Three-dimensional assessment of posterior capsule–intraocular lens interaction with and without primary posterior capsulorrhexis: an intraindividual randomized trial

Abstract

Purpose To assess the morphologic and clinical features of posterior capsule-intraocular lens (IOL) interaction following cataract surgery with and without primary posterior continuous curvilinear capsulorrhexis (PPCCC) at a three-dimensional (3-D) level using Scheimpflug imaging. Methods This prospective intraindividual randomized comparative study comprised 56 patients (112 eyes) with age-related cataract who had bilateral cataract surgery and hydrophobic acrylic IOLs implantation. In randomized order, cataract surgery with PPCCC was performed in 1 eye (PPCCC group), and the posterior capsule was left intact in the fellow eye (NPCCC group). Scheimpflug imaging containing 25 images distributed in 360° was taken 1 day, 1 week, 1 month, and 3 months postoperatively. Results 46 patients completed 3 months follow-up. Posterior capsule–IOL interaction can be morphologically classified into two types including complete adhesion and floppy shape in PPCCC group, and six types including full area wave, full area flat, concentric ring wave, concentric ring flat, sector, and complete adhesion in NPCCC group. The adhesion index (AI), defined as the proportion of complete adhesion of posterior capsule–IOL in 25 cross-section tomograms, was 0.45 ± 0.45, 0.79 ± 0.37, 0.92 ± 0.26 and 1.00 ± 0.00 in PPCCC group, while 0.05 ± 0.18, 0.41 ± 0.47, 0.87 ± 0.34, and 0.96 ± 0.21 in NPCCC group at 1 day, 1 week, 1 month and 3 months postoperatively, respectively (p = 0.001, 0.001, 0.338 and 0.151). Conclusions 3-D Scheimpflug imaging was favorable in observing of posterior capsule–IOL interaction. Faster posterior capsule adhesion to the IOL was found in PPCCC group than in NPCCC group.

Intraocular lens tilt and decentration after cataract surgery with and without primary posterior continuous curvilinear capsulorhexis

“…[23][24][25] Given our previous results that observed an earlier and firmer adhesion between the IOL optic and the posterior capsule in PPCCC eyes, we conjecture that PPCCC may lead to better IOL stability resulting from the earlier and firm capsule-IOL complex formation. 13 Similarly, Kim et al pointed out that IOL displacement attributable to capsular contraction was B: Comparison of the mean internal tilt between the PPCCC group and the NPCCC group at 1 day, 1 week, 1 month, and 3 months. NPCCC = no posterior continuous curvilinear capsulorhexis; PPCCC = primary posterior continuous curvilinear capsulorhexis reduced when cataract surgery involved PPCCC; however, in contrast with our results, no significant between-group difference in IOL decentration was found.…”

“…6,7 In our previous study, we found earlier optic-posterior capsular adhesion and good axial stability in eyes with PPCCC. 13 Therefore, we proposed that PPCCC might provide better IOL centration to lessen aberrations and improve visual quality. In this prospective intraindividual study, we evaluated IOL tilt and decentration and their effects on HOAs after cataract surgery with and without PPCCC based on a 1-piece 360-degree square-edge acrylic IOL, which might become the most popular design mode of the premium IOL in the future.…”

“…[15][16][17] In our previous study, we found that PPCCC resulted in earlier IOL optic-posterior capsule adhesion and better axial stability with implantation of 1-piece 360-degree square-edged hydrophobic IOL. 13 At 1 week postoperatively, 71.74% of eyes in the PPCCC group were observed to have complete adhesion between IOL optic and posterior capsule vs 34.78% in the control group. However, few studies have further investigated IOL performance and malposition in the process of capsular reconstruction after cataract surgery with PPCCC, and, to our knowledge, no pair-eye clinical study has assessed IOL tilt, decentration, and consequent visual quality after cataract surgery with PPCCC.…”

“…Some of these data from this cohort were published previously. 13 The patients of 2 studies were from the same consecutive patient series but enrolled by different inclusion criteria, where only patients with implantation of the TECNIS ZCB00 IOL in both eyes were enrolled in this study for eliminating the potential effect of IOL design. All data in this study, except for a portion of the demographics and visual acuity, have not been published elsewhere.…”

Primary Posterior Continuous Circular Capsulorhexis without the Use of Ophthalmic Viscosurgical Device

“… 5 , 6 Yu et al, using Scheimpflug imaging, also observed faster postoperative posterior capsule adhesion to the IOL and stabilization in eyes with PPCCC than in the control group, without PPCCC. 7 …”