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Clinical Outcomes of Primary Posterior Continuous Curvilinear Capsulorhexis in Postvitrectomy Cataract Eyes

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Clinical Outcomes of Primary Posterior Continuous Curvilinear Capsulorhexis in Postvitrectomy Cataract Eyes Hindawi Journal of Ophthalmology Volume 2020, Article ID 6287274, 7 pages https://doi.org/10.1155/2020/6287274 Research Article Clinical Outcomes of Primary Posterior Continuous Curvilinear Capsulorhexis in Postvitrectomy Cataract Eyes Mengting Yu ,1 Duan Yan,1,2 Wenjie Wu ,1,2 Yingbin Wang,1 and Xinna Wu1 1Ophthalmology Department, Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350001, China 2Ophthalmology Department, Fujian Provincial Hospital, Fuzhou 350001, China Correspondence should be addressed to Wenjie Wu; [email protected] Received 6 April 2020; Revised 11 June 2020; Accepted 14 July 2020; Published 31 July 2020 Academic Editor: Dirk Sandner Copyright © 2020 Mengting Yu et al. .is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To evaluate the safety and outcomes of primary posterior continuous curvilinear capsulorhexis (PPCCC) combined with phacoemulsification in postvitrectomy eyes. Design. Retrospective case series. Methods. Twenty-one postvitrectomy eyes of 21 patients with cataract between April 2017 and December 2019 were enrolled. PPCCC through the cornea incision was performed before in-the-bag intraocular lens implantation. All patients were followed up for at least 3 months postoperatively. .e outcome measures were corrected distance visual acuity (CDVA), intraocular pressure (IOP), corneal endothelium cell counts (CECC), central macular thickness (CMT), the occurrence of intraoperative or postoperative complications, and the incidence of posterior capsular opacification (PCO). Results. .e mean age was 56.14 ± 9.76 years (ranging from 31 to 68). .e mean Snellen CDVA was 20/400 preoperatively and improved to 20/67 postoperatively (P < 0:001). No significant differences were found between IOP (P � 0:96) and CMT (P � 0:42)preoperatively and postoperatively. .e mean CECC was 2571.8 ± 319.3 cells/mm2 preoperatively and 2498.2 ± 346.3 cells/mm2 postoperatively (P < 0:05). Lens epithelium cells proliferation was confined to the peripheral capsular bag during a mean follow-up of 12.9 ± 10.5 months (ranging from 3 to 28 months). Intraoperative posterior capsule extension occurred in 1 eye (4%), although it did not affect the patient’s vision. No serious complications, including retinal detachment or endophthalmitis, were detected in any of the 21 cases. Conclusion. PPCCC through cornea incision combined with phacoemulsification may be a safe and practical alternative to prevent PCO in postvitrectomy eyes with cataract. 1. Introduction patients’ satisfaction significantly. Besides, the opacified region also troubles doctors by hindering adequate visual- In recent years, improvements in surgical technique and ization of the retina. .e standard treatment to solve this advances in instruments facilitate the widespread use of problem is creating a posterior capsular opening via neo- vitrectomy in the management of posterior segment dis- dymium-doped yttrium aluminum garnet (Nd : YAG) laser, orders. Vitrectomy has been shown to bring about whereas Nd : YAG is not accessible in some developing and accelerated formation and progression of cataract [1, 2]. It is underdeveloped areas in China, besides some less-developed reported that 80–100% of phakic eyes require cataract regions in the world. .ose who develop PCO after vit- surgery within 2 years following vitrectomy [2, 3], which has rectomy have to be referred to the previous tertiary oph- made postvitrectomy eyes a significant proportion of cata- thalmic center again to receive laser posterior capsulotomy, ract eyes and has aroused more concerns of ophthalmolo- which poses further time and cost burden for these patients gists for this growing population. What’s more, the virtually. formation of posterior capsular opacification (PCO) is more One alternative of the Nd : YAG laser is to perform a rapid and extends in patients undergoing vitrectomy [4]. It is primary posterior capsular continuous curvilinear capsu- confusing for these patients confronted with vision loss lorhexis (PPCCC) at the time of cataract surgery, which may again in the early postoperative period, which lowers the avert vision deterioration in the postvitrectomy eye. 2 Journal of Ophthalmology Nowadays, PPCCC is widely used in pediatric cataract peripheral to create a 2 mm crescent-shaped fissure, and the surgery in the hope of preventing PCO, but not routinely capsule bag was refilled with OVD. Forceps were introduced adopted in adult cataract surgery, attributing to concerns through the main incision to grasp the peripheral edge of the regarding associated