Continuous Curvilinear Capsulotomy Research Articles

Late spontaneous posterior capsule rupture with single-piece hydrophobic acrylic intraocular lens dislocation

In this study, we described and discussed the late onset spontaneous posterior capsule rupture with intraocular lens (IOL) dislocation years after uncomplicated cataract surgery and implantation of hydrophobic acrylic IOLs. Eight patients presented with spontaneous posterior capsule rupture and IOL dislocation 5–20 years after uncomplicated phacoemulsification and IOL (AcrySof, Alcon, US) implantation. None of the patients had undergone posterior capsulotomy in the past. Four of the patients admitted habitual eye rubbing. An intact and well-centered continuous curvilinear capsulotomy edge was observed in all cases. IOLs were dislocated or displaced behind the anterior capsulotomy with a significant decrease in vision. A large rupture with a curled edge of the broken posterior capsule was visible. Dislocated IOLs were removed, and a three-piece IOL was inserted in the sulcus in six cases and suture fixated to the sclera in two cases. Improved vision was achieved in all cases. Although the mechanism underlying this late complication is unclear, habitual eye rubbing or IOL design may play a role. Further investigation is needed to prevent this complication in the future.

Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability: a comparison of three insertion methods.

To evaluate the efficacy and stability of haptic sutured in-the-bag intraocular lens (IOL) in eyes with zonular instability. A total 60 eyes of 60 patients were included in this retrospective cohort study. Postoperative stability in three groups [haptic sutured IOL in the bag, IOL in the bag insertion with haptics oriented toward areas of zonulysis, IOL with capsular tension ring (CTR) in the bag insertion] were compared according to the IOL insertion methods. To evaluate the IOL stability, the changes of anterior chamber depth (ACD), refraction, contraction of anterior continuous curvilinear capsulotomy (CCC) area, and tilt of IOL were compared. There was no significant difference in change of ACD (-0.04±0.01 mm in group of haptic sutured IOL, -0.07±0.01 mm in group of CTR insertion) and refraction (0.05±0.05 D in group of haptic sutured IOL, 0.37±015 D in group of CTR insertion) between the group of haptic sutured IOL in the bag and CTR insertion group. But in comparison of CCC contraction and IOL tilt, CTR insertion group showed less contraction (1.00%±0.52%) and less IOL tilt (2.66°±0.11°) than the group of haptic sutured IOL in the bag (6.32%±1.36%, 3.47°±0.11°, respectively). The CTR insertion group showed the least CCC contraction and the least tilt. In eyes with zonular instability, the method of haptic sutured IOL in-the-bag shows comparable stability in ACD and refraction in comparison with IOL with CTR in the bag insertion. The method of IOL only in-the-bag insertion shows the largest contraction of CCC and the largest tilt of IOL.

The study of different sizes and shapes of CCC (Continuous Curvilinear Capsulorhexis) in mature cataracts with & without trypan blue

The study of different sizes and shapes of CCC (Continuous Curvilinear Capsulorhexis) in mature cataracts with & without trypan blue - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.075, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Opht

Cell death and survival following manual and femtosecond laser-assisted capsulotomy in age-related cataract.

To study molecular and morphological changes in lens epithelial cells following femtosecond laser-assisted and manually performed continuous curvilinear capsulotomy (CCC) in order to get information about these methods regarding their potential role in the induction of development of secondary cataract. Anterior lens capsules (ALC) were removed from 40 patients with age-related cataract by manual CCC and by femtosecond laser-assisted capsulotomy (FLAC). Samples removed by manual CCC were assorted in group 1, FLAC samples were classified in group 2. Morphology of lens epithelial cells was examined with light and electron microscopes. Following capsulotomy, expressions of p53, Bcl-2 and cyclin D1 genes were analyzed with reverse transcriptase polymerase chain reaction. Immunohistochemistry was used to detect the pro-apoptotic p53 in the epithelial cells. Light and electron microscopic examination showed that ALC of group 1 contained more degenerating cells following manual CCC than after FLAC. The expression level of p53 was higher after manual than laser-assisted surgery. Immunocytochemistry indicated significantly higher number of cells containing p53 protein in the manual CCC group than following FLAC. Bcl-2 and cyclin D1 gene expression levels were slightly lower following manual CCC than after FLAC, but the difference was not significant. Manually removed ALC shows slightly, but not significantly larger damage due to the mechanical stretching and pulling of the capsule than those removed using FLAC.

Zepto cataract surgery: The way forward

Continuous curvilinear capsulotomy (CCC) is one of the most crucial steps of cataract surgery because of numerous surgical and anatomic advantages. The introduction of cataract surgery assisted by femtosecond laser has improved the repeatability and the accuracy of a perfectly rounded capsulotomy, as compared to the manual CCC. However, multiple surgical steps and the relatively high cost-per case have rendered this technology useful only to the affordable. This article describes a cost-effective and convenient new technique of perfecting the circular capsulotomy using a device called precision pulse capsulotomy or Zepto.

