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Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases.

Abstract：

PURPOSE:To study the efficacy of posterior optic buttonholing (POBH) through a primary posterior capsulorhexis (PPCCC) to preserve full capsular transparency, and its potential as a routine alternative to standard in-the-bag implantation of sharp-edged optic intraocular lenses (IOLs). SETTING:Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS:After standard cataract removal, a PPCCC 4.0 to 5.0 mm in diameter was performed and the optic of a 3-piece IOL buttonholed posteriorly. One third of the eyes additionally had extensive anterior capsule polishing. All surgeries were performed under topical anesthesia. RESULTS:The first 500 consecutive surgeries were evaluated. In 11 eyes, POBH was not performed as planned. In 4 cases, anterior capsulorhexis fixation of the optic was used as an alternative. In the early series, vitreous entanglement was seen in 5 eyes, of which 1 case prompted translimbal anterior vitrectomy. No case of cystoid macula edema was observed. One case of peripheral retinal detachment in a highly-myopic eye 4 months postoperatively appeared to be unrelated to the surgery. All lenses were well-centered without tilt, and both capsule leaves remained clear especially after additional polishing. CONCLUSION:Posterior optic buttonholing precludes lens epithelial cells from accessing the retrolental space. The sandwiched posterior capsule blocks optic contact and thus fibrosis of the anterior capsule. Posterior optic buttonholing avoids after-cataract independent of optic edge design. Anterior capsule polishing adds to its efficacy by excluding any residual fibrosis. Surgery under topical anesthesia was well-controlled and safe. Posterior optic buttonholing may become a routine alternative to standard in-the-bag IOL implantation when supported by a longer follow-up.

journal_name

J Cataract Refract Surg

journal_title

Journal of cataract and refractive surgery

authors

Menapace R

doi

10.1016/j.jcrs.2006.02.046

subject

Has Abstract

pub_date

2006-06-01 00:00:00

pages

929-43

issue

eissn

0886-3350

issn

1873-4502

pii

S0886-3350(06)00236-7

journal_volume

pub_type

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Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases.