incidence of posterior capsular opacification in rigid pmma

Incidence of Posterior Capsular Opacification in Rigid PMMA IOLs

Dr. Anand Sudhalkar

Dr. Sudhalkar Eye Hospital And Retinal Laser Centre, Baroda

204/10/23

Literature Review Ram Pandey, Apple et al JCRS 2001;27:1039-1046 (Visually

Significant PCO) Oliver Findl et al JCRS: Vol. 29 No.1, Jan 2003(PCO

Quantification by automated system) Tetz-M,Sperker-M et al Heidelberg Germany Ophthalmologe.

1996 Feb; 93(1) : 33-7) (Morphological PCO scoring) Ravalico, Tognetto, Italy JCRS 1996. Jan-Feb; 22(1):98-103

(Rhexis size and PCO) Yamada-K, Nagamoto-T et al JCRS Nov 1995; 21(6) : 697-700

(IOL design and PCO) Mamalis, Crandall et al JCRS 1995 Jan; 21(1): 99-102(IOL size) Anna Lundvall JCRS 2003 29:159-163(HSM IOL) Nishi O, Nishi K JCRS 1995 Sep 21(5) : 574-8 (Indomethacin

Coating)


304/10/23

Purpose :Compare incidence of PCO in following groups :

Age and Sex. ECCE / Phaco IOL designs : Convex-Plano / Biconvex,

sizes : 6.5 / 5.5 mm and Surface modifications : HSM / NONHSM


404/10/23

Study Design :

Retrospective analysis of 2500 RIGID PMMA IOLs done over last 14 years done by the same surgeon with ECCE or Phaco.

PCO considered visually significant when vision dropped to 6/18 over three year post op followup


504/10/23

Methods: ECCE

Canopener, > 7mm capsulotomy,

8mm limbal incision, Hydroprolapse of nucleus

in AC & Viscoexpression of nucleus.

Cortical removal by Simcoe canula

Implantation of 6.5mm PMMA IOL Convex-Plano or Biconvex design.

5, 10/0 interrupted Nylon sutures


604/10/23

Methods: Phaco

Rhexis, 5.5mm or less, 3mm direct entry phaco incision

Hydrodissection, delineation and nucleus rotation.

4 quad. Divide and conquer technique (Storz Protégé) of nucleus emulsification.

Bimanual cortical aspiration. Incision enlarged by 5.5mm 5.5mm rigid all PMMA biconvex

IOL implantaion under viscoelastics.

Wound left unsutured or with one 10/0 suture, after testing wound integrity with Q-tips.


704/10/23

Methods : All cases

Viscoelastics : Methyl cell. Or Healon used. NO CAPSULAR POLISHING. Post op Steroids, Antibiotics and cycloplegics

for two months Follow ups 1st, 7th day, 1month and three

monthly for 3 years. BCVA recorded each visit. Drop in BCVA due to PCO, by two or more

Snellen lines considered for yag laser Post YAG vision tested for full recovery.


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Study Design : Case Selection

Inclusion criteria : Uncomplicated cataract cases, uneventful surgeries, Immediate post op vision 6/9 or better.

Exclusion criteria : Associated conditions like glaucoma, iritis, maculopathies, corneal opacities.

Delayed exclusions : Failure to regain pre-yag vision (CME, Diabetic maculopathy etc)


904/10/23

Age And Sex Association

SEX TOTAL AGE <50 YAG % YAG AGE >50 YAG % YAG

MALE 1173 172 38 22.09% 1001 163 16.28%

FEMALE 1317 202 30 14.85% 1115 154 13.81%

TOTAL 2490 374 68 18.18% 2116 317 14.98%

Chi-square = 8.68 Degree of freedom =3 , P=0.0338


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ECCE :

III Piece PMMAConvex-Plano Single Piece Biconvex


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Age < 50 Years Age > 50 Years

Cases Yag % Yag cases Yag % Yag cases Yag % Yag

Convex Plano

371 36 9.7% 69 7 10.4% 302 29 9.6%

Biconvex 1811 282 15.5% 261 51 19.5% 1550 231 14.8%

Total 2182 318 14.5% 330 58 17.5% 1852 260 14.03%

ECCE : IOL Designs

Chi-square =12.39 Degree of freedom = 3 P = 0.0061


1204/10/23

ECCE : Surface Modifications HSM AGAINST NON HSM

Single PieceBiconvex


1304/10/23

ECCE :HSM AGAINST NON HSM


Cases Yag % Yag Cases Yag % Yag cases Yag % Yag

Non HSM 1788 282 15.7% 259 51 19.6% 1529 232 15.17%

HSM 24 0 0% 2 0 0% 22 0 0%

Total 1812 282 15.5% 261 51 19.4% 1551 232 14.9%

Chi-square = 7.93 Degree of freedom = 3 P = 0.0474


1404/10/23

PHACO : Biconvex IOLNON HSM v/s HSM


1504/10/23

PHACO : NON HSM v/s HSM


Cases Yag % Yag Cases Yag % Yag cases yag %yag

Non HSM

290 67 23.1% 40 13 32.5% 250 54 21.6%

HSM 18 2 11% 5 2 40% 13 0 0

TOTAL 308 69 22.4% 45 15 33.3% 263 54 20.5%

Chi-square = 7.08, Degree of freedom = 3, P= 0.06931


1604/10/23

ECCE V/S PHACO


1704/10/23

ECCE V/S PHACO


cases Yag % Yag

Cases Yag % Yag

cases yag % yag

ECCE 1812 318 17.5% 261 51 19.5% 1551 232 14.9%

Phaco 308 67 21.7% 44 13 29.5% 264 54 20.4%

Total 2120 385 18.1% 305 64 20.9% 1815 286 15.7%

Chi-square = 12.85 Degree of freedom = 3 P = 0.00496


1804/10/23

Conclusions 1. There was a statistically significant relation between the two genders,

males had a higher incidence of yag laser for PCO than females (P = 0.338)

2. In ECCE group, comparison between Three Piece against Single Piece all PMMA IOLs, with 13mm length and 6.5mm optic, showed highly significant decrease in PCO in the former group. (P=0.00061)

3.. In ECCE group alone, using all PMMA IOls, with or without Heparin Surface Modifications, showed statistically significant decrease in Yag Rate in HSM IOL subgroup (P = 0.0474)

4. In comparison between ECCE and Phaco groups using single piece all PMMA IOLs, the yag rate was higher in Phaco group (P= 0.00496)

5. In Phaco group, comparison between Single Piece all PMMA IOLs with and without Heparin surface modification, showed significant decrease in PCO with HSM group at 10% probability (P = 0.69)


1904/10/23

Summary : Choice for Rigid PMMA

Convex –Plano designHeparin Surface ModificationLarge capsulotomy


2004/10/23

incidence of posterior capsular opacification in rigid pmma

Health & Medicine

yag yag age

yag yag cases age

yag laser post yag vision

years age

higher incidence of

preyag vision cme

yag rate inhsm iolsubgroup

hsm vs hsm chisquare