Date Published: March 8, 2019
Publisher: Public Library of Science
Author(s): Kyung-Sup Shin, Hye-Jin Park, Young-Joon Jo, Jung-Yeul Kim, Andrzej Grzybowski.
To evaluate the efficacy and safety of posterior capsulotomy by analyzing the long-term visual outcomes in patients with rhegmatogenous retinal detachment (RD), who underwent combined phaco-vitrectomy with or without primary posterior capsulotomy.
A retrospective longitudinal cohort analysis was performed by using data of rhegmatogenous RD patients undergoing combined phaco-vitrectomy. Patients were divided into two groups; Group A (68 eyes of 68 patients) with capsulotomy, and Group B (39 eyes of 39 patients) without capsulotomy. We reviewed the best-corrected visual acuity (BCVA), incidence of posterior capsule opacification (PCO), clinical features at the diagnosis of rhegmatogenous RD, and intraoperative or postoperative complications following posterior capsulotomy.
The modified BCVA measured by the logarithm of the minimum angle of resolution at initial diagnosis and 3, 6, and 12 months after surgery was 0.67 in Group A versus 0.85 in Group B (p = 0.258), 0.40 in Group A versus 0.50 in Group B (p = 0.309), 0.27 in Group A versus 0.45 in Group B (p = 0.055), and 0.21 in Group A versus 0.47 in Group B (p = 0.014), respectively. In subgroup with macula-on RRD, Group A exhibited better visual outcomes compared to Group B at 6(0.17 versus 0.40 [p = 0.037]) and at 12 months(0.14 versus 0.39 [p = 0.030]). The incidence of PCO in Group B was higher than Group A(28.2% versus 4.4% (p < 0.001)). There were no complications associated with posterior capsulotomy. A primary posterior capsulotomy during combined phaco-vitrectomy using a 23-gauge vitreous cutter was a safe and effective surgical procedure in patients with RRD patients for preventing postoperative intraocular lens-related PCO.
With the advent of modern instrumentation, improved surgical techniques, and improved intraocular lens (IOL), the incidence of posterior capsule opacification has decreased after cataract surgery, but it still remains the most common cause of visual loss.[1, 2] To maximize the visual recovery of outpatients, posterior capsule opacification can be easily treated with non-surgical neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy. However, this procedure is associated with a small risk of complications such as vitreous floaters, a rise in intraocular pressure, macular edema, and damage and decentration of the IOL.[3–8]
This study analyzed the efficacy and usefulness of primary posterior capsulotomy using a 23-gauge vitreous cutter during combined phaco-vitrectomy in rhegmatogenous RD patients with a high risk of PCO. The mean modified BCVA in macular-on group was significantly better in the capsulotomy group than in the non-capsulotomy group at 6 and12 months. The poorer vision in the non-capsulotomy group was attributable to higher incidence of PCO. The incidence of PCO was 6.4-fold higher in the non-capsulotomy group than in the capsulotomy group (28.2% versus 4.4%). The incidence of PCO in our study was approximately 2-fold higher than that (12.5%) reported by Roh et al. who conducted a study of patients with various retinal diseases who underwent combined phaco-vitrectomy. The differences was that our study only reported rhegmatogenous RD patients who were placed in a face-down position after gas tamponade and who were followed up for 1 year. Scharwey et al. reported that combined surgery with intraocular air/gas tamponade induced severe posterior capsular fibrosis in the early postoperative period, and that was presumably caused by the accumulation of fibrin and proliferation stimulating factors in the narrow space between the IOL and the air/gas bubble. We hypothesize that a prolonged postoperative face-down position and an exudative membrane formed by inflammation associated with the intraocular laser might play a synergistic role in the development of PCO.