Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: Report of 500 consecutive cases
Accepted 16 April 2005.
Refers to erratum:
Erratum
Journal of Cataract & Refractive Surgery
September 2006 (Vol. 32, Issue 9, Page 1410) Full Text |
Full-Text PDF (27 KB)
Purpose
To study the efficacy of posterior optic buttonholing (POBH) through a primary posterior capsulorhexis (PPCCC) to preserve full capsular transparency, and its potential as a routine alternative to standard in-the-bag implantation of sharp-edged optic intraocular lenses (IOLs).
Setting
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Methods
After standard cataract removal, a PPCCC 4.0 to 5.0 mm in diameter was performed and the optic of a 3-piece IOL buttonholed posteriorly. One third of the eyes additionally had extensive anterior capsule polishing. All surgeries were performed under topical anesthesia.
Results
The first 500 consecutive surgeries were evaluated. In 11 eyes, POBH was not performed as planned. In 4 cases, anterior capsulorhexis fixation of the optic was used as an alternative. In the early series, vitreous entanglement was seen in 5 eyes, of which 1 case prompted translimbal anterior vitrectomy. No case of cystoid macula edema was observed. One case of peripheral retinal detachment in a highly-myopic eye 4 months postoperatively appeared to be unrelated to the surgery. All lenses were well-centered without tilt, and both capsule leaves remained clear especially after additional polishing.
Conclusion
Posterior optic buttonholing precludes lens epithelial cells from accessing the retrolental space. The sandwiched posterior capsule blocks optic contact and thus fibrosis of the anterior capsule. Posterior optic buttonholing avoids after-cataract independent of optic edge design. Anterior capsule polishing adds to its efficacy by excluding any residual fibrosis. Surgery under topical anesthesia was well-controlled and safe. Posterior optic buttonholing may become a routine alternative to standard in-the-bag IOL implantation when supported by a longer follow-up.
From the Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
Reprint requests to Prof. Rupert Menapace, MD, University of Vienna Medical School, Department of Ophthalmology, Währinger Gürtel 18-20, 1090 Wien, Austria.
The author has no financial or proprietary interest in any material or method mentioned.
ABSTRACT