Phacoemulsification in posterior polar cataract: does size of lens opacity affect surgical outcome?

BACKGROUND: To study the effect of size of the posterior polar opacity on surgical and visual outcome of phacoemulsification in posterior polar cataract. SETTING: Post Graduate Institute of Medical Education and Research, Chandigarh, India. METHODS: Consecutive patients with posterior polar cataract who underwent phacoemulsification were analysed for intraoperative complications and postoperative outcome. The continuous curvilinear capsulorhexis size was kept approximately 5.5 mm, and hydrodelineation was done instead of hydrodissection. RESULTS: There were 58 eyes of 51 patients who underwent phacoemulsification for posterior polar cataract. The mean follow-up time was 15.4 months (range 12-40 months). Twenty-three eyes had size of polar opacities 4 mm or more in diameter whereas 35 eyes had less than 4 mm. Posterior capsule rupture occurred in nine eyes (15.51%). In eyes with polar opacities 4 mm or more, seven (30.43%) had posterior capsule rupture whereas in eyes with less than 4 mm size, only two (5.71%) had posterior capsule rupture. Capsular bag placement of intraocular lens (IOL) was achieved in 50 eyes and sulcus-sulcus in eight eyes. Three-piece hydrophobic acrylic IOL was implanted in 47 eyes and all polymethylmethacrylate IOL in 11 eyes. Postoperatively best-corrected visual acuity of 6/12 or better was achieved in 55 eyes (94.8%) and three eyes achieved 6/24 or less. CONCLUSION: Phacoemulsification in eyes with larger size of polar opacity has significant risk of posterior capsule rupture.

Outcome of cataract surgery with primary intraocular lens implantation in children.

AIM: To report the results of paediatric cataract surgery with primary intraocular lens (IOL) implantation. METHODS: Children with congenital or developmental cataract who underwent phacoaspiration with posterior chamber (PC) IOL implantation were retrospectively studied. Group A included children with polymethyl methacrylate, group B hydrophobic acrylic and group C silicone IOLs. Outcome measures were visual axis clarity, visual outcome and refractive changes. RESULTS: There were 230 children (381 eyes) with the age ranging from 1 months to 15 years. Group A comprised 208, group B 144 and group C 29 eyes. Posterior capsule opacification was seen in 38/208 in group A and 21/144 in group B and 4/29 eyes in group C. The mean refractive error at 2 weeks, 1 year and 3 years after cataract surgery in the age group ≤2 years was +3.38±3.07 D (median +3.75 D), +1.72 D±3.19 (median +1 D) and -0.51 D±3.59 (median -0.5 D); in the age group >2-8 years +0.84±3.18 D (median+1.5 D), +0.27 D±3.14 (median +0.5 D) and -0.62 D±2.81(median -0.75D); and in the age group >8 years -0.44±1.73 D (median -0.5 D), -0.70±1.77 D (median -0.75 D) and -0.89 D±1.60 (median -0.75D) respectively. Children ≤2 years had a significant myopic shift (p<0.001). LogMAR visual acuity was ≥0.3 in 62.2% of eyes in bilateral and 30.90% in the unilateral group. CONCLUSIONS: Paediatric cataract surgery with primary PCIOL implantation is safe. Refractive changes and PCO are the main hurdles for achieving optimal visual outcome.

Nd:YAG laser capsulotomy rates following implantation of square-edged intraocular lenses: polymethyl methacrylate versus silicone versus acrylic.

OBJECTIVE: To study the influence of square-edged intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) and the requirement for laser capsulotomy. DESIGN: Retrospective study. PARTICIPANTS: Three hundred seventy-seven eyes of 377 patients were included. METHODS: All these patients underwent phacoemulsification and implantation of square polymethyl methacrylate (PMMA) (Aurolab), silicone (Tecnis Z9000), acrylic hydrophobic (AcrySof MA60AC and Sensar Optiedge), or acrylic hydrophilic (Akreos Adapt) IOLs with a minimum of 2 years' follow-up. Only those cases in which Nd:YAG laser capsulotomy had been performed for visually significant PCO were evaluated. RESULTS: Three hundred seventy-seven eyes of 377 patients were included in the study. Follow-up duration ranged from 24 to 54 (mean 40.27, SD 8.42) months. The incidence of PCO requiring Nd:YAG laser capsulotomy was found to be significantly less in the silicone lens group: 1.4% as compared with an incidence of 11.7% in the PMMA lens group (p = 0.018). In the square-edged acrylic group, visually significant PCO requiring Nd:YAG laser capsulotomy was observed in 3.6%, 4.8%, and 6.8% of eyes implanted with AcrySof MA60AC, Sensar Optiedge, and Akreos Adapt IOLs, respectively. In 5 of the 7 eyes (71.4%) exhibiting PCO in the PMMA group, the condition developed within the first 6 months. In the silicone and acrylic group, development of PCO was delayed. CONCLUSIONS: The rate of visually significant PCO as well as the need for Nd:YAG laser capsulotomy is influenced by IOL biomaterial in addition to square edge. It is significantly delayed with square-edged foldable acrylic and silicone IOLs compared with square-edged PMMA IOLs.