Effect of anterior capsule polishing on the visual quality after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the effect of anterior capsule polishing on visual quality after phacoemulsification.METHODS: Prospective randomized control study. A total of 65 patients(73 eyes)with age-related cataract who underwent phacoemulsification combined with intraocular lens(IOL)implantation in the Emergency General Hospital between November 2021 and June 2022 were included. These patients were randomly assigned to two groups, with one group(anterior polishing group)underwent anterior and posterior capsule polishing(30 cases, 35 eyes), while the other(control group)receive routine posterior capsule polishing(35 cases, 38 eyes). Best corrected visual acuity was observed at 1wk, 1, 3 and 6mo after operation. Area of anterior capsule orifice was measured at 3 and 6mo after operation. Meanwhile, posterior capsular opacification(P score), IOL tilt and decentration were recorded by Pentacam Scheimpflug system. In addition, wavefront aberration, Strehl ratio(SR)of point spread function(PSF)and modulation transfer function(MTF)were evaluated by OPD-Scan Ⅲ.RESULTS: At 1wk, 1, 3 and 6mo after operation, best corrected visual acuity in anterior polishing group is significantly better than that of control group(P<0.05). There were no significant differences in area of anterior capsule opening, P score, IOL decentration, SR of PSF and MTF between two groups at 3 and 6mo after operation(P>0.05). At 3mo follow-up, no significant differences in IOL tilt and wavefront aberration were measured between two groups either(P>0.05). However, IOL tilt [(1.65±0.60)° vs.(2.34±0.43)°, P<0.001] and wavefront aberration(0.03±0.01μm vs. 0.06±0.03μm, P<0.001)in anterior polishing group were significant lower compared to control group at 6mo after operation.CONCLUSION: 360° polishing of anterior and posterior capsule during phacoemulsification can improve best corrected visual quality, with reduced IOL tilt, lower wavefront aberration and better visual quality.

Effect of anterior lens capsule contraction on intraocular lens decentration after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the influence of lens capsule contraction on intraocular lens(IOL)decentration after cataract surgery.<p>METHODS: Totally 40 cases(40 eyes)of senile cataract underwent phacoemulsification combined with IOL implantation. Within 3mo after operation, the anterior capsule opening area was measured by Photoshop software, the IOL decentration was measured by iTrace visual quality analyzer. The influence of anterior capsule opening area on IOL decentration was assessed by Pearson correlation analysis.<p>RESULTS: At 1d, 1mo and 3mo after operation, anterior capsule opening area was gradually reduced, the difference between different time points was statistically significant(<i>P</i><0.01); IOL decentration gradually increased, and the difference between different time points was statistically significant(<i>P</i><0.01); the visual acuity of patients decreased gradually, and the difference between different time points was statistically significant(<i>P</i><0.01). The change of anterior capsule opening area was positively correlated with IOL decentration(<i>r</i>=0.566, <i>P</i><0.05), but there was no significant correlation between visual acuity and IOL decentration(<i>r</i>= -0.104, <i>P</i>> 0.05), the change of anterior capsule opening area was negatively correlated with the initial anterior capsule opening area(<i>r</i>= -0.476, <i>P</i><0.05).<p>CONCLUSION: The anterior capsule contraction after cataract surgery can lead to IOL decentration.

Application of polishing anterior capsule and equator in phacoemulsification and intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the application value of polishing anterior capsule and equator in the phacoemulsification and intraocular lens implantation. <p>METHODS: Totally 112 cases of cataract patients in our hospital from May 2012 to January 2015 were selected as research objects. They were divided into unpolished and polished group according to whether the anterior capsule and equatorial part polished or not with the informed consents, 56 cases in each group. The patients were followed up for 18mo after phacoemulsification and intraocular lens implantation. The clinical efficacy of the two groups was compared.<p>RESULTS: The complication rates of the two groups were 7.1% and 16.1%, that of the polished group was lower and the difference was statistically significant(<i>P</i><0.05). The lens position(effective lens position, ELP), refractive state, uncorrected visual acuity compared with unpolished group were statistically significant(<i>P</i><0.05). <p>CONCLUSION: Polishing anterior capsule and equator can significantly improve the effect of phacoemulsification combined with intraocular lens implantation in the treatment of cataract.

