Effect Of Manual Posterior Capsulorrhexis Morphological Features On Capsular Bag Dynamics And Postoperative Outcomes: A Prospective Cohort Study

To evaluate the influence of manual posterior continuous curvilinear capsulorrhexis (PCCC) morphological features on capsulorrhexis morphological changes, posterior capsule opacification development, intraocular lens (IOL) stability, and visual quality within the first year after cataract surgery.

This  prospective cohort study was conducted between April 2021 and December 2023 at the Fuzhou University Affiliated Provincial Hospital, Fuzhou, China.

This prospective cohort study was conducted involving adult patients undergoing cataract surgery with manual PCCC. Postoperatively, patients were stratified according to tertiles for each PCCC morphological parameters, including diameter, circularity, and decentration. Follow-up visits were conducted postoperatively at 1 day (baseline), 1 week, 1 month, 3 months, 6 months and 1 year. The presence of visual axis opacification (VAO), refractive change, IOL stability (decentration, rotation and axial movement), and higher-order aberrations (HOAs) were evaluated. The outcomes were compared across tertiles of each PCCC parameter; for significant findings, potential linear or nonlinear relationships were identified.

A total of 105 eyes (105 patients) were included. The range of baseline PCCC diameter, decentration, and circularity was 2.12-4.79 mm, 0.01-1.06 mm, and 0.85-0.88. Over one year, the PCCC area increased (4.35 ± 3.83%), while the ACCC area decreased (-7.20 ± 3.63%). The enlargement and shrinkage were independent of the baseline PCCC diameter. No VAO was observed in all eyes. A nonlinear association was found between baseline PCCC diameter and the change in anterior chamber depth (ACD) from 1 day to 1 year. When the diameter was < 3 mm, ACD change decreased with increasing diameter; for diameter > 3 mm, the decrease in ACD change leveled off. No other significant relationships were identified between PCCC parameters and IOL stability.

PCCC morphology do not affect the efficacy of PCO prevention within postoperative one year. In the context of PCCC size, diameter greater than 3 mm can achieve more stable axial IOL position. Minor deviations in PCCC centration and circularity are tolerable, as they minimally affect postoperative outcomes.