Study of State of Interface “Intraocular Lens — Posterior Capsule” Depending on Size of Capsulorhexis in Senile Cataract Phacoemulsification

Purpose. To study the state of interface “intraocular lens (IOL) — posterior capsule (PC)” depending on diameter of capsulorhexis in phacoemulsification of senile cataract.

Patients and methods. 227 patients (227 eyes) were examined after phacoemulsification of senile cataract at LenSx femtosecond laser (Alcon, USA). The study did not include patients with corneal opacities, signs of axial displacement of lens, with irido- and phacodonesis, glaucoma, axial length less than 22 mm and more than 26 mm. Depending on diameter of performed capsulorhexis, we formed 3 groups: 1st group — 76 eyes with diameter capsulorexis 5.5 mm; 2nd group — 73 eyes with 5.0 mm; 3rd group — 78 eyes with 4.5 mm. We studied type of interface “IOL — PC”, the maximum value of PC diastasis and the maximum depth of its folds using an RTVue-100 Optical Coherence Tomography (Optovue, USA) on the first day after the operation.

Results. The maximum number of eyes with absence of contact between IOL and PC was noted in the 3rd group (62.8 %), the largest number of eyes with full contact between IOL and PC (63.2 %) was in the 1st group. The minimum average depth of the PC folds (111.1 ± 32.7 μm) was noted in the 1st group, and the maximum (165 ± 75.4 μm) — in the 2nd group.

Conclusion. The analysis showed that type of interface “IOL — PC” in the first day after phacoemulsification of senile cataract depends on diameter of capsulorhexis. The largest number of eyes (64.6 %) with full contact between IOL and PC was observed in the group of patients with capsulorhexis 5.5 mm, and the smallest (6.4 %) — in eyes with diameter capsulorexis 4.5 mm. Presumably, the main reason for the absence or incomplete contact between IOL and PC is the presence of viscous dispersive between them. The deformation of PC in the form of folds does not directly depend on diameter of capsulorhexis and, obviously, is due to the uneven tension of the capsular bag by the IOL haptics.

1. Bai L., Vasiliev A.V., Egorova A.V. Clinical and functional results of IOL pneumocompression method implementation at phacoemulsification of senile cataract. Fyodorov Journal of Ophthalmic Surgery = Oftalmokhirurgiya. 2019;1:6–10 (In Russ.) DOI: 10.25276/0235-4160-2019-1-6-10

2. Vasiliev A.V., Egorova A.V., Egorov V.V., Bai L. Analysis of effectiveness of applying the IOL pneumocompression technique in phacoemulsification in prevention of posterior capsule opacification. Modern technologies in ophthalmology = Sovremennyye tekhnologii v oftal’mologii. 2017;6:32–34 (In Russ.)

3. Egorova E.V. Anatomical and topographical relations between the posterior lens capsule and the intraocular lens in pseudo-exfoliation syndrome. Ophthalmology in Russia = Oftalmologiya. 2018;15(2S):134–139 (In Russ.) DOI: 10.18008/1816-5095-2018-2S-134-139

4. Hirnschall N., Nishi Y., Crnej A., Koshy J., Gangwani V., Maurino V., Findl O. Capsular bag stability and posterior capsule opacification of a plate-haptic design micro incision cataract surgery intraocular lens: 3-year results of a randomized trial. Br. J. Ophthalmol. 2013;97(12):1565–1568. DOI: 10.1136/bjophthalmol-2013-303710

5. Lytvynchuk L.M., Glittenberg C.G., Falkner-Radler C.I., Neumaier-Ammerer B., Smretschnig E., Hagen S., Ansari-Shahrezaei S., Binder S. Evaluation of intraocular lens position during phacoemulsification using intraoperative spectral-domain optical coherence tomography. J. Cataract. Refract. Surg. 2016;42(5):694–702. DOI: 10.1016/j.jcrs.2016.01.044

6. Perez-Vives C. Biomaterial influence on intraocular lens performance: an overview. J Ophthalmol. 2018;2018:2687385. DOI: 10.1155/2018/2687385

