A posterior continuous curvilinear capsulorrhexis through the pars plana coupled with a 23-gauge vitrectomy successfully managed dense posterior capsule opacification and vitreous floaters with no complications, according to a 15-eye study.
“The study results really surprised us,” principal investigator Jijian Lin, MD, a professor at the Eye Center at Zhejiang University School of Medicine in China, said. “There were no intraoperative or postoperative complications.”
The mean overall corneal endothelial cell loss was 1.2% at 3 months postop.
“Approximately 80% of the 15 patients had no complaints of vitreous floaters after the procedure,” Lin told Ocular Surgery News. “After removing the dense posterior capsule opacification (PCO) and vitreous, all patients showed a clear visual axis. Most of the patients also demonstrated improved visual acuity and were satisfied after the surgery.”
Lin began to combine phacoemulsification with vitrectomy for patients with cataract and vitreoretinal disease in 2002. “However, as the number of surgeries sharply increased, the incidence of PCO also increased rapidly,” he said.
Lin presumed that if there was no posterior capsule in the optical zone, no PCO would occur. As a result, he and his colleagues designed new microforceps for posterior continuous curvilinear capsulorrhexis (PCCC).
“In pseudophakic eyes with dense PCO and vitreous floaters, it was hard to perform PCCC through a corneal incision because of the existence of an IOL,” Lin said. “With the help of the new microforceps, though, it was easy to complete PCCC through the pars plana after removing anterior vitreous.”
The procedure removes not only the central part of the posterior capsule, but the hyaloid opacities as well. “The incidence of PCO was significantly reduced after PCCC, avoiding the potential complications of Nd:YAG laser capsulotomy,” Lin said.
Lin said the anterior vitreous interface with the posterior capsule remains a challenge. “Just like posterior vitreous detachment, artificial anterior vitreous detachment was done by vitrectomy cutter at the anterior pole of the vitreous anterior membrane,” he said.
Suction was performed from the anterior pole toward the periphery. “Anterior vitreous, including the anterior vitreous cortex and membrane, was then removed and the posterior capsule exposed,” Lin said. Next, the microforceps were introduced through the pars plana to perform PCCC with a diameter of 4 mm to 5 mm, followed by using a vitrectomy cutter to remove the hyaloid opacities with vacuum aspiration.
Mandatory anterior vitreous detachment
Lin said that for the combined surgical procedure to be successful, artificial anterior vitreous detachment is necessary, “which is not difficult to perform because of vitreous liquefaction.”
Medium vacuum aspiration of 100 mm Hg to 150 mm Hg was applied during anterior vitreous detachment to avoid suction and tear of the posterior capsule.
“It is also much safer to do PCCC after IOL implantation,” Lin said. “The viscoelastic agent is injected into the anterior chamber to elevate the tension of the posterior capsule.”
Then, after posterior capsule puncture, curved forceps are used to catch the capsule flap and conclude the PCCC.
“The PCCC is usually completed with a diameter of 4 mm to 5 mm, and residual PCO is sucked by low-vacuum aspiration,” Lin said.
For surgeons starting out with the combined procedure, “you can obtain a good curvature effect,” Lin said.
For patients with cataract and vitreoretinal disease, the combination “eliminates the possibility of a second surgical procedure and helps to achieve earlier visual rehabilitation,” Lin said. “The central PCO can be avoided and the visual axis established long term.” – by Bob Kronemyer
- Lin J, et al. Retina. 2016;doi:10.1097/IAE.0000000000001037.
- For more information:
- Jijian Lin, MD, can be reached at Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China; email: firstname.lastname@example.org.
Disclosure: Lin reports no relevant financial disclosures.