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Ocena wyników leczenia zmętnienia torebki tylnej za pomocą kapsulotomii tylnej okrężnej wykonanej w czasie fakoemulsyfikacji
Evaluation of the Results of Posterior Capsule Opacification Treatment During Phacoemulsification with Posterior Circular Capsulotomy
Monika Aniukiewicz 1 , Maria Liwacz 2 , Sławomira Fenger-Woźnicka 1 , Anna Dziedzic 2 , Milena Kozera 3 , Marek Rękas 3 , Maciej Karolkiewicz 1
1 Oddział Okulistyki Szpitala Wielospecjalistycznego w Inowrocławiu
Ordynator: dr n. med. Sławomira Fenger-Woźnicka
2 Oddział Okulistyki Szpitala Wojewódzkiego w Koszalinie
Ordynator: lek. Maria Liwacz
3 Klinika Okulistyki CSK MON
Wojskowy Instytut Medyczny w Warszawie
Kierownik: płk prof. dr hab. n. med. Marek Rękas
Summary: Purpose: Assessment of the results of posterior capsule treatment via circular posterior capsulorhexis conducted during phacoemulsification in groups with a risk of posterior capsule opacification.
Material and methods: Twenty-two patients (22 eyes) included in the study were subjected to phacoemulsification with artificial lens implantation preceded by posterior continuous curvilinear capsulorhexis. Included patients had a risk of posterior capsule opacification (young patients with diabetes and posterior subcapsular cataracts), while excluded patients had a history of previous ophthalmic surgeries, trauma, uveitis, corneal diseases, optic nerve and retinal diseases, astigmatism >1.5 Dcyl. Before the surgery and 1, 7, 30, 90 and 180 days after the surgery, we assessed uncorrected distance visual acuity and corrected distance acuity, and conducted biomicroscopic evaluation of the anterior and posterior segment, Javal keratometry, and thickness measurement of the retina and choroid in the macula (using Optical Coherence Tomography camera). In the postoperative period, 1, 7, 30, 90 and 180 days after the surgery, surgically-induced astigmatism was calculated.
Results: In the postoperative period, a statistically significant improvement in visual acuity was noticed during the follow-up visits (p<0.001). The cylinder values of keratometric astigmatism before and six months after the surgery did not differ significantly (p=0.414). There were no statistically significant differences in the angles before and six months after the surgery (p=0.295). Surgically induced-astigmatism values from various periods of observation were not statistically significant (p=0.70). The means for the surgically-induced astigmatism angles did not differ significantly (p=0.38). A significant decrease in the mean intraocular pressure compared to the preoperative values was reported one week after the surgery (p<0.001). In one patient, intraocular pressure increase to 26 mmHg was observed 1 day after the surgery. Increase in the retinal thickness in the macula was reported in the horizontal dimension 1 month after the surgery (P<0.001) and in the vertical dimension 1 (P<0.001), 3 (P=0.026) and 6 months (P=0.028) after the surgery. Mean retinal thickness in the macula in the combined horizontal and vertical dimensions were statistically significant 1 month (P=0.001) and 3 months (P=0.017). Increase in the choroid thickness in the vertical dimension was observed 1 month after the surgery (P=0.041). The change in the retinal and choroidal thickness did not affect visual acuity in each period of observation after cataract surgery. Only at the time point of 3 months, a positive correlation of the retinal thickness in the vertical dimension and visual acuity was demonstrated (P<0.05). No intraoperative complications were observed in the study group. In two patients, on the first day after the surgery, corneal edema was reported. Cystoid macular edema was found in one person after one month.
Conclusions: Phacoemulsification with posterior continuous curvilinear capsulorhexis is a safe procedure that protects from posterior capsulae opacification and does not cause an increased number of intraoperative or postoperative complications.
Słowa kluczowe: kapsulotomia tylna okrężna (PCCC), zmętnienie torebki tylnej (PCO), astygmatyzm indukowany chirurgicznie (SIA), torbielowaty obrzęk plamki (CME).
Keywords: primary posterior continuous curvilinear capsulorhexis (PCCC), posterior capsule opacification (PCO), surgically induced astigmatism (SIA), cystoid macular edema (CME).