Primary Posterior Continuous Curvilinear Capsulorhexis Research Articles

Influence of posterior capsule abnormalities in pediatric cataract surgery.

To report how to manage posterior capsule abnormalities (PCAs) in pediatric cataracts and evaluate the influence of PCAs during intraocular lens (IOL) optic implantation in Berger space surgeries. Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. Retrospective case series study. Pediatric patients with PCAs who underwent cataract surgery were evaluated. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, types and management of PCAs, complications during primary posterior continuous curvilinear capsulorhexis (PCCC), need for anterior vitrectomy (AV), and feasibility of IOL optic capture. There were 227 pediatric cataract surgeries performed during the study period, and 76 eyes of 66 children with PCAs were evaluated (33.5%, 76/227). Unilateral cataract with PCAs were found in 50 eyes (22.0%, 50/227) and bilateral were found in 26 eyes (11.5%, 26/227). The PCAs were posterior capsule plaque (19.8%, 45/227), posterior capsule defect (6.2%, 14/227), posterior lenticonus (3.1%, 7/227), and persistent fetal vasculature (4.4%, 10/227). In the PCA cases, primary PCCC was successful in 44.7% of the cases (34/76). An unplanned AV during the surgeries was performed in 47.4% (36) of the 76 eyes. IOL optic implantation in Berger space was achieved in 63.2% of the eyes (48/76). PCAs are often encountered during pediatric cataract surgeries, especially in unilateral cases. The presence of PCAs may complicate a primary PCCC procedure, resulting in an unplanned AV in some cases. IOL optic implantation in Berger space can also be performed fortunately with well-designed and skilled operation.

Intraocular Lens Tilt and Decentration after Cataract Surgery with and without Primary Posterior Continuous Curvilinear Capsulorrhexis.

To evaluate intraocular lens (IOL) tilt and decentration and their effects on high-order aberrations (HOAs) after cataract surgery with and without primary posterior continuous curvilinear capsulorrhexis (PPCCC). Fujian Provincial Hospital, Fujian, China. Prospective, intraindividual, randomized, comparative clinical trial. This study enrolled 64 eyes of 32 patients with age-related cataract who underwent bilateral cataract surgery and IOL implantation. In randomized order, all patients had phacoemulsification cataract surgery with PPCCC in one eye (PPCCC group) and routine cataract surgery in the contralateral eye (NPCCC group). IOL decentration, tilt, HOAs, modulation transfer function, and point spread function were measured at 1 day, 1 week, 1 month, and 3 months after surgery using OPD-Scan III. 52 eyes of 26 patients were available for analysis. The mean overall decentration in NPCCC group was significantly higher than in PPCCC group at 3 months (0.302±0.157 mm vs 0.187±0.099 mm, P<0.001). Under 3-mm pupil, internal spherical aberration (SA) 1 day after surgery, and coma 1 week after surgery were lower in PPCCC group compared with NPCCC group (0.15±0.10 μm vs 0.30±0.21 μm, P<0.001, and 0.34±0.18 μm vs 0.47±0.31 μm, P=0.03, respectively). IOL decentration was significantly correlated with ocular and internal coma, ocular and internal SA, and internal HOAs at 5-mm pupil (R=0.083 and R=0.099, R=0.650 and R=0.613, R=0.418, respectively, all P<0.01). Less IOL decentration was observed in PPCCC group at 3 months after surgery, indicating that PPCCC may result in better IOL centrality.

Safety of the bag-in-the-lens implantation regarding the development of clinically significant pseudophakic cystoid macular edema: A retrospective case series study.

