J Korean Ophthalmol Soc.  2009 Sep;50(9):1341-1347. 10.3341/jkos.2009.50.9.1341.

Pars Plana Vitrectomy Combined With Surgical Removal of Anterior and Posterior Capsular Opacity

• Sun HJ
• Choi KS
• Lee SJ

• KMID: 2212617
• DOI: http://doi.org/10.3341/jkos.2009.50.9.1341

Abstract

PURPOSE
To evaluate the efficacy and intraocular lens (IOL) stability of vitrectomy combined with the surgical removal of anterior capsular opacity (ACO) and posterior capsular opacity (PCO). METHODS: Forty-four pseudophakic eyes of 43 patients with retinal disorders underwent vitrectomy with surgical removal after cataract diagnosis. Nineteen eyes of 19 patients (group 1) had ACO and PCO removed while 25 eyes of 24 patients (group 2) had only PCO removed. Total removal of the entire lens capsule, except for the area around the haptics, was performed when capsular opacity with fibrosis was observed around the capsulorrhexis margin. LogMAR best corrected visual acuity (BCVA), intraoperative complications and postoperative complications were compared. RESULTS: The retina was flat and postoperative BCVA improved in both groups. Intraoperative complications of IOL dislocation occurred in 3 eyes (15.8%) in group 1 and in 1 eye (4.0%) in group 2 (p=0.178). Among the 4 IOLs, 3 were open-loop haptic IOLs and 1 was a closed-loop haptic IOL. Late postoperative complications of IOL capture occurred in 1 eye (5.3%) in group 1. CONCLUSIONS: Removal of ACO and PCO for better visualization of the peripheral retina resulted in an improved visual recovery while intraoperative complications and postoperative complications were comparable to PCO removal alone. Removal limited to the optic zone would be more stable when considering any adhesion between the lens capsule and the IOL.

Keyword

After cataract; Anterior capsular opacity; IOL stability; Posterior capsular opacity; Vitrectomy

MeSH Terms

Capsulorhexis
Cataract
Dislocations
Eye
Fibrosis
Humans
Intraoperative Complications
Lenses, Intraocular
Postoperative Complications
Retina
Retinaldehyde
Visual Acuity
Vitrectomy
Retinaldehyde

Figure

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  Figure 1. Anterior segment photograph of a patient with anterior and posterior capsular opacity showing a dense fibrotic change around the contractured capsulorrhexis margin.

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  Figure 2. Surgical removal of anterior capsular opacity (ACO). (A) A broad ACO was seen preoperatively. (B) One half of the anterior capsule was cut using a bent 26G needle after confirming the degree of adhesion between the lens capsule and the IOL. (C) Another half was cut from the opposite side. (D) Then, the anterior capsule was removed through the corneal entry site. After ACO removal, the posterior capsular opacity was removed with vitreous cutter.

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  Figure 3. Intraocular lens (IOL) stability depending on the IOL type. Anterior and posterior capsular opacity in a 3 piece open-loop haptic IOL (A) and a single piece closed-loop haptic IOL (B). The postoperative photograph of closed-loop haptic IOL seems to be more stable with its wide haptic portion (D) than the open-loop haptic IOL (C). The arrows indicate the remnant lens capsule at the hapatic portion.

Reference

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