Abstract

Background: Combining primary posterior capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPCCC and POBH to conventional in-the-bag implantation of the IOL.

Design: Prospective, randomized clinical trial.

Methods: Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively. In randomized order, cataract surgery with combined PPCCC and POBH was performed in one eye; in the fellow eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12, and 24 hours postoperatively, as well as 1 week and 1 month postoperatively, using the Laser Flare Cell Meter KOWA FC-1000.

Results: The peak of intraocular flare was observed in POBH-eyes and eyes with in-the-bag IOL implantation one hour postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, slightly though statistically significantly higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). One week and one month postoperatively, intraocular flare measurements were comparable again (p>0.05).

Conclusion: Cataract surgery with combined PPCCC / POBH showed slightly lower postoperative anterior chamber reaction as conventional in-the-bag implantation during 4-week follow-up, indicating that POBH may trigger somewhat less inflammatory response. This may be explained by the posterior capsule sandwiching between the optic and the anterior capsule, which prevents direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.