Liquifaction Method and Extent of Liquifaction Method and Extent of Posterior Capsule Opacification: Posterior Capsule Opacification: Two-Year Follow-upTwo-Year Follow-up

Marie KalfertovaMarie Kalfertova, Mariya Burova, Pavel Rozsival, , Mariya Burova, Pavel Rozsival, Nada JiraskovaNada Jiraskova

The authors have no financial interest in the subject of this The authors have no financial interest in the subject of this posterposter

Supported in part by Charles University Grant Agency,

No. 103809

PurposePurpose

PCO is still one of the most common complication PCO is still one of the most common complication following cataract surgery with IOL implantation following cataract surgery with IOL implantation

we evaluate the extent of posterior capsule opacification we evaluate the extent of posterior capsule opacification (PCO) after cataract surgery(PCO) after cataract surgery

Right eye: torsional phacoemulsification and AquaLase Right eye: torsional phacoemulsification and AquaLase removal of the epithelial cells removal of the epithelial cells

Left eye: torsional phacoemulsification without AquaLaseLeft eye: torsional phacoemulsification without AquaLase

we examine the safety of this method for intraocular we examine the safety of this method for intraocular tissue – follow endothelial cell count (ECC), pachymetrytissue – follow endothelial cell count (ECC), pachymetry

MethodsMethods

prospective clinical study prospective clinical study we examine patient 3, 6, 12 and 24 months after we examine patient 3, 6, 12 and 24 months after

surgery, digital retroillumination photographs of the surgery, digital retroillumination photographs of the anterior segment, pachymetry, endothelial cell count anterior segment, pachymetry, endothelial cell count (ECC) and best corrected visual acuity are obtained(ECC) and best corrected visual acuity are obtained

ECC and pachymetry were obtained preoperatively tooECC and pachymetry were obtained preoperatively too Evaluation of posterior capsule opacificationEvaluation of posterior capsule opacification - - EPCO 2000 software (Evaluation of Posterior Capsule EPCO 2000 software (Evaluation of Posterior Capsule

Opacification)Opacification) OSCA software (Open-Access Systematic Capsule OSCA software (Open-Access Systematic Capsule

Assessment)Assessment)

MethodsMethods

Liquifaction Method:Liquifaction Method: uses warm pulses (57°C) of balanced salt uses warm pulses (57°C) of balanced salt

solution (BSS) to strain and dissolve the lens for solution (BSS) to strain and dissolve the lens for aspiration.aspiration.

we use the pulses for removal of the epithelial we use the pulses for removal of the epithelial cellscells

within the AquaLase handpiece, 4within the AquaLase handpiece, 4µµL fluid pulses L fluid pulses are generated as current passes between are generated as current passes between electrodeselectrodes

the BSS pulses are delivered at a maximum rate the BSS pulses are delivered at a maximum rate of 50 Hzof 50 Hz

Methods - patientsMethods - patients 50 patients (mean age 69,66 50 patients (mean age 69,66 ±± 9,1) 9,1) 34 women (70,68 34 women (70,68 ±± 7,5) 7,5) 16 men (67,5 16 men (67,5 ±± 11,5) 11,5) patient with bilateral cataract, preferably with similar patient with bilateral cataract, preferably with similar

density gradesdensity grades patient with corneal and retinal disease were patient with corneal and retinal disease were

excludedexcluded informed consent was obtained from all selected informed consent was obtained from all selected

patientspatients two years after surgery were 48 patients examined two years after surgery were 48 patients examined

(two patients haven´t underwent the last (two patients haven´t underwent the last examination)examination)

MethodsMethods EPCO 2000EPCO 2000 - - Evaluation of

Posterior Capsule Opacification software

computer-assisted system of PCO morphologic assessment, introduced in 1997 by Tetz

incorporates planimetric and grading assessment

the density of the opacification is graded clinically from 0 to 4

the selection process and grading of areas are subjective

OSCA systemOSCA system - - Open-Access Systematic Capsule Assessment

is based on location-sensitive entropy-based texture analysis

presented by Aslam (2006) most objective system possible OSCA scores

range from 0 (no PCO) to approximately 15 (expected maximum PCO)

typical OSCA value for images with very little or no PCO is approximately 0.5

Nekolova J, Pozlerova J, Jiraskova N et al.: Comparison of posterior capsule opacification after Nekolova J, Pozlerova J, Jiraskova N et al.: Comparison of posterior capsule opacification after two different surgical methods of cataract extraction. Am J Ophthalmol 2008;145:493-498two different surgical methods of cataract extraction. Am J Ophthalmol 2008;145:493-498