A Comparative Histopathological Study of Lens Capsule and Epithelial Cells in Various Types of Cataract

PURPOSE: To evaluate the histopathological changes of anterior capsule and lens epithelial cells in various types of cataract. METHODS: Patients scheduled for cataract surgery of phacoemulsification with intraocular lens implantation were enrolled in this study. Anterior capsule tissues sized 5 mm were obtained at the time of continuous curvilinear capsulorhexis during surgery. Histological examination of the obtained tissue was performed by transmission electron microscope. RESULTS: Nuclear cataract showed a uniform cuboidal monolayer of epithelial cells firmly attached to the anterior capsule. But, the mitochondria, Golgi apparatus, and endoplasmic reticulum were damaged and replaced with vacuoles. Anterior subcapsular cataract showed multilayers of epithelial cells with irregular intracellular structures. Epithelial cells of mature cataract were severely damaged and detached from the anterior capsule, accompanied by expansion of intra-cellular space and a large amount of vacuoles. Epithelial cells were irregular and severely damaged, and intracellular structures were hardly observed in traumatic cataract. Deposition of pseudoexfoliation materials on the anterior capsule was observed in pseudoexfoliation cataract. CONCLUSIONS: Changes in epithelial cells caused by fluid accumulation and electrolyte imbalance in the lens attributes more to cataract formation than do changes the in lens capsule.

Clinical observation on Nd:YAG laser for treating high-risk patients with anterior capsule contraction after cataract operation / 重庆医学

Objective To observe the clinical effect of anterior capsule relaxing incisions with Nd:YAG laser in treating postop-erative anterior capsule contraction in high-risk cataract patients.Methods 120 high-risk cataract patients with postoperative ante-rior capsule contraction collected from December 2010 to November 2012 were divided into experimental group(performed the ante-rior capsule relaxing incisions on postoperative 3 d)and control group.The anterior capsule opening area was measured immediately after laser operation(baseline),in postoperative 1,3,6 months by using the Scheimpflug video photogeaphy system,and the descent rate of the opening area was simultaneously calculated.The decentration degree and tilt of intraocular lens(IOL),posterior capsule opacification and other complications were also assessed.Results Of the observed 120 cases,40 cases were pseudo posterior capsule stripping syndrome,40 cases were primary angle closure and 40 cases were diabetic retinopathy.There was no statistically signifi-cant difference in the baseline value of the opening area between the experimental group and the control group(P>0.05).In the ca-ses of primary angle closure 1,3,6 months after operation,the anterior capsule opening area in the experimental group was signifi-cantly increased compared with the control group(P0.05),the descent rate of the opening area was significantly diminished(P<0.05).No significant differences were found in the aspects of IOL decen-tration and tilt,posterior capsule opacity,or other complications.Conclusion YAG laser anterior capsule relaxing incisions in the early period after cataract surgery is safe and effective in preventing anterior capsule contraction in high-risk patients.

Use of indocyanine green staining technique for phacoemulsification in white cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the application efficiency of 5g/L indocyanine green ( ICG ) staining technique for continuous circular capsulorhexis ( CCC ) during phacoemulsification in white cataract. METHODS:Ninety-eight patients (98 eyes) with white cataract were randomly divided into staining group ( 50 cases, 50 eyes) and control group (48 cases, 48 eyes). The control group didn't do anterior capsule staining. The staining group was injected to fill the anterior chamber, 5g/L ICG 0.1mL was applied on the central surface of the anterior capsule, using a 27G blunt needle through the side-port after 30s, and the redundant ICG was replaced by BSS, and continuous curvilinear capsulorhexis was accomplished using capsulorhexis forceps. RESULTS: In staining group: after ICG staining, the capsule, which presented uniform light green and visualization of the anterior capsule was significantly improved. There are 48 eyes capsulorhexis success. The rate of success was 96%. Meanwhile, in control group, there was 29 eyes capsulorhexis success. The rate of success was 60%. The difference was statistically significant (P CONCLUSION:Indocyanine green staining increases the visibility of anterior capsule in over mature cataract, and it should be an effective and helpful method which can increase the success rate of capsulorehxis. At the same time, it can reduce the incidence of intraoperative complications. This will help beginners quickly grasp continuous curvilinear capsulorhexis, and shorten the learning curve.

