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

Primary Posterior Continuous Circular Capsulorhexis without the Use of Ophthalmic Viscosurgical Device

Performing primary posterior capsulorhexis (PPCCC) during cataract surgery is an effective prevention of secondary cataracts. It is important not to damage the anterior vitreous membrane to minimize the possible complications and adverse side effects of this step of the surgery. Most authors use a viscoelastic material to protect the anterior vitreous membrane, injected into the space between the posterior lens capsule and the vitreous membrane through a small hole in the posterior capsule. The creation of posterior capsulorhexis using 25G forceps under an implanted intraocular lens while continuously filling the anterior chamber with irrigation fluid from an irrigation cannula, without the use of a viscoelastic material is, in our opinion, a safe, fast and cheap technique of PPCCC. This technique could theoretically lead to a lower incidence of postoperative complications such as higher postoperative intraocular pressure or anterior segment inflammatory response.

Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial

PURPOSE

To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years.

DESIGN

Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison.

METHODS

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

PATIENT POPULATION

Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye.

OBSERVATION PROCEDURES

Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA).

MAIN OUTCOME MEASURE

PCO score (scale, 0-10).

RESULTS

The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23).

CONCLUSION

The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.

Capsular fibrosis: a review of prevention methods and management

Opacification of the posterior capsule caused by residual lens epithelial cells (LEC) is still the most frequent long-term complication of cataract surgery. Beside the opacification of the visual axis with posterior capsule opacification (PCO), resulting in a decrease in visual function, fibrotic changes may also have a mechanical effect on intraocular lens (IOL) position such as axial shift, decentration, tilt and capsule striae. In this article, two types of capsular fibrosis are explored, on the one hand the anterior capsule fibrosis and on the other hand PCO. Results from clinical trials concerning their causes, natural course, incidence, influencing factors and possible methods of prophylaxis are presented.