The Effect Of Anterior Capsulorhexis Morphology On Posterior Capsular Opacification

Background Phacoemulsification combined with intraocular lens implantation is currently widely used in the treatment of cataract.It has the advantages of safety,effectiveness and short recovery time.However,the most common postoperative complication,posterior capsular opacity(PCO),can lead to the decline of postoperative visual quality.PCO is thought to be related to the proliferation,migration and transdifferentiation of residual lens epithelial cells.Neodymium:yttrium aluminum garnet(nd:yag)laser posterior capsulotomy can effectively improve visual acuity in the treatment of posterior cataract.However,nd:yag laser posterior capsulotomy has been reported to have ocular complications such as intraocular lens injury,elevated intraocular pressure,macular edema and retinal detachment,and the laser procurement cost is high and the universality is low.Nowadays,with the continuous progress of surgical techniques,intraocular lens materials and other interventions,the incidence rate of PCO has decreased,but it has not been completely eliminated.With the development of cataract surgery,people’s expectations for the effect of surgery are also improving.The design of surgical scheme has a significant impact on postoperative PCO.How to safely and effectively prevent PCO is the top priority.In this study,we retrospectively studied the posterior capsule opacification in patients after cataract surgery,and observed the effect of anterior capsulorhexis on posterior capsule opacification.Objective To study the effect of anterior capsulorhexis on posterior capsular opacification during cataract surgery,and to explore the possibility of preventing PCO from the perspective of surgery.Methods 120 patients(152 eyes)who received cataract phacoemulsification combined with intraocular lens implantation in the Department of Ophthalmology of Shandong Provincial Hospital,including 58 males(71 eyes)and 62 females(81 eyes),with an average age of 66.90±10.01 years,were included.All subjects were fully mydriatic after eliminating the taboo of mydriasis.The red light reflection images of the anterior and posterior capsules were collected by the digital slit lamp micro imaging system,Each inspection shall be completed by the same operator under the same conditions.The patients were divided into groups according to the covering degree of the capsulorhexis edge to the edge of the optical part of the IOL:46 patients(62 eyes)in the complete covering group in group A,49 patients(60 eyes)in the incomplete covering group in group B,and 25 patients(30 eyes)in the complete uncovered group in group C.The obtained anterior segment images were imported into Photoshop processing software for marking and selection.The posterior capsule opacification area,capsulorhexis diameter,capsulorhexis shape factor and other indicators were measured and recorded with Image J software.Results The basic data of all subjects were comparable.Posterior capsular opacification occurred in 121 eyes of 152 eyes,and the incidence of PCO was 79.6%.The incidence of PCO in the completely covered group was the lowest,and the incidence of regenerative PCO was the highest.The postoperative time was significantly longer in PCO group.PCO grade was positively correlated with postoperative time.The irregular rate of capsulorhexis edge in PCO group was higher than that in non PCO group.The defect of the tear shape of PCO group was smaller than that of PCO group.The coverage rate of the capsulorhexis edge and the IOL optical part edge in the incomplete occlusion group without PCO was higher than that in the PCO group.Conclusion PCO is a late complication after cataract surgery.With the extension of postoperative time,PCO grade became worse.Fibrotic PCO occurred earlier than regenerative PCO.Regenerative PCO is the most common type of clinical PCO.The regularity of the anterior capsulorhexis edge and the covering degree of the capsulorhexis edge and the edge of the IOL optical part all affect the occurrence of PCO.The closer the shape of the continuous circular capsulorhexis of the anterior capsule is to the positive circle,the more conducive it is to reduce the incidence of postoperative posterior capsular opacification.The perfect capsulorhexis close to the positive circle during the operation is a favorable factor to reduce the incidence of postoperative PCO.