Microsurgical Treatment of the Posterior Capsule Opacification

Overview

Purpose:
To evaluate irrigation/aspiration and posterior capsulectomy in thetreatment of the posterior capsule opacification (PCO).Setting: Department of Ophthalmology, School of Medicine, Comenius University,Bratislava, Slovakia.Material and methods: Between 1. 1. 1999 and 31. 7. 2000 we treated 75 patients(79 eyes) for PCO. Cataract surgery was performed in the years 1990-1999. Theartificial intraocular lens (IOL) was implanted in 62 eyes. The interval betweencataract surgery and PCO surgery ranged from 4 m. - 10 y. The regenerative typeof PCO was present in 41, fibrotic in 23 and combined in 15 eyes. Irrigation/aspiration (I/A) was performed in 44 eyes. Capsulectomy with a vitrectomy probe wasperformed in 35 eyes. I/A procedure was 42x performed with a bimanual system.Capsulectomywasperformedin combinations of various insertions of the infusion line (without, anterior chamber maintainer - AChM,pars plana) andcapsulectomy(limbal or pars plana approach). It was evaluated: occurence of peri- and postoperative complications; achieved best corrected visual acuity.Results: Complications during I/A: posterior capsule tearing with vitreous prolaps4x, IOL subluxation 3x, partial zonular dialysis 2x - 1x with vitreous prolaps.During capsulectomy performed through the limbus was observed vitreous prolaps in two eyes. After capsulectomy, performed through pars plana withoutinfusion line, was observed the chronical corneal oedema in one eye. The bestcorrected visual acuity improved for 2 and more lines in 79,5 % of eyes after I/Aprocedure and in 74,3 % of eyes after capsulectomy. The achieved visual acuitylower then6/60 wascausedbychanges not related to the cataract andPCOsurgery.After testing of various combinations, the most suitable capsulectomy proceduresemms to be: infusion line through the limbus, capsulectomy through the radialscleral tunnel incision. In this fashion it is possible to performe the procedure asno-stitch surgery.Conclusions: Instead of possibility of occurence of various peri- and postoperativecomplication after I/A and capsulectomy used for treatment of PCO these procedures complete possibilities in the treatment of PCO. For the regenerative typeof PCO is suitable I/A procedure. For the fibrotic type of PCO is suitable capsulectomy through pars plana with AChM. By this procedure it is possible to removealso nearly all vitreous opacities.

Key words:
opacification of the posterior capsule, microsurgical treatment