Incidence of Posterior Capsular Opacification Based on Low and High Fluid-dynamic Parameters

Yun Hyup Na; Joo Youn Shin; Jong Hyun Lee; Jin Hyoung Kim; Do Hyung Lee

doi:10.3341/jkos.2016.57.10.1555

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Na, Shin, Lee, Kim, and Lee: Incidence of Posterior Capsular Opacification Based on Low and High Fluid-dynamic Parameters

Original Article

J Korean Ophthalmol Soc 2016;57(10):1555-1562.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1555

Incidence of Posterior Capsular Opacification Based on Low and High Fluid-dynamic Parameters

Yun Hyup Na, MD, Joo Youn Shin, MD, Jong Hyun Lee, MD, PhD, Jin Hyoung Kim, MD, PhD, Do Hyung Lee, MD, PhD

Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Address reprint requests to Do Hyung Lee, MD, PhD Department of Ophthalmology, Inje University Ilsan Paik Hospital, #170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea Tel: 82-31-910-7240, Fax: 82-31-911-7241 E-mail: eyedr0823@hotmail.com

Received 16 June 2016 Accepted 28 September 2016

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 compare the incidence of posterior capsular opacification (PCO) based on low and high fluid-dynamic parameters during cataract surgery and evaluate the importance of these findings.

Methods

This retrospective study included 125 eyes in 73 patients with senile cataract who received a cataract surgery between September 2013 and March 2014. Patients were divided into 2 groups: those with low (vacuum: 180 mm Hg, aspiration flow: 18 mL/min, bottle height: 55 cm) and high (vacuum: 400 mm Hg, aspiration flow: 22 mL/min, bottle height: 90 cm) fluidic parameters during the nucleus was removal. We measured the total surgery time, ultrasound time, and balanced salt solution consumption during phacoemulsification. Best corrected visual acuity (BCVA), PCO score, PCO percentage and severity were measured at 3, 6 and 12 months postoperatively. Endothelial cell density (ECD) was measured preoperatively and 12 months postoperatively.

Results

The study included 20 eyes of 13 patients with low parameters and 20 eyes of 15 patients with high parameters. There was no statistically significant difference in the mean total surgery time, ultrasound time or fluid consumption between the two groups. BCVA and ECD were not significantly different between the two groups during the postoperative follow-up. PCO score, percentage and severity were higher in the low parameter group at 3, 6 and 12 months postoperatively.

Conclusions

Surgery with low fluid-dynamic parameters is equally effective as with high parameters in terms of surgical time and postoperative BCVA. However, the incidence of PCO was higher in the low fluid-dynamic parameter group up to 12 months. Surgical efforts to reduce remnant lens epithelial cells are needed during low fluidic-dynamic parameter surgery.

Keywords: Cataract, Fluid-dynamic parameters, Phacodynamics, Phacoemulsification, Posterior capsular opacification

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Figure 1.

Posterior capsular opacification (PCO) scoring by slit lamp derived reflected light photographs and retroillumination. ‘Grade 0’ means ‘PCO do not intrude the intraocular lens (IOL) edge’. ‘Grade 1’ means ‘PCO intrude less than half of IOL edge area and below the continuous curvilinear capsulorrhexis (CCC) margin’. ‘Grade 2’ means ‘PCO intrude more than half of IOL edge area and below the CCC margin’. ‘Grade 3’ means ‘PCO intrude the CCC margin but do not intrude visual axis’, and ‘Grade 4’ means ‘PCO intrude visual axis’. ‘Visual axis' means ‘3 mm from center of pupil’.

Table 1.

Patient baseline characteristics in low and high fluid-dynamic parameter group

Characteristics	Low Group	High Group	p-value^*
Eyes	20	20
Age (years)	68.71 ± 6.60	69.28 ± 6.25	0.421
Gender (male:female)	9:11	8:12
Lens opacity
Nuclear opalescence	3.38 ± 0.72	3.43 ± 0.63	0.392
Nuclear color	3.47 ± 0.68	3.52 ± 0.75	0.434
Cortical	2.68 ± 1.25	2.37 ± 1.35	0.523
Posterior subcapsular	1.52 ± 0.98	1.76 ± 1.12	0.621
BCVA (log MAR)	0.29 ± 0.35	0.20 ± 0.19	0.874
Endothelial cell density (cells/mm²)	2512.78 ± 281.78	2,538.36 ± 309.69	0.832

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity.

^* Mann-Whitney U-test.

Table 2.

Comparison of intraoperative parameters and outcomes

Exam	Low Group (n = 20)	High Group (n = 20)	p-value^*
Surgery time (seconds)	495.59 ± 82.79	476.62 ± 68.52	0.254
Ultrasound time (seconds)	64.31 ± 18.07	56.78 ± 24.85	0.249
Fluid consumption (mL)	107.50 ± 28.21	117.81 ± 35.50	0.459

Values are presented as mean ± SD unless otherwise indicated.

^* Mann-Whitney U-test.

Table 3.

Comparison of postoperative BCVA

BCVA	Low Group (n = 20)	High Group (n = 20)	p-value^*
Preoperative	0.29 ± 0.35	0.20 ± 0.19	0.873
Postoperative
3 months	0.03 ± 0.01	0.02 ± 0.01	0.954
6 months	0.05 ± 0.02	0.03 ± 0.01	0.932
12 months	0.07 ± 0.02	0.05 ± 0.02	0.826

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity (log MAR).

^* Mann-Whitney U-test.

Table 4.

Preoperative and postoperative ECD and change in ECD

ECD	Low Group (n = 20)	High Group (n = 20)	p-value^*
Preoperative (cells/mm²)	2,512.78 ± 281.78	2,538.36 ± 309.69	0.785
Postoperative 12 months (cells/mm²)	2,297.45 ± 268.87	2,316.87 ± 287.36	0.842
Mean change (%)^†	7.79 ± 5.72	7.82 ± 4.89	0.674

Values are presented as mean ± SD unless otherwise indicated.

ECD = endothelial cell density (cells/mm²).

^* Mann-Whitney U-test

^† Comparison of ECD change between groups.

Table 5.

Comparison of postoperative PCO score, percentage, and severity

PCO	Low Group (n = 20)	High Group (n = 20)	p-value^§
PCO score^*
Postop 3 m	1.75 ± 0.62	1.00 ± 0.76	0.012
Postop 6 m	1.82 ± 0.54	1.05 ± 0.91	0.035
Postop 12 m	2.01 ± 0.55	1.23 ± 0.59	0.009
PCO percentage^†
Postop 3 m	28.23 ± 6.24	19.90 ± 6.09	<0.001
Postop 6 m	36.82 ± 5.08	27.48 ± 5.99	0.023
Postop 12 m	41.45 ± 7.30	36.45 ± 6.06	0.009
PCO severity^‡
Postop 3 m	0.29 ± 0.08	0.22 ± 0.07	0.031
Postop 6 m	0.35 ± 0.06	0.26 ± 0.04	0.048
Postop 12 m	0.40 ± 0.05	0.34 ± 0.04	0.043

Values are presented as mean ± SD unless otherwise indicated.

PCO = posterior capsular opacification; Postop = postoperative; m = months.

^* PCO score ranged from 0 to 4

^† PCO percentage ranged from 0 to 100

^‡ PCO severity ranged from 0 (totally clear) to 3 (total severe opacification)

^§ Mann-Whitney U-test.

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