Abstract
Purpose The aim of this study was to assess the effects of residual anterior lens epithelial cell (LEC) removal by anterior capsule polishing on the effective lens position (ELP) and axial position stability of the intraocular lens (IOL) after cataract surgery via postoperative measurement of the anterior chamber depth. Methods We enrolled 30 patients (60 eyes) requiring bilateral cataract surgery for age-related cataracts. Meticulous anterior capsule polishing and removal of residual LECs under the capsule were performed using a bimanual irrigation/aspiration system for one randomly selected eye in each patient. The eye without polishing served as a control. ELP was measured at five different time points after surgery, and axial shifting of IOL was determined at each visit by comparison with the position at the previous visit. Results The polishing and control groups showed significant differences with regard to the mean ELP at 1 (3.40 ± 0.29 versus 3.53 ± 0.32 mm, resp.; p=0.026) and 2 months (3.42 ± 0.32 versus 3.61 ± 0.35 mm, resp.; p=0.001) after surgery, the mean standard deviation for the five ELP values (0.087 ± 0.093 versus 0.159 ± 0.138 mm, p=0.001), and the root mean square of the change in ELP at each follow-up visit (0.124 ± 0.034 versus 0.246 ± 0.038 mm, p=0.047). The eyes in the control group exhibited a tendency for backward IOL movement with a concurrent hyperopic shift in refraction of approximately 0.2 diopter at 2 months after surgery. Conclusion Our findings suggest that residual anterior LEC polishing enhances the axial position stability of IOLs, without any complications, after cataract surgery.
Highlights
In recent years, phacoemulsification with concurrent foldable intraocular lens (IOL) implantation has taken the place of refractive surgery, with the development and increase in the popularity of various refraction-correcting IOLs, including multifocal or toric IOLs
One study reported that inaccurate effective lens position (ELP) prediction can account for 22% to 38% of the total refractive prediction error [6], while a postoperative shift in ELP could induce an unexpected refractive change apart from the prediction error. e reciprocal action between capsular fibrosis and bag fusion possibly accounts for the change in ELP after surgery [7]
Significant differences were observed in the mean ELP at 1 and 2 months after surgery (p 0.026 and 0.004, resp.). e mean standard deviation (SD) for the five ELP values was significantly smaller for the polishing group (0.087 ± 0.093 mm) than that for the control group (0.159 ± 0.138 mm; p 0.001)
Summary
Phacoemulsification with concurrent foldable intraocular lens (IOL) implantation has taken the place of refractive surgery, with the development and increase in the popularity of various refraction-correcting IOLs, including multifocal or toric IOLs. One study reported that inaccurate ELP prediction can account for 22% to 38% of the total refractive prediction error [6], while a postoperative shift in ELP could induce an unexpected refractive change apart from the prediction error. E reciprocal action between capsular fibrosis and bag fusion possibly accounts for the change in ELP after surgery [7]. Residual lens epithelial cells (LECs) after cataract surgery play a significant role in the development and progression of capsule fibrosis and contraction [8,9,10]. Several studies have reported that the removal of residual anterior LECs resulted in delayed or lesser capsular bag contraction and anterior capsule fibrosis [11,12,13,14]
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