The effect of capsule tension ring on posterior capsule opacification: A meta-analysis.

BACKGROUND: Posterior capsule opacification is one of the most common complications after cataract surgery. Studies have suggested that the introduction of a capsule tension ring might play a critical role in the prevention of capsule opacification, yet quantitative evidence is still lacking. This work consists of a meta-analysis on available data in order to explore the influence of a capsule tension ring on posterior capsule opacification. METHODS: A comprehensive review of the literature on capsule tension ring and posterior capsule opacification was carried out using the Embase, Pubmed, Web of Science, and Cochrane electronic databases. The selected studies included randomized controlled trials, retrospective studies and prospective studies published before June 2020. The studies of interest were selected by two reviewers independently from the included studies. Odds ratios (ORs) and standardized mean differences (SMD) were used in order to assess the association. A fixed-effects model or a random-effects model was applied to combine data according to heterogeneities. Sensitivity analysis was used to assess the heterogeneity of the studies. Publication bias was estimated using the Egger test. Statistical analysis was performed using the stata15.1 software. RESULTS: The meta-analysis included in total 8 studies involving 379 cases and 333 controls. There was a statistically significant difference of Nd:YAG laser capsulotomy rate (OR=0.241, 95% CI: 0.145, 0.400 I2=42.1%) between the capsule tension ring group and the control group, indicating that the tension ring reduced the Nd:YAG laser capsulotomy rate. Further studies with continuous data also revealed that the use of capsule tension ring was associated with a lower posterior capsule opacification score (SMD = -1.402, 95% CI: -2.448, -0.355 I2=95.0%). The sensitivity analysis suggested that the result of the re-combined analysis did not change notably, indicating that the result was reliable and stable. Both pooled analysis showed no evidence of publication bias. CONCLUSION: The findings of this meta-analysis confirmed that capsule tension ring might reduce capsule opacification. Further studies should be made to validate the result.

Opacificación de la cápsula posterior, síndrome de distensión capsular y síndrome de fimosis de la cápsula anterior: estudio de cohortes retrospectivo / Posterior capsule opacification, capsular bag distension syndrome, and anterior capsular phimosis: A retrospective cohort study

OBJETIVO: Determinar la incidencia y los factores de riesgo implicados en el desarrollo de las tres principales complicaciones capsulares postoperatorias: opacificación de cápsula posterior (OCP), síndrome de distensión capsular (SDC) y fimosis de la cápsula anterior (FCA). Sujetos, material y métodos: Estudio de cohortes retrospectivo. Se incluyó a 801 pacientes operados mediante cirugía de catarata en el Servicio de Oftalmología del Hospital del Henares (Madrid), entre el 2 de marzo de 2009 y el 28 de febrero de 2010. La historia clínica electrónica fue revisada durante el mes de julio de 2012. La OCP se estudió utilizando el método de Kaplan-Meier (log rank test). RESULTADOS: Un total de 167 pacientes desarrollaron OCP. No se pudo demostrar asociación entre la OCP y edad, sexo, diabetes mellitus, técnica de facoemulsificación, modelo de lente intraocular (LIO), consumo de tamsulosina, grado de síndrome de iris flácido intraoperatorio, glaucoma ni la degeneración macular asociada a la edad. Tres pacientes desarrollaron SDC, todos ellos habían recibido una LIO Akreos Adapt AO® (Bausch & Lomb). Dos de ellos eran varones jóvenes, con diagnóstico de catarata subcapular posterior. Tres pacientes desarrollaron FCA, dos de ellos habían recibido una LIO MicroSlim® (PhysIOL). CONCLUSIONES: No pudo demostrarse asociación de la OCP con ninguna de las variables estudiadas. El sexo masculino, la edad joven, la catarata subcapsular posterior y las LIO grandes no anguladas como la Akreos Adapt AO®podrían asociarse al desarrollo de SDC. Las LIO de microincisión, como la MicroSlim®, podrían asociarse al desarrollo de FCA

OBJECTIVE: To determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP). Subjects, material and methods: A retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test). RESULTS: A total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO® (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim® IOL (PhysIOL). CONCLUSIONS: No association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO® could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim®) are implanted

[Femtosecond laser in cataract surgery. A critical appraisal]. / Femtosekundenlaser in der Kataraktchirurgie. Eine kritische Betrachtung.