Histological comparison between the anterior capsule integrity in femtosecond laser-assisted capsulotomy and traditional continuous curvilinear capsulotomy in cataract surgeries

Purpose To compare the histological edge structures of anterior lens capsule specimens obtained from laser-assisted cataract surgery capsulotomies using two different laser platforms (LenSx post-soft-fit and Victus II) with that of traditional continuous curvilinear capsulorhexis (CCC) using scanning electron microscopy (SEM). Setting I-Care Center, Alex Eye Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Design Prospective comparative series. Patients and methods Anterior capsule specimens following CCC (n=15) or femtosecond laser-assisted capsulotomy using two platforms (LenSx, n=15 and Victus, n=15) were studied by SEM. Irregularity of the capsule edge was quantified using two parameters (angular second moment and contrast) using ImageJ software. The clinical features and laser parameters were correlated with angular second moment and contrast. SEM images were analyzed for the coefficient of variation (CoV) of pixilation along the capsule edge and homogeneity using gray-level co-occurrence matrix analysis. Subjective analysis for cut-surface irregularities and assessment for complications and anomalies, such as tags and misdirected laser shots, were also made. Results The femtosecond laser-assisted capsulotomy edge surfaces created by both laser platforms showed marked irregularity compared with the smoother edge of the CCC. The angular second moment and contrast measures for both lasers differed significantly from those obtained for CCC (P Conclusion Laser capsulotomies are approaching the smoothness of manual capsulorhexis. The LenSx post-soft-fit platform shows less anomalies and smaller difference for the CoV and homogeneity metrics compared with the Victus II platform. In the manual group, there is dishomogeneous thickness along the capsulorhexis edge, while in the femtosecond laser samples the cuts are more homogeneous regarding thickness throughout the whole capsulorhexis edge.

Comparison of surgical and visual outcomes following capsulotomy using the envelope and continuous curvilinear capsulorhexis technique in manual small incision cataract surgery

Background & Objectives: Capsulotomy is one of the important step in cataract surgery which can affect the surgical outcomes. The aim of the study was to compare the outcomes of envelope and continuous curvilinear capsulorhexis technique in manual small incision cataract surgery (MSICS). Materials & Methods: A total of 72 eyes of 72 patients undergoing MSICS were studied. The patients were equally divided into two groups i.e. 36 patients each in envelope capsulotomy (Group A) and continuous curvilinear capsulotomy (CCC) group (Group B).Results: Mean surgical time (±SD) in Group A was 355.83 sec ±37.79 sec and in Group B was 375 sec ±31.214 (p=0.02). Uncorrected visual acuity on postoperative day 1 was 6/9 or better in 50% (18) cases in Group A and in 36% (13) cases in Group B (p=0.28). Best corrected visual acuity (BCVA) on post-operative week 12 was 6/9 or better in 30.6% (n=11) cases in Group A and in 36% (n=13) cases in Group B (p=0.43). On 12th week postoperatively, Grade 2 posterior capsular opacification (PCO) was seen in 30.6 % (n=11) cases of Group A and in 16.6 % (n=6) cases of Group B (p=0.17). Conclusion: CCC technique can be considered superior to envelope technique for long term visual rehabilitation.JCMS Nepal. 2016;12(1):10-13.

Femtosecond laser capsulotomy versus manual capsulotomy: a Meta-analysis.

To perform a Meta-analysis on the precision and safety of femtosecond laser (FSL) capsulotomy compared with manual continuous curvilinear capsulotomy (CCC). We searched PubMed, EMBASE, Web of Science, the Cochrane Library databases, and Clinical Trials.gov that maintained our inclusion criteria. Reference lists of retrieved articles were also reviewed. The effects of morphology of capsulorhexis and the tears of anterior capsule were calculated by using random-effect models. We identified 4 randomized and 7 nonrandomized studies involving 2941 eyes. The diameter of capsulotomy and the rates of anterior capsule tear showed no statistically difference between FSL group and manual group (MD=0.03; 95%CI, -0.03 to 0.09, P=0.31), and (OR=1.40; 95%CI, 0.28 to 6.97, P=0.68) respectively. In terms of the circularity of capsulotomy, FSL group had a more significant advantage than the manual CCC group (MD=0.09; 95%CI, 0.05 to 0.12, P<0.0001). Our Meta-analysis shows that FSL can perform a capsulotomy with more precision and higher reliability than manual CCC. The results in diameter of capsulotomy and the rate of anterior capsule tears was no significant difference between FSL and manual CCC groups. However in terms of circularity, the FSL was superior to the manual procedure.