To determine the incidence of clinically significant pseudophakic cystoid macular edema (CSPME) after phacoemulsification using the 'bag-in-the-lens' lens (BIL) implantation technique and to examine the influence of associated risk factors for clinically significant pseudophakic macular edema (CSPME), both ocular and systemic. This retrospective study included 2419 first-operated eyes of 2419 adults who underwent phacoemulsification cataract surgery using the BIL implantation technique between January 2013 and December 2018 in the Antwerp University Hospital, Belgium. The significance of several risk factors (age, gender, previous history, intra- and postoperative complications) was examined by extraction of electronic medical files. The 3-month incidence of CSPME in the subgroup without risk factors was 0.00% (95% CI: 0.00 -NA). The 3-month incidence of CSPME in the subgroup with risk factors was 0.57% (95% CI 0.22-1.29%). The 3-month incidence of CSPME in the total population of 2419 patients was 0.29% (95% CI: 0.11-0.65%). The risk factors most significantly associated with CSPME included renal insufficiency (hazard ration [HR]: 5.42; 95% CI: 1.69-17.44; P = .014), exudative age-related macular degeneration (HR: 74.50, 95% CI: 25.75-215.6; P < .001) and retinal vein occlusion (HR: 22.48, 95% CI: 4.55-111.02; P = .005). In the absence of risk factors, the incidence of CSPME was zero. We can conclude that Primary Posterior Continuous Curvilinear Capsulorhexis (PPCCC) does not increase the risk for CSPME. Non-inferiority of the BIL implantation regarding the development of CSPME, relative to the traditional 'lens-in-the-bag' (LIB) implantation, confirms that BIL is a safe surgical technique. This study also illustrates a previously undescribed risk factor for developing CSPME, namely renal insufficiency.

Evaluation of the vitreolenticular interface with intraoperative OCT.

To determine the prevalence of anterior vitreous detachment (AVD) in routine bag-in-the-lens (BIL) cataract cases and possibly to identify risk factors for its presence. University Hospital of Antwerp, Belgium. Prospective cross-sectional study. Patients having routine BIL cataract surgery were included. Patients with traumatic cataract, previous intraocular surgeries, YAG laser treatment, intravitreal injection, or medical conditions that might affect normal ophthalmologic anatomy were excluded. Several parameters were collected from the patients' records, and their surgical videos/photographs/optical coherence tomography were evaluated. 99 eyes of 99 patients were included. Detectable AVD was observed in 62 eyes (63%). AVD was not present in 37 eyes (37%). The difference in prevalence of AVD between men and women was not statistically significant ( P = .55, Pearson χ 2 test). The Mann-Whitney U test for axial length was not statistically significant ( P = .38). However, it was statistically significant for age ( P < .005). A logistic regression model to ascertain the effect of age on the likelihood that patients had AVD did reach statistical significance (χ 2 (1) = 8.246, P < .005). The prevalence of AVD in a routine cataract population was 63%. Age was identified as a risk factor. This study model determined that the odds for AVD increase 5.3% with each year of patient age. These data allowed for better preoperative and postoperative assessment of complications. The BIL, by its mandatory primary posterior continuous curvilinear capsulorhexis, did not increase the risk for postoperative ocular complications in the posterior segment of the eye.

Early-Onset Posterior Capsule Opacification: Incidence, Severity, and Risk Factors.

IntroductionTo evaluate the incidence, severity, and risk factors of early-onset posterior capsule opacification (PCO) following uneventful phacoemulsification and intraocular lens (IOL) implantation.MethodsPatients with cataracts who underwent phacoemulsification and IOL implantation surgery for 3 months from September 2019 to April 2020 were enrolled. All the subjects completed a comprehensive ocular examination. Retroillumination images of the posterior capsule were obtained using a slit lamp with imaging system, and PCO was graded by two ophthalmologists. Univariate and multivariate logistic regression analyses were performed to assess the risk factors for PCO.ResultsA total of 1039 subjects were enrolled, with mean age 66.68 ± 11.43 years and 42.06% were male. The incidence of early-onset PCO in the 3 months after cataract surgery was 29.93%, and PCO of grade 3 and grade 4 was present in 31 patients (2.98%). Patients with complicated cataract had a higher incidence of PCO than age-related cataract, especially for patients with previous pars plana vitrectomy (PPV) surgery (P < 0.001). Moreover, the incidence of PCO increased with the deficiency of capsulorhexis–IOL overlap (P < 0.001). Multivariate logistic regression also showed that previous PPV surgery (OR 2.664, P = 0.003) and incomplete capsulorhexis–IOL overlap were risk factors for PCO (180–360° overlap: OR 2.058, P < 0.001; < 180° overlap: OR 5.403, P < 0.001).ConclusionsLarger capsulorhexis and PPV surgery history contribute to the occurrence of early-onset PCO, indicating that primary posterior continuous curvilinear capsulorhexis can be considered during cataract surgery for patients with PPV history.

