Posterior Capsular Cleaning In Eyes With Long Axial Length And High Grade Posterior Capsular Opacification

Posterior capsule opacification (PCO) is the most common postoperative complication of cataract surgery. In this study, we wanted to evaluate the efficacy and safety of the surgical posterior capsule cleaning technique in patients with long axial lenght and posterior capsular opacity.

Konyagoz Eye Hospital, Department of Ophthalmology, Konya, Turkey.

Twenty-four eyes of 24 patients with an axial length of 26 mm or more, who underwent posterior capsule cleaning due to grade 4 PCO in our clinic, were included in the study. The main clear corneal incision and three side port incisions were made. The intraocular lens (IOL) was released with the help of a spatula and the posterior capsule was polished by entering under the IOL with a coaxial irrigation and aspiration (I/A) probe. Preoperative and postoperative best-corrected visual acuity (in decimal notation), astigmatism, corneal endothelial cell loss, spherical equivalent, intraoperative and postoperative complications were evaluated.

The mean patient age was 67.8 ± 10.1 years (range, 40-82 years). The mean pre-and postoperative best-corrected visual acuities were 0.25 ± 0.14 and 0.85 ± 0.19, respectively (p<0.001). The mean axial length was 28.1 ± 1.7 mm. No major intraoperative complications were observed. In the postoperative period, IOL decentralization, uveitis, hypotonia, choroidal effusion, cystoid macular edema, retinal detachment, and endophthalmitis were not observed in any patient. There was only transient IOP elevation in 1 eye (4.1%) and mild anterior chamber reaction in 1 eye (4.1%). The mean endothelial cell density reduced from 2,644.4 ± 332.4 cells/mm2  preoperatively to 2,537.6 ± 347.2 cells/ mm2  postoperatively (p<0.05).

Especially in patients with high-grade PCO, a previous history of retinal detachment, long axial length, lattice degeneration, or complicated cataract surgery, posterior capsular cleaning technique may be an alternative treatment option to avoid sight-threatening complications such as retinal detachment, retinal tear, and cystoid macular edema by preserving the capsular bag.