Effect of Haptic Material and Number of Intraocular Lens on Anterior Capsule Contraction after Cataract Surgery

PURPOSE: To evaluate changes over time of the anterior capsule opening size after phacoemulsification, based on haptic number and composition of three acrylic intraocular lenses (IOLs). METHODS: Fifty-five patients (70 eyes) were included. All underwent phacoemulsification followed by implantation of either an acrylic IOL with two-haptic (one-piece, 26 eyes; three-piece, 22 eyes), or four-haptic (one-piece, 22 eyes). The area of the anterior capsule opening size was measured one week postoperatively (baseline) and at three months. RESULTS: There was a significant reduction in the area of the anterior capsule opening from one week as compared to three months postoperatively in all groups (p < 0.001). However, there was no significant difference in the reduction in the anterior capsule opening between the IOLs (p = 0.36). CONCLUSIONS: The number and material of the haptic of the three acrylic IOLs did not influence the degree of anterior capsule opening shrinkage.

A Case of Anterior Lens Capsule Rupture from Blunt Ocular Trauma

PURPOSE: To report a case of isolated anterior capsule rupture with cataract after blunt ocular trauma. CASE SUMMARY: A 38-year-old male complained of decreased visual acuity in the right eye after blunt ocular trauma 5 days earlier. The visual acuity was counting fingers at 30 cm in the right eye, and intraocular pressure, measured using an applanation tonometer, was 25 mm Hg. Slit lamp examination showed a white intumescent cataract with anterior lens capsule rupture and cortical lens material extruding into the anterior chamber. Under local anesthesia, removal of the cataract was approached via a clear corneal incision. After removal of the cataract using irrigation and aspiration, the intact posterior capsule was observed. IOL haptic was implanted in the sulcus, and IOL optic was implanted in the bag. Postoperatively, the BCVA improved in the right eye to 0.8 at 1 month, and the intraocular pressure, by the Goldmann applanation tonometer was 13 mm Hg at that time.

Anterior Fibroblastic Proliferation of Lens Epithelial Cells in Acrylic Intraocular Lens

PURPOSE: To report upon two cases of anterior capsule opacification (ACO) proliferating into the pupillary region of the anterior surface of a single piece acrylic AcrySof(R) intraocular lens (IOL) (SA60AT, Alcon Laboratories, Inc., USA). The surgical removal of the ACO was also reported. METHODS: An 80-year-old woman and a 75-year-old woman underwent phacoemulsification with implantation of a single piece foldable AcrySof(R) IOL in the posterior capsular bag. ACO proliferating from the opposite sides of the IOL along the central axis were found three months after surgery. To recover visual acuity in the 80-year-old woman's eye, ACO was surgically removed with a Sinskey hook and irrigation and aspiration system. RESULTS: The patient's visual acuity was recovered after surgical removal of the ACO. Histopathologic findings of the removed tissues revealed fibroblastic proliferation of lens epithelial cells. The ACO in 75-year-old woman's eye was not treated, as it was not associated with a visual disturbance. CONCLUSIONS: In eyes containing an AcrySof(R) IOL, clinically significant ACO proliferation into the pupillary region along the central axis can occur. Surgical removal can be beneficial for recovery of visual acuity.

Preservation of anterior capsule during vitrectomy and lensectomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the preservation of anterior capsule during vitrectomy and lensectomy.ment (RD) and grade C proliferative vitreoretinopathy (PVR)underwent pars plana vitrectomy (PPV) and pars plana lensectomy (PPL) with preservation and polishing of the anterior capsule. Of the 15 eyes, 4 eyes had giant tear, 3 had recurrent rhegmatogenous retinal detachment (RRD), 2 had diabetic retinopathy. Totally 6 eyes had gas and 9 had silicone oil tamponade. The surgeries were evaluated according to the visual acuity (VA) and the postoperative complications during the follow-up of at least 3 months.in all eyes, improved by 3± 3 lines overall. Eight eyes were implanted posterior chamber intraocular lens (PCIOL) successfully at 2-3 months after operation, including 6 having gas and 2 having silicone oil tamponade. No eyes had central anterior capsule opacity, corneal decompensation, puplillary block, retina redetachment or other complications.an intact anterior capsule in eyes with RD and PVR. Preserving the anterior capsule can help preventing intraoperative and postoperative complications of gas or silicone oil, simplify future PCIOL placement, and maintaining a normal iris appearance.

