Posterior capsule surgery and posterior capsulorhexis

Abstract

Abstract Purpose To review the available intraoperative maneuvers to reduce the occurrence of posterior capsule opacification (PCO) after cataract surgery, including lens epithelial cell aspiration (LECA), posterior capsular membrane removal (PCMR), and posterior capsulorhexis (PCRX). Methods Review of the literature and of the available techniques to prevent PCO. Case‐control retrospective studies on the efficacy of LECA for PCO prevention and on the safety of PCRX, namely its influence on vitreoretinal complications. Results To reduce PCO, a number of surgical maneuvers have been described, including LECA, PCMR and PCRX, with variable results. In a series of consecutive 1574 eyes of 1147 patients followed‐up a minimum of 3 years, performing a meticulous LECA following phacoemulsification (PE) reduced PCO occurrence from 36.6% to 17.2% (p>0.01). In another series of consecutive 2.441 eyes operated of PE with or without PCRX, the rate of retinal detachment and cystoid macula edema was nonsignificantly higher after PCRX than cases with an intact capsule (respectively p=0.065 and p=0.32), while comparing favorably to Nd:YAG laser capsulotomy and with unplanned capsule tears. Conclusion Intraoperative capsular techniques such as LECA, PCMR and PCRX may effectively and safely reduce PCO. The variability of the results in the literature may be due to the multiple nonsurgical factors involved (lens design and materials, associated conditions, etc.), as well as minor surgical details indicating that the surgeon factor should not be understated.