complications, including vitreous in- fissure to create a flap. .e edge of the flap was grasped and terface damage, vitreous prolapse, resulting cystoid macular regrasped every quarter circle, enabling a well-centered and edema (CME), and even retinal detachment (RD) [5, 6]. round PPCCC with a diameter of 4-5 mm in size (shown in .ough previous studies have demonstrated its safety and Figure 1). Care should be taken to lift towards the center and efficacy in age-related cataract [7–9], most inexperienced upward along the tangent direction during PPCCC proce- surgeons may still hesitate to this technical demanding dure. A foldable acrylic one-piece IOL (Tecnis ZCB00, J&J manipulation considering the potential complications Vision Inc.) with a 6.0 mm round optic was injected into the mentioned above. anterior chamber using a cartage. We paid attention to keep However, we speculate that compared with non- the main body (optic) of the IOL above the anterior capsule vitrectomy eyes, PPCCC may carry lower risks in post- in case that the IOL tilt or dislocate from the posterior vitrectomy eyes on account of absent vitreous body. To date, capsulotomy. After that, a spatula was used to adjust and few studies have evaluated the use of PPCCC at the time of rotate the IOL into the capsular bag. .e residual OVD was cataract surgery in postvitrectomy eyes of adults. From 2017 aspirated and the surgical wounds were watertight. to 2019, we performed PPCCC with capsular forceps 13 out of 21 eyes coexisted with the residual silicone oil through the corneal incision during cataract surgery in droplets in the vitreous cavity. postvitrectomy eyes. .e safety, feasibility, efficacy, and After PPCCC and before the IOL implantation, the clinical outcomes of PPCCC combined with phacoemulsi- silicone oil droplets were guided and removed by a 21-gauge fication in postvitrectomy eyes are shown as follows. infusion-aspiration syringe from the main incision. .en, the IOL was implanted and the OVD was aspirated from the 2. Materials and Methods anterior and posterior chambers. At last, the surgical wounds were watertight. 2.1. Patients. .is was a retrospective study conducted at the All patients received topical antibiotics, corticosteroids, ophthalmology department, Fujian Provincial Hospital, and nonsteroidal anti-inflammatory eye drops for 4 weeks between April 2017 and December 2019. Postvitrectomy eyes postoperatively. were enrolled consecutively. Exclusion criteria included patients with uveitis, trauma, pseudoexfoliation syndrome, and connective tissue diseases. .e present research adhered 2.3. Statistical Analysis. Snellen visual acuity was converted to the tenets of the Declaration of Helsinki and was approved to logMAR units for comparisons. We used a logMAR VA of by the Institution Review Board of Fujian Provincial Hos- 2 and 3 to represent counting fingers and hand move vision pital, Fujian Medical University. .e informed consent was [10]. Corrected distance visual acuity, corneal endothelial obtained from all the patients. cell density, intraocular pressure, and central macular All patients went through a comprehensive ophthal- thickness were compared between pre- and postprocedural mologic examination preoperatively and at the last follow- levels. .e means and standard deviations (SD) of the up, including Snellen corrected distance visual acuity quantitative variables were calculated. .e paired t-test was (CDVA), IOP measure, corneal endothelial cell count used to detect the differences of quantitative variables when (CECC), slit-lamp examination, fundus examination, central data obeyed normal distribution; otherwise, the Wilcoxon macular thickness (CMT) measurement using spectral do- matched-pairs signed ranks sum test was used. .e differ- main optical coherence tomography (OCT) (Spectralis, ences were considered statistically significant if the P value Heidelberg Engineering GmbH), and anterior segment was less than 0.05. All calculations were performed using retroillumination photograph (SL-D7, TOPCON). .e rate SPSS software (version 24, SPSS, Inc.). of complications and the incidence of PCO were recorded. 3. Results 2.2. Surgical Technique. Surgery was performed by an ex- PPCCC combined with phacoemulsification was performed perienced surgeon (WJ. W). Preoperatively, compound in 21 postvitrectomy eyes of 21 adult patients. .e demo- tropicamide eye drops were used for pupil dilation and graphic characteristics are shown in Table 1. .e mean age of proparacaine eye drops were applied for topical anesthesia. the 9 women and 12 men was 56.14 ± 9.76 years (ranging .e major procedures of phacoemulsification were per- from 31 to 68) when the surgery was performed. .e pre- formed as conventional surgery. .e anterior continuous vious reasons requiring vitrectomy were rhegmatogenous curvilinear
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