MethodsMethods

digital retroillumination photographsdigital retroillumination photographs after EPCO 2000 evaluationafter EPCO 2000 evaluation

ResultsResults

00,050,1

0,150,2

0,250,3

0,350,4

0,450,5

PCO total index

3 6 12 24

months

EPCO results

Right eye

Left eye

Right eye: 0,260 ± 0,198 (3M); 0,259 ± 0,173 (6M); 0,308 ± 0,19 (12M); 0,419 ± 0,252 (24M)Left eye: 0,279 ± 0,170 (3M); 0,280 ± 0,153 (6M); 0,333 ± 0,197 (12M); 0,480 ± 0,313 (24M)

ResultsResults

0,560,570,580,590,6

0,610,620,630,640,650,66

OSCA score

3 6 12 24

months

OSCA results

Right eye

Left eye

Right eye: 0,599 ± 0,240 (3M); 0,605 ± 0,333 (6M); 0,598 ± 0,256(12M); 0,655 ± 0,402 (24M)Left eye: 0,627 ± 0,403 (3M); 0,635 ± 0,360 (6M), 0,629 ± 0,328 (12M), 0,654 ± 0,452 (24M)

ResultsResults

there was minimal loss of endothelial cell count and minimal changes in the corneal thickness in both eyes

there was no statistical significant difference between right eye and left eye

Conclusions Nd-YAG laser capsulotomy one year after surgery underwent Nd-YAG laser capsulotomy one year after surgery underwent

one patient (both eyes) and one patient two years one patient (both eyes) and one patient two years postoperatively (right eye)postoperatively (right eye)

BCVA two years postoperatively:BCVA two years postoperatively: Right eye: 0,896 Right eye: 0,896 ±± 0,13 (min.0,6; max.1,2) 0,13 (min.0,6; max.1,2) Left eye: 0,883 Left eye: 0,883 ±± 0,16 (min.0,4; max.1,2) 0,16 (min.0,4; max.1,2) ECC (cells/ mmECC (cells/ mm²²): ): Right eye - preop.: 2537,6; 3 months postop.: 2354,6 Right eye - preop.: 2537,6; 3 months postop.: 2354,6 Left eye - preop.: 2582,5; 3 months postop.: 2387,0Left eye - preop.: 2582,5; 3 months postop.: 2387,0 Pachymetry (Pachymetry (µµm): m): Right eye – preop.: 565,1; 3 months postop. 561,2Right eye – preop.: 565,1; 3 months postop. 561,2 Left eye – preop.: 562,2; 3 months postop. 557,1Left eye – preop.: 562,2; 3 months postop. 557,1 our results show that this method is safe for intraocular tissue, our results show that this method is safe for intraocular tissue,

our work confirmed previous results Jiraskova et al.our work confirmed previous results Jiraskova et al. Jiraskova N, Kadlecova J, Rozsival P et al. Comparison of the effect of AquaLase and NeoSoniX Jiraskova N, Kadlecova J, Rozsival P et al. Comparison of the effect of AquaLase and NeoSoniX

phacoemulsification on the corneal endothelium. J Cataract Refract Surg 2008; 34:377-382phacoemulsification on the corneal endothelium. J Cataract Refract Surg 2008; 34:377-382

Conclusions a increase in EPCO 2000 indexes and OSCA scores

found during 24 months in both eyes the comparison of PCO between right eye (with

liquifaction method) and left eye is done: paired t test analysis P-values: EPCO: 0,1 (3M); 0,29 (6M); 0,052 (12M); 0,153 (24M) OSCA: 0,379 (3M); 0,525 (6M); 0,952 (12M); 0,949 (24M) there was no proven significant difference between right

eye and left eye, the mean total EPCO index and OSCA score was slightly better for the right eye