 6 months after surgery. RESULTS Thirty-one patients (62 eyes) with DM were enrolled. At all postoperative timepoints, the anterior capsule opening was significantly larger in eyes with the 7.0 mm optic IOL than in eyes with the 6.0 mm optic IOL (P<.05, Mann-Whitney U test). There were no significant differences in postoperative aqueous flare intensity, SIA, ECD, or CCT based on the size of the capsulorhexis and IOL. CONCLUSION A larger capsulorhexis and implantation of a 7.0 mm IOL resulted in a larger anterior capsule opening after cataract surgery in patients with DM. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Yoshihiro Takamura
- From the Department of Ophthalmology (Takamura, Tomomatsu, Yokota, Matsumura, Takihara, Inatani), Faculty of Medical Sciences, University of Fukui, Fukui, and the Department of Ophthalmology and Visual Sciences (Yokota), Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Tomomatsu
- From the Department of Ophthalmology (Takamura, Tomomatsu, Yokota, Matsumura, Takihara, Inatani), Faculty of Medical Sciences, University of Fukui, Fukui, and the Department of Ophthalmology and Visual Sciences (Yokota), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Yokota
- From the Department of Ophthalmology (Takamura, Tomomatsu, Yokota, Matsumura, Takihara, Inatani), Faculty of Medical Sciences, University of Fukui, Fukui, and the Department of Ophthalmology and Visual Sciences (Yokota), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takehiro Matsumura
- From the Department of Ophthalmology (Takamura, Tomomatsu, Yokota, Matsumura, Takihara, Inatani), Faculty of Medical Sciences, University of Fukui, Fukui, and the Department of Ophthalmology and Visual Sciences (Yokota), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Takihara
- From the Department of Ophthalmology (Takamura, Tomomatsu, Yokota, Matsumura, Takihara, Inatani), Faculty of Medical Sciences, University of Fukui, Fukui, and the Department of Ophthalmology and Visual Sciences (Yokota), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaru Inatani
- From the Department of Ophthalmology (Takamura, Tomomatsu, Yokota, Matsumura, Takihara, Inatani), Faculty of Medical Sciences, University of Fukui, Fukui, and the Department of Ophthalmology and Visual Sciences (Yokota), Kyoto University Graduate School of Medicine, Kyoto, Japan
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Matsushima H, Iwamoto H, Mukai K, Katsuki Y, Nagata M, Senoo T. Preventing secondary cataract and anterior capsule contraction by modification of intraocular lenses. Expert Rev Med Devices 2014; 5:197-207. [DOI: 10.1586/17434440.5.2.197] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jin-Poi T, Shatriah I, Khairy-Shamel ST, Zunaina E. Rapid anterior capsular contraction after phacoemulsification surgery in a patient with retinitis pigmentosa. Clin Ophthalmol 2013; 7:839-42. [PMID: 23674886 PMCID: PMC3652515 DOI: 10.2147/opth.s42122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A decrease in the anterior capsule opening after cataract surgery has been observed in eyes with weakened lens zonules. It commonly occurs in diabetes mellitus, uveitis, pseudoexfoliation syndrome, high myopia, and elderly patients. Herein, we report the case of a middle-aged man with advanced retinitis pigmentosa who developed a rapid contraction of the anterior capsule after an uneventful phacoemulsification surgery that resulted in severe visual loss during the early postoperative period.