7. Zhao Y., Li J., Lu W., Chang P., Lu P., Yu F., Xing X., Ding X., Lu F., Zhao Y. Capsular adhesion to intraocular lens in highly myopic eyes evaluated in vivo using ultralong-scan-depth optical coherence tomography. Am. J. Ophthalmol. 2013;155(3):484–491. DOI: 10.1016/j.ajo.2012.08.019

8. Zhu X., He W., Yang J., Hooi M., Dai J., Lu Y. Adhesion of the posterior capsule to different intraocular lenses following cataract surgery. Acta Ophthalmologica. 2016;94(1):16–25. DOI: 10.1111/aos.12739

9. Zhu X., Lu Y. Detection and influencing factors of capsular bag distention syn‑ drome after cataract surgery using the Pentacam Scheimpflug system. Am J Ophthalmol. 2013;156(6):1134–1140. DOI: 10.1016/j.ajo.2013.07.028

10. Gao Y., Dang G.-F., Wang X., Duan L., Wu X.-Y. Influences of anterior capsule polishing on effective lens position after cataract surgery: a randomized controlled trial. Int J Clin Exp Med. 2015;8(8):13769–13775.

11. Modesti M., Pasqualitto G., Appolloni R., Pecorella I., Sourdille P. Preoperative and postoperative size and movements of the lens capsular bag: ultrasound biomicroscopy analysis. J Cataract Refract Surg. 2011;37(10):1775–1784. DOI: 10.1016/j.jcrs.2011.04.035

12. Egorova E.V., Betke A.V., Bezborodov V.G. Mathematical modeling in a solution of the long-term complications problem of cataract surgery with zonular weakness. Fyodorov Journal of Ophthalmic Surgery = Oftalmokhirurgiya. 2014;3:13–18 (In Russ.)

13. Kugelberg M., Wejde G., Jayaram H., Zetterstrom C. Two-year follow-up of posterior capsule opacification after implantation of a hydrophilic or hydrophobic acrylic intraocular lens. Acta Ophthalmol. 2008;86(5):533–536. DOI: 10.1111/j.16000420.2007.01094.x

14. Moreno-Montanes J., Alvarez A., Bes-Rastrollo M., Garcia-Layana A. Optical coherence tomography evaluation of posterior capsule opacification related to intraocular lens design. J. Cataract. Refract. Surg. 2008;34(4):643–650. DOI: 10.1016/j.jcrs.2007.11.035

15. Nagy Z.Z., Dunai A., Kranitz K., Takács A.I, Sándor G.L., Hecz R., Knorz M.C. Evaluation of femtosecond laser-assisted and manual clear corneal incisions and their effect on surgically induced astigmatism and higher-order aberrations. J. of Refractive Surgery. 2014;30(8):522–525. DOI: 10.3928/1081597x-20140711-04

16. Yotsukura E., Torii H., Saiki M., Negishi K., Tsubota K. Effect of neodymium:YAG laser capsulotomy on visual function in patients with posterior capsule opacification and good visual acuity. J Cataract Refract Surg 2016;42(3):399–404. DOI: 10.1016/j.jcrs.2015.11.042

17. Takhchidi Kh.P. The method of removal of a visco-drug from the cavity of the eye. Patent RU 2125857?10.02.1999 (In Russ.)

18. Kollias A.N., Vogel M.A., de Kaspar H.M. Propionibacterium acnes in capsular bag distension syndrome. J. Cataract Refract. Surg. 2010;36(1):167–169. DOI: 10.1016/j.jcrs.2009.06.047

19. Dyachenko Yu.N., Kravchenko I.Z., Pshenichnov M.V., Sorokin E.L. Capsule block — postoperative complication of phacoemulsification, clinical manifestations, tactics. Modern technologies in ophthalmology = Sovremennyye tekhnologii v oftal’mologii. 2017;3:290–292 (In Russ.)

20. Malyugin B.E., Verzin A.A., Vlasenko A.V. Capsular block syndrome as a complication of phacoemulsification and posterior chamber intraocular lens implantation. Fyodorov Journal of Ophthalmic Surgery = Oftalmokhirurgiya. 2015;1:57–61 (In Russ.)