Real-time intraoperative OCT imaging of the vitreolenticular interface during pediatric cataract surgery.

To report on the use of intraoperative optical coherence tomography (OCT) imaging of the vitreolenticular interface (VLI) during pediatric cataract surgery and to determine the incidence of VLI dysgenesis and surgical difficulties. Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. Retrospective cohort study. This study included 51 pediatric patients who underwent cataract surgery between April 2016 and December 2018. Video recordings and OCT images of the VLI were analyzed and compared. VLI dysgenesis was considered present when intraoperative OCT images demonstrated partial or total adhesions between the posterior lens capsule and the anterior hyaloid membrane. Video recordings were analyzed to describe surgical difficulties, more specifically: inability to create a calibrated primary posterior continuous curvilinear capsulorhexis (PPCCC), occurrence of vitreous prolapse, need for anterior vitrectomy, and complicated IOL implantation. Of the 51 patients included, VLI dysgenesis was demonstrated in 27 patients (52.9%). The incidence of VLI dysgenesis was greater in children with unilateral cataract (72.4%), and children with a posterior capsule plaque (90%). PPCCC was challenging in 20 patients. A defect of the anterior hyaloid membrane was found in 16 patients. Anterior vitrectomy or cutting vitreous strands with scissors was necessary in 10 patients. Intraoperative OCT images were an excellent tool to evaluate the VLI and to demonstrate the presence of VLI dysgenesis during pediatric cataract surgery. Performing a calibrated PPCCC was more challenging in the presence of VLI dysgenesis. This can subsequently expose a defect in the anterior hyaloid membrane, which may result in vitreous prolapse.

Clinical Outcomes of Primary Posterior Continuous Curvilinear Capsulorhexis in Postvitrectomy Cataract Eyes.

Purpose To evaluate the safety and outcomes of primary posterior continuous curvilinear capsulorhexis (PPCCC) combined with phacoemulsification in postvitrectomy eyes. Design Retrospective case series. Methods Twenty-one postvitrectomy eyes of 21 patients with cataract between April 2017 and December 2019 were enrolled. PPCCC through the cornea incision was performed before in-the-bag intraocular lens implantation. All patients were followed up for at least 3 months postoperatively. The outcome measures were corrected distance visual acuity (CDVA), intraocular pressure (IOP), corneal endothelium cell counts (CECC), central macular thickness (CMT), the occurrence of intraoperative or postoperative complications, and the incidence of posterior capsular opacification (PCO). Results The mean age was 56.14 ± 9.76 years (ranging from 31 to 68). The mean Snellen CDVA was 20/400 preoperatively and improved to 20/67 postoperatively (P < 0.001). No significant differences were found between IOP (P = 0.96) and CMT (P = 0.42) preoperatively and postoperatively. The mean CECC was 2571.8 ± 319.3 cells/mm2 preoperatively and 2498.2 ± 346.3 cells/mm2 postoperatively (P < 0.05). Lens epithelium cells proliferation was confined to the peripheral capsular bag during a mean follow-up of 12.9 ± 10.5 months (ranging from 3 to 28 months). Intraoperative posterior capsule extension occurred in 1 eye (4%), although it did not affect the patient's vision. No serious complications, including retinal detachment or endophthalmitis, were detected in any of the 21 cases. Conclusion PPCCC through cornea incision combined with phacoemulsification may be a safe and practical alternative to prevent PCO in postvitrectomy eyes with cataract.

Clinically significant pseudophakic cystoid macular edema after bag-in-the-lens implantation.

