Effect of anterior capsule polishing on posterior capsule opacification and neodymium:YAG capsulotomy rates: Three-year randomized trial
Accepted 13 March 2005.
Purpose
To compare the long-term effect of extensive polishing and nonpolishing of the anterior lens capsule on posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates.
Setting
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Methods
This prospective randomized bilateral double-masked study included 108 eyes of 54 consecutive patients with age-related cataract. Following phacoemulsification, 3-piece intraocular lenses (IOLs) with round-edged silicone optics were implanted. Patients received an Allergan SI-40 IOL with a truncated, round optic edge or a Domilens Silens6 IOL with a fully round optic edge. Patients were randomly assigned to have extensive anterior capsule polishing with the Menapace aspiration curette or no treatment in the first eye; the second eye received the opposite treatment. Digital retroillumination images were taken at 1 week, 1 year, and 3 years, and Nd:YAG capsulotomy rates were evaluated. Posterior capsule opacification was objectively scored using automated image analysis software (AQUA) or estimated based on clearly defined assumptions if a capsulotomy had been performed.
Results
Thirty-nine patients (78 eyes) concluded the study. Three-year PCO scores after polishing did not differ significantly (P>.05). However, 21 polished eyes (53.8%) required Nd:YAG laser capsulotomy compared with 14 nonpolished eyes (35.9%). The mismatch between PCO scores and Nd:YAG rates resulted from a change in PCO morphology that is not detected by scoring methods based on retroillumination photography but is visually disturbing to patients.
Conclusions
Polishing the anterior capsule was effective in reducing fibrotic opacification but ineffective in reducing regeneratory opacification. Changes in regeneratory PCO morphology not picked up by retroillumination photography increased the need for Nd:YAG laser capsulotomy.
From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
Reprint requests to Rupert Menapace, MD, University of Vienna Medical School, Department of Ophthalmology, Währinger Gürtel 18-20, 1090 Wien, Austria.
Presented in part at the XXIst Congress of the European Society of Cataract and Refractive Surgeons, Munich, Germany, 2003.
No author has a financial or proprietary interest in any method or material mentioned.
ABSTRACT