Anterior capsulotomy with a pulsed-electron avalanche knife

To evaluate a new pulsed-electron avalanche knife design for creating a continuous curvilinear capsulotomy (CCC) and compare the CCC with a mechanical capsulorhexis. Department of Ophthalmology, Stanford University, Stanford, California, USA. In this study, CCCs were created in freshly enucleated bovine eyes and in rabbit eyes in vivo. The cutting velocity was adjusted by controlling the burst repetition rate, voltage amplitude, and burst duration. Tissue samples were fixed and processed for histology and scanning electron microscopy (SEM) immediately after surgery. The study included 50 bovine eyes and 10 rabbit eyes. By adjusting the electrosurgical waveforms, gas-bubble formation was minimized to permit good surgical visualization. The optimum voltage level was determined to be +/-410 V with a burst duration of 20 mus. Burst repetition rate, continuously adjustable from 20 to 200 Hz with footpedal control, allowed the surgeon to vary linear cutting velocity up to 2.0 mm/s. Histology and SEM showed that the pulsed-electron avalanche knife produced sharp-edged capsule cutting without radial nicks or tears. The probe of the pulsed-electron avalanche knife duplicated the surgical feel of a 25-gauge cystotome and created a histologically smooth capsule cut. It may improve precision and reproducibility of creating a CCC, as well as improve its proper sizing and centration, especially in the face of surgical risk factors, such as weak zonules or poor visibility. Drs. Palanker and Vankov hold patents to the pulsed electron avalanche knife technology, which are licensed to PEAK Surgical by Stanford University. Drs. Palanker and Chang are consultants to PEAK Surgical. Dr. Vankov is an employee of PEAK Surgical. Neither of the other authors has a financial or proprietary interest in any material or method mentioned.

Late anterior traumatic subluxation of a circular in-the-bag intraocular lens associated with lack of posterior capsule opacification

We report a case of traumatic subluxation of a circular poly(methyl methacrylate) intraocular lens (IOL) 5 years after surgery. Slitlamp examination revealed the lack of epithelial cells or fibrosis in the intact capsule bag. Trauma was minor, and no other complication was found in the eye and orbit. The subluxated IOL was easily relocated in the bag with a hook, revealing the poor capsule sealing. Among the factors ensuring the fixation of IOLs placed in the bag after continuous curvilinear capsulotomy are sealing of the anterior and posterior capsules and proliferation of epithelial cells from the equator of the bag.

Posterior chamber intraocular lens dislocation with the bag

We report a rare case of a 46-year-old man presenting with a luxation of a posterior chamber intraocular lens (IOL) with the capsular bag after ocular contusion. Preoperative axial length was 36.58 mm. After trauma, pars plana extraction of the dislocated IOL inside the capsular bag was performed using a forceps. Capsular fibrosis had probably weakened the zonules, which were ruptured by the trauma. This observation confirms the necessity of a large continuous curvilinear capsulotomy and meticulous cleaning of the anterior and posterior capsules to minimize postsurgical fibrosis and capsule contraction.

Bimanual technique to manage subincisional cortical material

The aspiration of subincisional cortical material using a standard irrigation/aspiration (I/A) handpiece can be a difficult maneuver in phacoemulsification. Access to the cortex is restricted and made more problematic by an incision carried into clear cornea and a continuous curvilinear capsulotomy. A bimanual technique for I/A has been developed that provides better access to subincisional cortex and improved chamber maintenance during aspiration.

Intraocular pressure change after neodymium:YAG capsulotomy

Purpose: To study intraocular pressure (IOP) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy in eyes that had phacoemulsification, anterior continuous curvilinear capsulotomy, in-the-bag intraocular lens (IOL) implantation, and no apparent communication between the aqueous and vitreous compartments after the Nd:YAG capsulotomy.Setting: Northwest Kansas Eye Clinic, Hays, Kansas.Methods: This study comprised 101 eyes. All patients received one drop of apraclonidine hydrochloride 0.5% (lopidine®) 30 to 60 minutes before and then after Nd:YAG capsulotomy. Intraocular pressure was measured preoperatively before administration of lopidine and at 1 to 3 and 24 hours, 1 week, and 1 month postoperatively.Results: Within 24 hours after the Nd:YAG capsulotomy, no significant IOP elevations occurred. Although there was one case of modest IOP elevation at 1 week postcapsulotomy, none was seen at 4 weeks. There was no relation between change in IOP and number of laser pulses, energy per pulse, or total energy.Conclusion: The results indicate that lack of communication between the aqueous and vitreous compartments with an intact capsulorhexis over the lens optic rim prevented obstruction of the trabecular network by cellular debris or vitreous. This, coupled with the reduction in aqueous formation by lopidine, prevented significant IOP elevation. In patients meeting the study criteria, routine IOP measurements 1 to 3 hours and 1 day after capsulotomy may not be necessary.

