Pars Plana Vitrectomy Combined With Surgical Removal of Anterior and Posterior Capsular Opacity

Hae Jung Sun; Kyung Seek Choi; Sung Jin Lee

doi:10.3341/jkos.2009.50.9.1341

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Sun, Choi, and Lee: Pars Plana Vitrectomy Combined With Surgical Removal of Anterior and Posterior Capsular Opacity

Original Article

J Korean Ophthalmol Soc 2009;50(9):1341-1347.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1341

Pars Plana Vitrectomy Combined With Surgical Removal of Anterior and Posterior Capsular Opacity

Hae Jung Sun, MD, Kyung Seek Choi, MD, PhD, Sung Jin Lee, MD, PhD

Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Sung Jin Lee, MD, PhD Department of Ophthalmology, Soonchunhyang University Hospital #22 Daesaguan-gil, Yongsan-gu, Seoul 140-743, Korea Tel: 82-2-709-9354, Fax: 82-2-798-7797, E-mail: wismile@unitel.co.kr

Received 9 March 2009 Accepted 9 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy and intraocular lens (IOL) stability of vitrectomy combined with the surgical removal of anterior capsular opacity (ACO) and posterior capsular opacity (PCO).

Methods

Forty-four pseudophakic eyes of 43 patients with retinal disorders underwent vitrectomy with surgical removal after cataract diagnosis. Nineteen eyes of 19 patients (group 1) had ACO and PCO removed while 25 eyes of 24 patients (group 2) had only PCO removed. Total removal of the entire lens capsule, except for the area around the haptics, was performed when capsular opacity with fibrosis was observed around the capsulorrhexis margin. LogMAR best corrected visual acuity (BCVA), intraoperative complications and postoperative complications were compared.

Results

The retina was flat and postoperative BCVA improved in both groups. Intraoperative complications of IOL dislocation occurred in 3 eyes (15.8%) in group 1 and in 1 eye (4.0%) in group 2 (p=0.178). Among the 4 IOLs, 3 were open-loop haptic IOLs and 1 was a closed-loop haptic IOL. Late postoperative complications of IOL capture occurred in 1 eye (5.3%) in group 1.

Conclusions

Removal of ACO and PCO for better visualization of the peripheral retina resulted in an improved visual recovery while intraoperative complications and postoperative complications were comparable to PCO removal alone. Removal limited to the optic zone would be more stable when considering any adhesion between the lens capsule and the IOL.

Keywords: After cataract, Anterior capsular opacity, IOL stability, Posterior capsular opacity, Vitrectomy

References

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Figure 1.

Anterior segment photograph of a patient with anterior and posterior capsular opacity showing a dense fibrotic change around the contractured capsulorrhexis margin.

Figure 2.

Surgical removal of anterior capsular opacity (ACO). (A) A broad ACO was seen preoperatively. (B) One half of the anterior capsule was cut using a bent 26G needle after confirming the degree of adhesion between the lens capsule and the IOL. (C) Another half was cut from the opposite side. (D) Then, the anterior capsule was removed through the corneal entry site. After ACO removal, the posterior capsular opacity was removed with vitreous cutter.

Figure 3.

Intraocular lens (IOL) stability depending on the IOL type. Anterior and posterior capsular opacity in a 3 piece open-loop haptic IOL (A) and a single piece closed-loop haptic IOL (B). The postoperative photograph of closed-loop haptic IOL seems to be more stable with its wide haptic portion (D) than the open-loop haptic IOL (C). The arrows indicate the remnant lens capsule at the hapatic portion.

Table 1.

Demographics of the patients

	Group 1 (n=19)	Group 2 (n=25)	p value
Age (years)	59.21±13.15	64.04±8.66	0.103
F/U (months)	12.05±14.75	13.56±18.14	0.424
Preop logMAR VA	1.53±1.08	1.38±1.06	0.796
Postop logMAR VA	0.74±0.39	0.95±0.81	0.043^∗
Proliferative diabetic retinopathy	12 (63.2%)	14 (56.0%)	0.632
Macular hole	2 (10.5%)	6 (24.0%)	0.251
Epiretinal membrane	2 (10.5%)	3 (12.0%)	0.879
Rhegmatogenous retinal detachment	2 (10.5%)	2 (8.0%)	0.773
Vitreous opacity	1 (5.3%)	0 (0%)	0.246
Gas tamponade	10 (52.6%)	16 (64.0%)	0.447
Scleral buckling/encircling	4 (21.1%)	5 (20.0%)	0.932

Group 1=Removal of both anterior and posterior capsular opacity; Group 2=Removal of posterior capsular opacity only.

^∗ Statistical significance by t-test, p<0.05.

Table 2.

Types of implanted IOLs

		Group 1 (n=19)	Group 2 (n=25)
1 piece IOL	570C (Rayner)	8 (1^∗)	9
	604A (Rayner)	2	1
3 piece IOL	AR40e (Advanced Medical Optics)	7 (1^∗)	12 (1^∗)
	Silens6 (Bausch & Lomb)	1 (1^∗)	2
	SI40NB (Advanced Medical Optics)	1	1

Group 1=Removal of both anterior and posterior capsular opacity; Group 2=Removal of posterior capsular opacity only.

^∗ No of dropped IOL.

Table 3.

Intra- and postoperative complications

Complications		Group 1 (n=19)	Group 2 (n=25)	p value
Intraoperative	IOL dislocation	3 (15.8%)	1 (4.0%)	0.178
	Corneal epithelial peeling	0 (0.0%)	2 (8.0%)	0.317
Postoperative	Corneal edema	2 (10.5%)	9 (36.0%)	0.054
	IOL capture	1 (5.3%)	none	0.246

Group 1=Removal of both anterior and posterior capsular opacity; Group 2=Removal of posterior capsular opacity only.

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