Ram J, Pandey S K, Apple D J, Werner L, Brar G S, Singh R, Chaudhary K P, Gupta A
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
J Cataract Refract Surg. 2001 Jul;27(7):1039-46. doi: 10.1016/s0886-3350(00)00841-5.
To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence.
Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.
This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic.
Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P <.001, chi-square test) after a mean follow-up of 2.4 years +/- 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P <.001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P <.05, chi-square test).
In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.
比较囊外白内障摘除术（ECCE）和超声乳化术后后囊膜混浊（PCO）的发生率，并评估后房型人工晶状体（PC IOL）襻固定及生物材料/设计在降低其发生率方面的作用。
印度昌迪加尔医学教育与研究研究生院；美国南卡罗来纳州查尔斯顿市南卡罗来纳医科大学风暴眼研究所眼治疗与生物装置研究中心。
本研究纳入263例行ECCE的患者的278只眼以及297例行超声乳化联合PC IOL植入术的患者的318只眼。导致Snellen视力下降2行或更多行的后囊膜混浊被视为具有视觉显著性。术后使用裂隙灯生物显微镜评估PCO的存在及IOL襻固定情况。记录襻的位置为囊袋内（B-B）、1个襻在囊袋内1个在睫状沟（囊袋-睫状沟[B-S]）或两个襻均在囊袋外（睫状沟-睫状沟[S-S]）。此外，比较了3种IOL生物材料（聚甲基丙烯酸甲酯、硅酮和疏水丙烯酸酯）之间具有视觉显著性PCO的发生率。
平均随访2.4年±0.7（标准差）后，行ECCE的眼中42.45%发生了具有视觉显著性的PCO，而行超声乳化术的眼中这一比例为19.18%（P<0.001，卡方检验）。在两组中，B-B固定的眼中具有视觉显著性的PCO明显少于B-S或S-S固定的眼（P<0.001）。超声乳化组中B-B固定的所有眼中具有视觉显著性PCO的发生率较低（11.90%），而使用疏水丙烯酸酯IOL的眼中该发生率显著更低（2.22%；P<0.05，卡方检验）。
需要囊袋内PC IOL固定以持续降低PCO的发生率。无论采用何种手术方式或IOL类型，彻底清除晶状体物质（包括水分离辅助的皮质清除）及囊袋内PC IOL固定似乎是降低PCO的最重要因素。IOL生物材料和设计也有助于预防PCO。