Endothelial morphological and functional evaluation after cataract surgery.

To assess endothelial barrier function, morphological appearance and corneal thickness three months after cataract surgery in order to evaluate intraoperative endothelial damage. Endothelial permeability was examined by fluorophotometry, and contact specular microscopy and corneal pachymetry measurements were made in 40 patients (40 eyes) with senile, non-complicated cataracts one month before and three months after cataract surgery. Twenty eyes underwent uneventful phacoemulsification (Group 1) and 20 uneventful extracapsular cataract extraction (ECCE) with continuous curvilinear capsulotomy (Group 2). Results were analyzed using the two-tailed Student's t test, analysis of variance, and multifactorial and regression analysis. There was a significant postoperative increase in endothelial permeability in both groups (p < 0.001), but no real differences between the postoperative values (p = 0.07). Mean cell loss was 15.2% in ECCE and 18.3% in phacoemulsification (p = 0.4). There was a significant linear correlation between ultrasound time, cell loss and functional damage. Postoperative pachymetric measurements were not significant. Endothelial response showed no differences between the surgical techniques. Endothelial barrier function remained disturbed in spite of the apparent morphological stabilization. Corneal pachymetry is not useful for assessing postoperative endothelial changes.

Long-term decentration of intraocular lenses implanted with envelope capsulotomy and continuous curvilinear capsulotomy: A comparative study

Intraocular lens (IOL) decentration was studied in a series of 569 consecutive eyes that had extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation. In 383 of the eyes, an envelope capsulotomy (EC) was performed; in 186, a continuous curvilinear capsulotomy (CCC). In 33 eyes, the anterior capsule had one radial tear that reached the lens equator. In all eyes, IOL decentration was determined more than six months after surgery. Mean IOL decentration was 0.42 ± 0.02 mm in the EC eyes and 0.27 ± 0.01 mm in the CCC eyes (P < .001). In the CCC eyes, mean IOL decentration was 0.23 ± 0.02 mm when the anterior capsule had no tears and 0.42 ± 0.06 mm when it had one radial tear (P < .01). In the EC eyes, mean decentration was less with lenses with a total diameter of 11.0 mm or less and 360 degree circular loops (compressible disc and circular openloop lenses) than with C- and J-loop lenses with a total length of 13.5 mm to 14.0 mm. With the C- and J-loop lenses in all three capsulotomy groups, mean decentration was related to the presence and number of tears in the anterior capsule: 0.58 mm in the EC eyes, 0.41 mm in the CCC with tear eyes, and 0.23 mm in the CCC without tear eyes. A similar relationship was seen with the bag-implanted lenses: 0.48 mm in the EC eyes, 0.28 mm in the CCC with tear eyes; 0.22 mm in the CCC without tear eyes.

Behaviour of Intraocular Lenses Implanted after Capsulorhexis and Envelope Capsulotomy. PART I: Postoperative IOL Displacement

OBJECTIVE:To evaluate postoperative variation in loop situation and postoperative intraocular lens (IOL) displacement, i.e. the difference between early and late decentration and correlations with the type of capsulotomy, presence of tears in the anterior capsule, loop situation and type of IOL. STUDY DESIGN: Prospective study. The patients were examined in the first postoperative week and 6 months later. SETTING: Patients from the Red Cross Hospital and private patients of the senior author. PATIENTS: Patients operated on for extracapsular cataract extraction (ECCE) with posterior chamber IOL implantation. Envelope capsulotomy was performed in 147 eyes and capsulorhexis in 156 eyes. MAIN OUTCOME MEASURES: IOL decentration in relation to the centre of the cornea was measured in the first postoperative week and 6 months later. Gonioscopy was performed at the same time to determine the loop situation. RESULTS: Mean IOL displacement was −0.01 mm in the continuous curvilinear capsulotomy group without tears of the anterior capsule, −0.11 mm when there were tears in the anterior capsule and −0.19 mm in the envelope group (P < 0.01 between the capsulorhexis group without tears and the envelope group). With regard to the loop situation, mean postoperative IOL displacement was −0.02 mm for in-the-bag lenses and −0.73 for asymmetrically implanted lenses (P < 0.001). In the envelope capsulotomy group, 79% of the lenses were in-the-bag in the first postoperative week; of these 70% were still there 6 months later. In the capsulorhexis group with tears 86% were in-the-bag in the first week; of them 80% were still there at the sixth month. In the capsulorhexis group without tears 98% of the lenses were in-the-bag in the first week and all of them were still there 6 months later. CONCLUSIONS: The most important single factor affecting postoperative IOL stability was the absence of radial tears in the anterior capsule. This prevents the loops of the lens coming out of the bag, the cause (increased by postoperative fibrosis) of IOL displacement. In consequence, continuous curvilinear capsulotomy is the best capsulotomy technique, providing a perfect lens stability.