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LESS-THAN – PERFECT OUTCOMES AFTER UNEVENTFUL CATARACT SURGERY
:
WHAT ARE WE MISSING WHAT ARE WE MISSING ??????
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P C O
WHAT ARE WE MISSING?
1. PATIENT SPECIFIC FACTORS2. OCULAR SURFACE DISEASE3. KERATITIS
MEDICAMENTOSA4. REFRACTIVE SURPRISES5. EARLY PCO6. DYSPHOTOPSIA7.
SUBTLE CORNEAL PATHOLOGIES8. IOL DECENTRATION9. PROBLEMS WITH MF
IOLS 10. SUBTLE MACULAR PATHOLOGIES
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PCO
EARLY PCO
ARUP CHAKRABARTICataract & Glaucoma ServicesChakrabarti Eye
Care Centre
Trivandrum, Kerala, India
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Financial Interest – NIL
How Do We Manage?
PCO ASSESSMENT
v S/L BiomicroscopyvRetroillumination
v Distant Direct Ophthalmoscopyv Direct Ophthalmoscopy
vClarity of Fundus View
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PCO PROPHYLAXIS
v Complete Removal of LEC
vInhibition of LEC Prolifern / Migration
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v Surgical
v Pharmacologicv Immunologic
v LCOPLaser Capsular Opacity Prevention
Laser Capsular Opacity Prevention (LCOP)ARC Nd:YAG laser
photolysis
[email protected] CATARACT REFRACT SURG - VOL 36, JUNE 2010
Laser Capsular Opacity Prevention (LCOP)ARC Nd:YAG laser
photolysis
[email protected] CATARACT REFRACT SURG - VOL 41, DECEMBER
2015
• WHAT WAS KNOWN• LP is capable of removing LECs from
the Ant Capsule & the capsular bag Fx in an in vitro
setting
• LP capsule polishing can be performed safely during in vivo
cataract surgery
• WHAT THIS PAPER ADDS• Circumferential LP capsule polishing
provides complete and sustained prevention of PCO in an in vitro
setting.
• Thorough ablation of LECs from the capsular bag fornix can be
achieved in vitro using a standardized, stepwise surgical
approach
Evaluation of laser capsule polishing for prevention of PCO in a
human ex vivo model
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PCO PROPHYLAXIS
v Complete Removal of LEC
vInhibition of LEC Prolifern / Migration
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v Surgical
v Pharmacologicv Immunologic
v LCOPLaser Capsular Opacity Prevention
Capsulorhexis :Regular, Round, Well-cent. , 3600 IOL Optic
Overlap
PCO PROPHYLAXIS
I & A : Thorough Cortical Clean – up to ¯ S- Ring
Role of Anterior Capsular Polishing :
Hydrodissection : Thorough Cortical Cleaving Hydrodissection
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Role of Posterior Capsular Polishing :
PCO Prophylaxis - CapsulorhexisCapsulorhexis
v Regular,
v Round,
v Well-cent. ,
v 3600 IOL Optic Overlap
v Capsular Sequestration
v “Shrink Wrap” the Capsule Around IOL
Optic
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v Rhexis Dia = 1 mm < IOL Optic Dia≥ 4 mm
v Rhexis Dia = 1 mm < IOL Optic Dia≥ 4 mm
Proper Sizing of the Capsulorhexis
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v Verus Capsulorhexis Device (Mile High Ophthalmics, Denver)
-Malik Y Kahook.. JCRS 2014(May)
v Verus Capsulorhexis Device (Mile High Ophthalmics, Denver)
-Malik Y Kahook.. JCRS 2014(May)
CapsuLaser Aperture TX - CTC ZeptoRhexis
PCO Prophylaxis – Cortical Cleaving Cortical Cleaving
HydrodissectionHydrodissection
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PCO Prophylaxis – Role of PC Role of PC PolishingPolishing
0.31
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PCO Prophylaxis – Role of AC Role of AC PolishingPolishing-
Controversial
- Many Would Like to Avoid It
Ring Polishers
Singer’s Sweep
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PCO Prophylaxis – Role of AC Role of AC PolishingPolishing
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PCO Prophylaxis – Role of AC Role of AC PolishingPolishing
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Maximal IOL Optic ContactPosterior Angulated HapticPost.
Convexity of the Optic
Adhesive Biomaterial ( Shrink-Wrap)
IOL Optic Geometry- Square, Truncated Edge- Optiedge
• “Biocompatible IOL Material¯ Stimuln of Cellular Prolifern
• “Small Haptic-Optic Junction
IOL IssuesPCO PROPHYLAXIS
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PCO : MANAGEMENT
Decision More Complex in a MF IOL Pt
? Cause of Visual Disability- Early PCO- Other Mechanism- Early
PCO + Other Mechanisms
• YAG Capsulotomy for Early PCO (When PCO wasn’t the Cause)
Nonimprovement of SymptomsComplicate Further Mx if IOL Exchange
is Needed
YAG Capsulotomy Definitive
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MANAGEMENT : Post YAG Capsulotomy
Guard Against CME & other Retinal Complications
Topical Steroids
NSAIDs
Topical IOP Lowering Agents
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Well Centered + Adequate Size
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WHAT ARE WE MISSING?
6. DYSPHOTOPSIA7. SUBTLE CORNEAL PATHOLOGIES8. IOL
DECENTRATION9. PROBLEMS WITH MF IOLS 10. SUBTLE MACULAR
PATHOLOGIES
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1. PATIENT SPECIFIC FACTORS2. OCULAR SURFACE DISEASE3. KERATITIS
MEDICAMENTOSA4. REFRACTIVE SURPRISES
5. EARLY PCO
CONCLUSION : MANAGEMENT of EARLY PCO
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• “Early PCO” Assumes Significance in the Context of MFIOL
• Prophylaxis – Good Surgical Technique, Strategy - Appropriate
IOL Design
• YAG Capsulotomy is Definitive but the Decision Process is
Complex