A Case of Thick Anterior Capsule of Hypermature Cataract in Down Syndrome

PURPOSE: We report a case of severe thickening of the anterior capsule in a case of hypermature cataract with Down syndrome. METHODS: A 30-year-old woman with Down syndrome underwent intracapsular phacoemulsification followed by in-the-bag implantation of an intraocular lens (IOL) under general anesthesia. Pathologic examination was performed. The anterior capsule was then incised at the 12 o'clock position by intraocular scissors because continuous curvilinear capsulorhexis (CCC) was too difficult given the thickened anterior capsule. Intracapsular phacoemulsification was followed by in-the-bag implantation of IOL and the incised anterior capsule was trimmed. RESULTS Pathologic findings of the extracted anterior capsule documented a thickening of the anterior capsule 20-fold over that of a normal anterior capsule as well as depositions of fibroblasts and collagen materials. Six months after the operation, the patient's visual acuity was 0.3 and no complication was found.

A Case of Thick Anterior Capsule of Hypermature Cataract in Down Syndrome

PURPOSE: We report a case of severe thickening of the anterior capsule in a case of hypermature cataract with Down syndrome. METHODS: A 30-year-old woman with Down syndrome underwent intracapsular phacoemulsification followed by in-the-bag implantation of an intraocular lens (IOL) under general anesthesia. Pathologic examination was performed. The anterior capsule was then incised at the 12 o'clock position by intraocular scissors because continuous curvilinear capsulorhexis (CCC) was too difficult given the thickened anterior capsule. Intracapsular phacoemulsification was followed by in-the-bag implantation of IOL and the incised anterior capsule was trimmed. RESULTS Pathologic findings of the extracted anterior capsule documented a thickening of the anterior capsule 20-fold over that of a normal anterior capsule as well as depositions of fibroblasts and collagen materials. Six months after the operation, the patient's visual acuity was 0.3 and no complication was found.

Anterior Capsular Staining with a Mixture of Indocyanine Green Dye and Viscoelastic Material

PURPOSE: The authors used a mixture of ICG dye and viscoelastic material to perform continuous curvilinear capsulorhexis (CCC) in white cataract, in order to stain the anterior capsule with the minimal contact with the corneal endothelial cells. METHODS: In 10 eyes with white cataract, CCC was performed under the anterior capsular staining with ICG dye. The ICG solution was prepared by dissolving 25 mg of ICG in 1 mlof an aqueous solvent, which was mixed in 3 ml of balanced salt solution. With a three-way connector, one way was occluded, the other was connected with 1 ml of viscoelastic material, and the third was connected with 4 ml of the prepared ICG solution. One half percent mixture of ICG and viscoelastic material was made by alternate injection. The anterior chamber was filled with viscoelastic material, and then the anterior capsule was stained by slow spread of the prepared ICG mixture between anterior capsule and viscoelastic material. The remains of ICG mixture was removed by infusion and aspiration. The anterior chamber was filled with viscoelastic material again, CCC was performed with cystotome. Corneal edema and anterior chamber reaction was evaluated with slit lamp at 1 day, 1 week and 1 month after surgery. RESULTS: In all cases, CCC was successfully completed under the anterior capsular staining of the desired area with 0.5% ICG dye mixture and there was no contact with the corneal endothelial cells. Mild corneal edema and mild anterior chamber reaction that observed on the 1st postoperative day subsided within 1 week in all cases. CONCLUSIONS: Staining the anterior capsule with 0.5% ICG dye mixture, after the anterior chamber was filled with viscoelastic material, it was helpful to perform CCC in white cataract. Using this technique, we could minimize the contact with the corneal endothelial cells and stain the desired area.

Quantitative Analysis of Anterior Capsule Opening after PMMA, Silicone and Acrylic Intraocular Lens Implantation

To quantify the periodic changes in the area of anterior capsule opening after cataract surgery and to compare any difference between polymethylmethacrylate (PMMA), silicone and soft acrylic IOLs, we prospectively studied 442 patients (465 eyes)who were operated from September 1997 to November 1999 at our hospital.All patients had standardized phacoemulsification, continuous curvilinear capsulorhexis, and intraocular lens implantation performed by the same surgeon.Patients were randomized into three groups based on the type of intraocular lens.The area of anterior capsule opening was quantitated using the Anterior Eye Segment Analysis System (EAS-1000), and examinations were performed at 1 week and 1, 3 and 6 months after surgery.The mean anterior capsular opening area at 1, 3 and 6 months postoperatively was smaller than that of 1 week in all 3 groups (P<.05)and the mean percentage of reduction in the PMMA and soft acrylic intraocular lens groups was significantly smaller than that in the silicone intraocular lens group at 1, 3 and 6 months after surgery (P<.05).In the silicone group, the contraction of the anterior capsule opening was greater than either PMMA or soft acrylic intraocular lens groups.Further studies will be needed for the evaluation of clinical application of silicone and soft acrylic intraocular lens.