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Affiliation(s)
- Tan Jin-Poi
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Langwińska-Wośko E, Broniek-Kowalik K, Szulborski K. The impact of capsulorhexis diameter, localization and shape on posterior capsule opacification. Med Sci Monit 2012; 17:CR577-82. [PMID: 21959612 PMCID: PMC3539474 DOI: 10.12659/msm.881984] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the impact of capsulorhexis diameter, localization and shape on posterior capsule opacification (PCO) development after cataract extraction with phacoemulsification. MATERIAL/METHODS We retrospectively analyzed of 297 patients who underwent phacoemulsification and AcrySof SA60AT implantation. In a first group of 97 patients, 53 received small capsulorhexis (3.9 to 4.9 mm in diameter) and 44 patients received large capsulorhexis (5.0 to 5.9 mm in diameter). Another group of 99 patients was split into subgroups--66 patients whose capsulorhexis were centrally located and 33 patients whose capsulorhexis were paracentral. A third group of 101 patients was split into subgroups--a subgroup of 59 patients were classified as having a regularly rimmed capsulorhexis and a subgroup of 42 patients as having an irregularly rimmed capsulorhexis. At 6 months follow-up, PCO was classified as none, mild, moderate, or severe, depending on the number of quadrants involved. RESULTS 86.79% of the patients with a small capsulorhexis had no or mild PCO (p<0.001), whereas, 68.18% of the patients with a large capsulorhexis experienced moderate or severe PCO; 89.4% of the patients with a central capsulorhexis had no or mild PCO (p<0.001), whereas, 75.75% of the patients with a paracentral capsulorhexis had moderate or severe PCO; 86.44% of the patients with a regularly rimmed anterior capsulorhexis had no or mild PCO (p<0.001); and 69.04% of the patients with an irregular capsulorhexis rim had moderate or severe PCO. CONCLUSIONS A small capsulorhexis diameter, its central localization and regular shape result in less PCO following phacoemulsification.
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Affiliation(s)
- Ewa Langwińska-Wośko
- Department of Ophthalmology, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland
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Michael K, O'Colmain U, Vallance JH, Cormack GM. Capsule contraction syndrome with haptic deformation and flexion. J Cataract Refract Surg 2010; 36:686-9. [PMID: 20362866 DOI: 10.1016/j.jcrs.2009.09.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 09/20/2009] [Accepted: 09/20/2009] [Indexed: 10/19/2022]
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Liu X, Cheng B, Zheng D, Liu Y, Liu Y. Role of anterior capsule polishing in residual lens epithelial cell proliferation. J Cataract Refract Surg 2010; 36:208-14. [DOI: 10.1016/j.jcrs.2009.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 06/14/2009] [Accepted: 08/07/2009] [Indexed: 10/19/2022]
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Chéour M, Mghaieth K, Bouladi M, Hasnaoui W, Mrabet I, Kraiem A. Traitement au laser Nd:Yag du syndrome de contraction de la capsule antérieure après phacoémulsification. J Fr Ophtalmol 2007; 30:903-7. [DOI: 10.1016/s0181-5512(07)74026-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hanson RJ, Rubinstein A, Sarangapani S, Benjamin L, Patel CK. Effect of lens epithelial cell aspiration on postoperative capsulorhexis contraction with the use of the AcrySof intraocular lens. J Cataract Refract Surg 2006; 32:1621-6. [PMID: 17010857 DOI: 10.1016/j.jcrs.2006.04.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine whether aspiration of lens epithelial cells (LECs) from under the anterior capsule reduces postoperative contraction of the capsulorhexis aperture. SETTING Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom. METHODS This prospective randomized observer-masked study comprised 100 patients who had routine phacoemulsification by the same surgeon at a district general hospital in the United Kingdom. The postoperative changes in capsulorhexis apertures and anterior capsule opacification (ACO) between Group A (aspiration of LECs) and Group B (control) were compared. Digital retroillumination images of the capsulorhexis aperture were taken 1 week and 3 months postoperatively. The area of capsulorhexis aperture was determined with computer software, and capsule opacification was graded subjectively. RESULTS Three months postoperatively, the mean decrease in capsulorhexis aperture was 1.9% in Group A and 5.6% in Group B (P = .02). The ACO at 3 months was grade 2 in 44% of eyes in Group A and in 61% in Group B (P = .13). CONCLUSION Aspiration of LECs from the anterior capsule was a safe procedure that reduced capsulorhexis aperture contraction 3 months after cataract surgery.
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