BACKGROUND: The use of femtosecond lasers (FSL) is increasingly spreading in cataract surgery. Potential advantages over standard manual cataract surgery are the superior precision of corneal incisions and capsular openings as well as the reduction of ultrasound energy for lens nucleus work-up. Exact positioning and dimensioning of the anterior capsular opening should help reduce decentration and tilt of the intraocular lens (IOL) optics and thus achieve better target refraction. Together with the possibility to correct low-grade corneal astigmatism by precise arcuate incision, FSL technology is expected to convert cataract surgery from a purely curative into a refractive procedure. METHODS: Apart from own experiences this review article critically analyses the pertinent literature published so far as well as congress presentations and personal reports of other FSL surgeons. The advantages and disadvantages are scrutinized with regard to their impact on the surgical and refractive results and compared with those experienced by the authors with manual cataract surgery over several decades. Economic and healthcare political aspects are also addressed. RESULTS: The use of FSL surgery improves the precision and reproducibility of corneal incisions and the capsular opening and reduces the amount of ultrasound energy required for lens nucleus work-up. However, the clinical benefits must be put into perspective due to the subsequent surgical manipulation of the incisions (during lens emulsification, aspiration and IOL injection), the lacking possibility to visualize the crystalline lens equator as the reference for correct capsulotomy centration and the relativity of ultrasound energy consumption on the corneal endothelial trauma. This is of particular relevance against the background of the significantly higher costs. Conversely, tears of the anterior capsule edge which, apart from interfering with correct IOL positioning, may entail serious complications presently occur more frequently with all FSL instruments. From the economic and healthcare political viewpoint, thought should be given to the possible acquisition of the cataract surgical business by the industry or investors, as cataract surgery is a high-volume standardized procedure with enormous future potential. This could fundamentally change our currently decentralized and individualized structures and subsequently the steam of patient and make surgeons largely dependent or superfluous.

[Femtosecond laser-assisted lens surgery depending on interface design and laser pulse energy: results of the first 200 cases]. / Femtosekundenlaser-gestützte Linsenchirurgie abhängig von Interfacedesign und Laserpulsenergie : Ergebnisse der ersten 200 Fälle.

BACKGROUND: This study was designed to evaluate the effectiveness and safety of femtosecond laser-assisted lens surgery depending on interface design and laser pulse energy settings. METHODS: In this non-randomized, consecutive case series200 eyes underwent femtosecond laser-assisted (LenSx, Alcon) lens surgery between November 2012 and June 2013. Group 1 consisted of 85 eyes with 60 cataracts and 25 refractive lens exchanges (RLE) which were treated with a curved direct contact interface, and group 2 consisting of 115 eyes with 72 cataracts and 43 RLEs treated with a modified interface using an additional soft contact lens (SoftFit™, Alcon) between the corneal surface and the interface. The degree of opacity of the lens in cataract eyes was measured with a Scheimpflug camera. Afterwards, phacoemulsification was performed with intraocular lens (IOL) implantation in all eyes. Primary endpoints were the effective phacoemulsification time (EPT), the average laser treatment time and the occurrence of intraoperative complications. RESULTS: The mean EPT in group 1 was 1.62 ± 1.12 s (cataract 1.94 ± 1.31 s, RLE 1.29 ± 1.01 s) and in group 2 the mean EPT was 1.66 ± 0.92 s (cataract 1.98 ± 1.28 s, RLE 1.33 ± 1.22 s, p = 0.32 between groups). The laser treatment lasted on average 48.90 ± 2.45 s (group 1) and 49.70 ± 2.87 s (group 2) with an average lens fragmentation thickness of 3401.48 ± 401.12 µm (all groups). In four cases of group 1, a second applanation of the interface was necessary. Furthermore, one anterior capsule tear, 39 cases of intraoperative wrinkling of the corneal surface and 21 cases in which the corneal incision had to be opened manually were documented in group 1. In group 2 no second applanation of the interface, no anterior capsule tears and no corneal wrinkling but 9 cases with a manual opening of corneal incisions were documented (p < 0.01 between groups). CONCLUSION: The minor intraoperative complications of the femtosecond laser technique investigated could be significantly reduced using an optimized interface and reduced laser pulse energy.

Laser-assisted cataract surgery in small pupils using mechanical dilation devices.

PURPOSE: To describe methods for performing laser-assisted cataract surgery in small pupils. METHODS: Iris retractors or a Malyugin Ring (Microsurgical Technology, Redmond, WA) were used for mechanical pupil dilation before laser capsulotomy and lens fragmentation. The laser treatment can be performed with or without use of ophthalmic viscosurgical devices (OVD). RESULTS: In 73 eyes with small pupils, laser treatment was possible after mechanical dilation device installation. With and without an OVD, no flattening of the anterior chamber or other complications occurred during re-docking, laser treatment, or the manual part of the operation. Small adhesions of the anterior capsulotomy were more frequent when the anterior chamber was still filled with the OVD and did not occur when the OVD was removed. CONCLUSION: A small, poorly dilating pupil constitutes a major challenge in cataract surgery, particularly when performing capsulorhexis. Femtosecond laser treatment can be employed with considerable benefit for the patient, even in these difficult cases.