To determine the incidence of clinically significant pseudophakic cystoid macular edema (CSPME) after phacoemulsification using the bag-in-the-lens intraocular lens (BIL IOL) implantation technique and to examine the influence of associated risk factors, both ocular and systemic. Monocentric, Antwerp University Hospital, Belgium. Retrospective. This study included 1 077 first-operated eyes of 1 077 adults who underwent phaco-emulsification cataract surgery using the BIL IOL implantation technique between January 2013 and December 2015. The 3-month incidence of CSPME in the subgroup without risk factors was 0% (95% CI, 0.0-0.0). The 3-month incidence of CSPME in the subgroup with risk factors was 2.8% (95% CI, 1.3-4.3). The 3-month incidence of CSPME in the total group of 1077 patients was 1.4% (95% CI, 0.6-2.1). The risk factors most significantly associated with CSPME included diabetes (hazard ratio [HR]: 5.37; 95% CI, 1.5-19.3; P = .019), exudative age-related macular degeneration (HR: 121; 95% CI, 36.1-409; P < .001), and macular traction (HR: 6.47; 95% CI, 1.9-22.1; P < .009). The incidence of CSPME was zero in eyes without risk factors. The incidence was consistent with previous reports in the literature regarding the lens-in-the-bag IOL implantation technique in eyes with risk factors. This indicates that the BIL IOL implantation technique is a safe procedure and does not confer a higher risk for developing cystoid macular edema after cataract surgery compared with the lens-in-the-bag IOL implantation technique, despite the requirement of a primary posterior continuous curvilinear capsulorhexis.

Ophthalmology Residents' Experience with Complex Cataract Surgery at a VA Hospital over 10 Years

Abstract Objective The purpose of this study was to determine the proportion of complex cataract surgery performed by third-year ophthalmology residents at an academic Veterans Administration Medical Center. Methods A chart review was conducted of all resident cataract surgeries performed at the James J. Peters Veterans Administration Medical Center in The Bronx, NY between July 1, 2007, and June 30, 2017. Correct categorization was confirmed by review of operative report and reason for complex categorization was recorded, as well as the use and type of nonstandard device or technique. Results A total of 2,429 routine and 114 complex cataract surgeries were performed by 40 different residents over the 10-year period. In total, 4.5% of all cataract surgeries were categorized as complex. The most common reasons for complex categorization included intraoperative floppy iris syndrome (35.8%), miosis (38.4%), zonular instability (9.6%), mature cataract (7%), posterior synechiae (7.8%), and posterior capsular plaque (1.8%). Nonstandard techniques/devices included iris hooks (65.3%), pupil expansion device (8.5%), extracapsular cataract extraction (6.8%), synechiolysis (7.6%), mechanical iris dilation (0.8%), capsular tension ring (9.3%), and primary posterior continuous curvilinear capsulorhexis (1.7%). Conclusion A review of third-year resident cataract surgery experience at our institution's VA hospital where a significant amount of their surgical volume, approximately 50%, is obtained revealed that complex cataracts constituted a minimal portion of the cases. Education in cataract surgery should be competency based, extend beyond achieving minimums, and focus on variety and complexity of surgical experience. Formal tracking of routine versus complex cases should be considered to optimize training experience and assure patient safety.

Comparison of posterior optic capture of intraocular lens without vitrectomy vs endocapsular implantation with anterior vitrectomy in congenital cataract surgery: A randomized prospective study.

Purpose:To compare surgical outcome of two procedures in pediatric cataract surgery.Methods:Prospective randomised interventional study. Consecutive patients with bilateral congenital cataract who were operated during January 2016 to October 2016 at a tertiary care referral institute were included. One eye of all patients underwent Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis (PPC) without vitrectomy while in the other eye endocapsular IOL implantation was performed along with PPC and anterior vitrectomy. Intraoperative challenges and postoperative complications were noted.Results:15/18 children who fulfilled the inclusion criteria were included for follow up analysis. Mean age at the time of surgery was 21 ± 14.7 months. At a mean follow up of 25.69 ± 1.06 months; all eyes in both groups maintained a clinically centred IOL with clear visual axis. One patient with endocapsular IOL implantation developed anterior capsular phimosis. The rate of fibrinous complications (IOL deposits and synechiae) were more in the eyes with IOL in the bag (6 eyes) vs eyes where posterior optic capture was done (1 eye); P = 0.039.Conclusion:Posterior optic capture is a safer alternative to conventional pediatric cataract surgery in terms of inflammatory sequelae and lens epithelial cell proliferation. However the two methods work equally well in preventing visual axis obscuration over a long follow-up.

