Local Inflammatory Response After Phacoemulsification Complicated By Lens Material In The Retrolental Space With And Without Draining Posterior Capsulorhexis

To evaluate the severity of local inflammatory response after cataract surgery complicated by lens material in the retrolental space by assessing the profile of proinflammatory cytokines in tear and central retinal thickness (CRT) changes according to OCT.

To evaluate the safety and efficacy of draining posterior capsulorhexis (DPCR) in case of lens material in the retrolental space during phacoemulsification.

IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia

Authors suggest original technique of primary posterior capsulorhexis with following passive aspiration of lens material from the retrolental space before IOL implantation which was called draining posterior capsulorhexis (DPCR)

There were 3 groups of patients in the prospective study: 1). control group - uneventful phaco (30 patients); 2). comparison group - phaco complicated by lens particles in the retrolental space (30 patients); 3). study group -phaco complicated by lens particles in the retrolental space with DPCR (30 patients).

BCVA, concentration of IL-6, IL-8 in tear using ELISA, central retinal thickness (CRT) according to OCT were assessed before surgery, on the1st day, at 1 week and 1 month postop.

There was no statistically significant difference in BCVA among groups during follow-up period. In all groups, an increase in the concentration of the studied cytokines was noted on 1st day postop, followed by a decrease in the concentrations of IL-6 and IL-8 at 1 week postop. However, the degree of decrease in the concentration of proinflammatory cytokines was lower in the comparison group (IL- 6 – -29%, IL8 - -4% pre-op to 1 week postop). CRT changes were similar at 1 week but showed significant increase in comparison group at 1 month postop (+4,1% in control group; + 17,3% in comparison group; + 5,2% in study group; Kruskal-Wallis test p= .015). There was strong correlation between IL-6 and CRT change in the comparison group.

Presence of lens material in the retrolental space during phacoemulsification leads to an increased local inflammatory response. It was confirmed by lower degree of proinflammatory cytokines concentration decrease in tear at 1 week postop, as well as a significant increase in the CRT according to OCT at 1 month postop.

Performing DPCR allows to reduce the local inflammatory response severity, that was confirmed by lower concentration of pro-inflammatory cytokines in tear compared to the group with lens material in the retrolental space at 1 week postop, as well as absence of significant changes in CRT in comparison with uneventful phacoemulsification group at 1 month postop.