Comparison of Anterior Capsule Opening after Silicone Intraocular Lens Implantation with and without Capsular Tension Ring

To evaluate the effect of capsular tension ring on prevention of capsular opening reduction induced by CCC in Phacoemulsification with silicone intraocular lens implantation, we prospectively studied 60 patients (60 eyes)who were operated from Sept, 1997 to Jun, 1998 at our hospital.All patients had standardized Phacoemulsification, continuous curvilinear capsulorhexis, and intraocular lens implantation performed by the same surgeon.Patients were randomized into two groups based on capsular tension ring insertion.We compared uncorrected visual acuity (UCVA), spherical equivalent (SE), astigmatism and the data obtained by the Anterior Eye Segment Analysis System (EAS-1000), anterior chamber depth, IOL tilting, decenteration, and anterior capsule opening area at 1 week and 1, 3, 6 months after surgery.Two groups showed a similar pattern of change of UCVA, SE and astigmatism. There are no statistical significances in comparison of anterior chamber depth and IOL decenteration in two groups, but IOL tilting of group II is greater than that of group I at 6 months after surgery.The mean anterior capsular opening area at 1, 3, 6 months postoperatively was smaller than that of 1 week in two groups, but no statistical significances were observed in group II (1, 3, 6 months, P = or > .05).The mean percentage reduction of group I was significantly smaller than that of group II at 3 and 6 months (P<.05)after surgery.Capsular tension ring might prevent a contraction of capsular opening and might enhance the stability of IOL.

A Laboratory Study of Diathermy Capsulorhexis

This study was performed to evaluate histopathologic and physical characteristics of anterior capsule during capsulorhexis with a new high-frequency diathermy.The authors investigated the histopathologic characteristics of anterior capsule according to coagulation time and anterior capsular diameter in diathermy capsulorhesxis(DC),comparing with those in continuous curvilinear capsulorhexis(CCC). Thermally induced histopathologic alter-ation was localized at anterior capsule with coagulation for 0.5 second, while it was extended into cortex with coagulation for 2 seconds.When capsulorhexis was performed with diameter of 6 mmand the margin was pulled with iris retractor,anterior capsular edge was fully extended both in CCC and DC.But with diameter of 3.5 mm,DC mostly led to tear of capsular edge on its extension,while CCC permitted full extension of anterior capsular edge.These results suggest that strength of anterior capsular edge in DC is inferior to that in CCC.However diathermy capsulorhexis is a useful alternative technique in cases,which CCC is difficult to perform,such ashypermature or congenital cataracts.

Pars Plana Vitrectomy Combined with Anterior Capsule-Sparing Lensectomy Clinical Report of 43 Cases

We performed pars plana vitrectomy combined with anterior capsule-sparing lensectomy on forty three eyes WJth coexisting cataract and vitreoretinal disease and followed up more than 6 months. Preoperative vitreoretinal diseases consisted of nondiabetic vitreous hemorrhage (thirteen eyes), retained metallic intraocular foreign bodies (nine eyes), posterior uveitis (nine eyes), proliferative diabetic retinopathy (seven eyes) and rhegmatogenous retinal detachment (five eyes) . Thirty six eyes (84%) revealed the visual acuity of 0.1 or less before operation. Thirty eight eyes (88%) could get a better visual acuity after operation than before operation. Posterior chamber intraocular lenses were implanted to thirty eight eyes. The severity of anterior capsular opacity showed a statistically significant difference between the eyes with injection of intraocular gas or silicone oil and them without injection of that (p=0.004). In this study, we can find that the technique of pars plana vitrectomy combined with anterior capsule-sparing lensectomy would be recommendable and the anterior capsular opacity may have relation with intraocular gas or silicone oil.