Сравнительная оценка отдаленных результатов выполнения первичного заднего капсулорексиса при псевдоэксфолиативном синдроме

Сравнительная оценка отдаленных результатов выполнения первичного заднего капсулорексиса при псевдоэксфолиативном синдроме

Influence of the vitreolenticular interface in pediatric cataract surgery

To report the status of Berger space in pediatric cataract cases and the influence of anterior vitreolenticular interface dysgenesis during primary posterior continuous curvilinear capsulorhexis (PCCC). Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. Prospective case series. The study comprised consecutive pediatric cataract cases planned for bag-in-the-lens intraocular lens (BIL IOL) implantation. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, presence of a posterior capsule plaque (PCP), presence of anterior vitreolenticular interface dysgenesis, complications during primary PCCC, integrity of the anterior hyaloid membrane, need for anterior vitrectomy, and feasibility of BIL IOL implantation. Abnormalities in Berger space were observed in 35 of the 64 pediatric cataract cases. Anterior vitreolenticular interface dysgenesis was most often found in cases with persistent fetal vasculature (PFV) and those with posterior cataract. Anterior vitreolenticular interface dysgenesis was diagnosed significantly more often in eyes with unilateral cataract and those with PCP. In pediatric cataract cases presenting with PCP and anterior vitreolenticular interface dysgenesis, the primary PCCC procedure was surgically more demanding, often resulting in detectable breaks in the anterior hyaloid membrane (58.6%) and sometimes necessitating an unplanned anterior vitrectomy (13.8%). Bag-in-the-lens IOL implantation was feasible in all except 1 eye with PFV, which was left aphakic. Primary vitreolenticular interface abnormalities are often encountered during pediatric cataract surgeries, especially when confronted with PCP in a unilateral cataract. The presence of anterior vitreolenticular interface dysgenesis may complicate a primary PCCC procedure, resulting in an unplanned anterior vitrectomy in some cases.

Primary posterior capsulotomy in adults with posterior capsule opacification

To evaluate the efficacy and safety of primary posterior continuous curvilinear capsulorhexis (PCCC) in adult patients with cataract. Zagazig University Hospital, Ash-Sharkya, Egypt. Prospective nonrandomized case series. This study comprised patients with senile cataract who had phacoemulsification. All patients had a dense posterior capsule opacification (PCO) discovered intraoperatively. Primary PCCC was performed to remove the residual opacification after posterior capsule polishing. All patients were followed for 3months postoperatively. The outcome measures were corrected distance visual acuity (CDVA), macular edema detected by optical coherence tomography, and the occurrence of intraoperative or postoperative complications. Twenty-five eyes of 25 cataract patients had phacoemulsification. The mean age was 61.9years±7.5 (SD). The mean CDVA preoperatively was 0.14±0.08 and postoperatively it was 0.86±0.15 at 1week, 0.93±0.08 at 1month, and 0.94±0.08 at 3months (P=.001). The mean central macular thickness was 313.16±8.39μm preoperatively and 315.04±10.6μm, 319.88±26.06μm, and 316.4±13.7μm at 1week, 1month, and 3months postoperatively, respectively (P=.35). Posterior capsule opening contracture occurred in 1 eye (4%), although it did not affect the patient's vision. Intraoperative posterior capsule extension occurred in 1 eye (4%). No serious complications, such as retinal detachment or endophthalmitis, were detected in any patient. Cataract surgery with primary PCCC was a safe procedure to treat residual PCO in adults and had a low rate of complications. Neither author has a financial or proprietary interest in any material or method mentioned.

