[Microsurgical treatment of posterior capsule opacification]

To evaluate irrigation/aspiration and posterior capsulectomy in the treatment of the posterior capsule opacification (PCO).

Department of Ophthalmology, School of Medicine, Comenius University, Bratislava, Slovakia.

Between 1.1.1999 and 31.7.2000 we treated 75 patients (79 eyes) for PCO. Cataract surgery was performed in the years 1990-1999. The artificial intraocular lens (IOL) was implanted in 62 eyes. The interval between cataract surgery and PCO surgery ranged from 4 m.-10 y. The regenerative type of PCO was present in 41, fibrotic in 23 and combined in 15 eyes. Irrigation/aspiration (I/A) was performed in 44 eyes. Capsulectomy with a vitrectomy probe was performed in 35 eyes. I/A procedure was 42x performed with a bimanual system. Capsulectomy was performed in combinations of various insertions of the infusion line (without, anterior chamber maintainer-AChM, pars plana) and capsulectomy (limbal or pars plana approach). It was evaluated: occurrence of peri- and postoperative complications; achieved best corrected visual acuity.

Complications during I/A: posterior capsule tearing with vitreous prolaps 4x, IOL subluxation 3x, partial zonular dialysis 2x-1x with vitreous prolaps. During capsulectomy performed through the limbus was observed vitreous prolaps in two eyes. After capsulectomy, performed through pars plana without infusion line, was observed the chronical corneal oedema in one eye. The best corrected visual acuity improved for 2 and more lines in 79.5% of eyes after I/A procedure and in 74.3% of eyes after capsulectomy. The achieved visual acuity lower then 6/60 was caused by changes not related to the cataract and PCO surgery. After testing of various combinations, the most suitable capsulectomy procedure seems to be: infusion line through the limbus, capsulectomy through the radial scleral tunnel incision. In this fashion it is possible to perform the procedure as no-stitch surgery.

Instead of possibility of occurrence of various peri- and postoperative complication after I/A and capsulectomy used for treatment of PCO these procedures complete possibilities in the treatment of PCO. For the regenerative type of PCO is suitable I/A procedure. For the fibrotic type of PCO is suitable capsulectomy through pars plana with AChM. By this procedure it is possible to remove also nearly all vitreous opacities.