Primary posterior continuous curvilinear capsulorhexis combined with diffractive multifocal intraocular lens implantation.

PurposeTo evaluate the effect of mild posterior capsule opacity (PCO) on visual acuity (VA) in eyes implanted with a diffractive multifocal intraocular lens (IOL) compared with a monofocal IOL, and the effect of posterior continuous curvilinear capsulorhexis (PCCC) combined with diffractive multifocal IOL implantation.MethodsFor the initial evaluation, we compared charge-coupled device (CCD) camera photographs taken through both a monofocal IOL-loaded model eye and a diffractive IOL-loaded model eye under the conditions of both with and without an opaque filter for the simulation of mild PCO. The clinical evaluation involved 20 patients who underwent bilateral implantation of the same diffractive multifocal IOL. In all 20 cases, PCCC was performed in 1 eye (PCCC group) and not performed in the fellow eye (NCCC group). Postoperative clinical results were then compared between the two groups.ResultsThe CCD photographs revealed that the diffractive IOL-loaded eye was more strongly affected by the simulated PCO than was the monofocal IOL-loaded eye. In the clinical setting, the PCCC group registered better results than NCCC group in distance and near VA, low-contrast VA, and contrast sensitivity testing.ConclusionsDiffractive multifocal IOLs tend to be more influenced by mild PCO than do monofocal IOLs, and PCCC prior to IOL implantation can contribute to the avoidance of this effect.

Clinical application of posterior continuous curvilinear capsulorhexis in traumatic cataract surgery

Objective To observe the clinical effect of posterior continuous curvilinear capsulorhexis in traumatic cataract with posterior capsular rupture. Methods Twenty-five 25 eyes of 25 patients were selected as clinical trial group and other 18 eyes of patients as control group. In trial group, traumatic cataract extraction, primary IOL implantation and posterior continuous curvilinear capsulorhexis were performed, while in control group, routine traumatic cataract extracion and IOL implantation were fulfilled. The visual acuity and surgical complications were compared between two groups. The follow-up period was 3 months. Results The differences of surgical complications and IOL position between two groups were statistically significant (P<0.05). Three months after operation, the differences of visual acuity, posterior capsular opacity, cystoid macular edema betweenin two groups were statistically significant (P<0.05). The visual acuity of trial group was better than that of control group, and the incidence rate of surgical complications in control group was higher than that in trial group. Conclusion Posterior continuous curvilinear capsulorhexis can improve the therapeutic effect and prevent surgical complications for traumatic cataract with posterior capsular rupture. Key words: Cataract, traumatic; Capsulorhexis, curvilinear, continuous, posterior

A safe technique for in-the-bag intraocular lens implantation in pediatric cataract surgery.

To describe a safe technique for in-the-bag intraocular lens (IOL) implantation in pediatric cataract patients who undergo lens aspiration with primary posterior capsulorhexis and anterior vitrectomy. Sixty eyes of 45 consecutive patients with congenital/developmental cataract underwent lens aspiration with primary posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy and in-the-bag IOL implantation using the described technique of IOL implantation using anterior capsule as support. All eyes had stable IOL at the end of surgery and none of the eyes had lens decentration/dislocation in posterior vitreous. Implantation of in-the-bag IOL is difficult in children who undergo primary PCCC with anterior vitrectomy. Our technique of implanting IOL by pushing it against the back surface of anterior capsule is a safe method and results in no complications related to faulty IOL implantation.

Clinical outcomes of cataract surgery after bag-in-the-lens intraocular lens implantation following ISO standard 11979-7:2006

To assess the clinical outcomes of bag-in-the-lens intraocular lens (BIL IOL) implantation following the International Organization for Standardization (ISO) 11979-7:2006 in pediatric eyes and eyes with ocular comorbidities. Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. Cohort study. This cohort included the first series of patients having IOL implantation using the bag-in-the-lens technique. Surgeries were performed between December 1999 and September 2006. In addition to IOL implantation, the technique comprised creation of a primary posterior continuous curvilinear capsulorhexis (PCCC) equal in size to the anterior capsulorhexis. The study enrolled 807 eyes of 547 patients; 326 of the eyes (40.40%) had ocular comorbidity. In the 481 eyes without ocular comorbidity, the mean decimal corrected distance visual acuity was 0.52 ± 0.24 (SD) (0.276 ± 0.206 logMAR) preoperatively and 0.94 ± 0.18 (-0.012 ± 0.053 logMAR) postoperatively. The mean postoperative achieved spherical equivalent was 0.48 ± 0.83 diopter (D) and the mean targeted refraction, -0.24 ± 0.71 D. The A-constant was modified from 118.4 to 118.04. Posterior capsule opacification (PCO) did not occur in any adult eye during the follow-up. Retinal detachment after IOL implantation occurred in 10 eyes (1.24%). In 19 eyes, the iris was captured by the IOL haptics postoperatively. Hypopyon occurred in 3 patients and toxic anterior segment syndrome in 1 patient. The BIL IOL met the ISO criteria; that is, primary PCCC was safe in healthy eyes and in eyes with ocular comorbidities and no eye developed PCO over a mean follow-up of 26.1 ± 21.3 months.

Safety of the anterior vitreous detachment induced by microplasmin, pharmacologic vitreolysis to separate the posterior capsule from the anterior hyaloid

Abstract Purpose The aim of this project is to establish the safety of the use of microplasmin in the vitreolenticular interface to promote the separation of the anterior hyaloid from the posterior capsule. Methods The safety of the use of microplasmin solution will be examined in 24 eyes of 12 rabbits after having performed a cataract surgery and a primary posterior continuous curvilinear capsulorhexis and having exposed the anterior hyaloid interface with a solution of different doses of microplasmin (125µg or 250µg in 0.1ml balanced salt solution)and having left this solution in place during different time intervals starting from 5 minutes to one hour. The rabbit eyes will be examined at well‐defined time intervals: day 1 and 7, month 1,2,3,6 and 12. Slitlamp examination and OCT‐SLO imaging will be performed to monitor ocular inflammation, visual axis reproliferation and anterior vitreous anatomy. Conclusion Congenital cataracts, whether or not combined with persistent fetal vasculature may present different degrees of congenital dysgenesis of the vitreolenticular interface. Pharmacological separation of the interface between posterior lens capsule and anterior hyaloid would be benificial to improve the surgical outcome. Therefore the feasibility, safety and clinical application of intravitreal injection of microplasmin for this indication need to be examined first.

Macular Thickness Changes after Phacoemulsification Combined with Primary Posterior Curvilinear Capsulorhexis

To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC). Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months. Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema. Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.

Effect of primary posterior continuous curvilinear capsulorhexis with and without posterior optic buttonholing on postoperative anterior chamber flare

To evaluate the effect of primary posterior continuous curvilinear capsulorhexis (PCCC) with and without posterior optic buttonholing (POBH) on the anterior chamber reaction after small-incision cataract surgery. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Consecutive patients with age-related cataract having cataract surgery in both eyes under topical anesthesia were prospectively enrolled in a randomized clinical trial. In randomized order, cataract surgery with combined primary PCCC and POBH was performed in 1 eye; in the other eye, cataract surgery was performed with primary PCCC and in-the-bag implantation of an intraocular lens. Intraocular flare was measured with an FC-1000 laser flare-cell meter preoperatively and postoperatively at 1, 4 to 6, and 24 hours, 1 week, and 1 month. Thirty patients (60 eyes) were evaluated. The peak of intraocular flare was 1 hour postoperatively in all study eyes. In both groups, the response steadily decreased thereafter. Anterior chamber flare was statistically significantly higher in eyes with primary PCCC without POBH than in eyes with combined primary PCCC-POBH at all postoperative testing points (P<.001), including at 1 month (P = .01). Cataract surgery with combined primary PCCC-POBH led to significantly lower postoperative anterior chamber reaction than conventional in-the-bag implantation during a 4-week follow-up. The tight capsule-optic diaphragm effectively prevented the ophthalmic viscosurgical device captured behind the optic from entering the anterior chamber postoperatively.