THE USAGE OF SEALEDCAPSULE IRRIGATION SYSTEM PERFECTCAPSULE IN MYOPIC EYES

1
THE USAGE OF SEALED-CAPSULE IRRIGATION SYSTEM
(PERFECTCAPSULE) IN MYOPIC EYES

• Firat Helvacioglu, MD, Sadik Sencan, MD, Secil
  Ozdemir, MD, Hasan Oguzhan, MD

BAKIRKOY EDUCATION AND RESEARCH HOSPITAL,
DEPARTMENT OF OPHTHALMOLOGY ISTANBUL
TURKEY The authors have no financial or
proprierity interests
2
POSTERIOR CAPSULE OPACIFICATION (PCO)

• The most common cause of vision loss in the
  modern cataract surgery is the formation of PCO.
• The onset of PCO after surgery ranges from 3
  months to 4 years and its incidence increases
  with time.
• The Posterior capsule opacification is caused by
  proliferation, migration, and metaplasia to the
  fibroblasts of residual lens epithelial cells
  (LEC) which usually remains in the equatorial
  regions of the capsule after the cataract
  surgery.
• Bertelmann E, Kojetinsky C. Posterior capsule
  opacificationand anterior capsule opacification.
  Curr Opin Ophthalmol 2001 123540, Tetz MR,
  Nimsgern C. Posterior capsule opacification.Part
  2 clinical findings. J Cataract Refract
  Surg 1999 2516621674
• Hanuch OE, Agrawal VB, Papernov S, del Cerro
  M, Aquavella JV. Posterior capsule polishing with
  the neodymium YLF picosecond laser Model eye
  study. J Cataract Refract Surg 1997 23 1561-71.
  
• Birinci H, Kuruoglu S, Oege I, et al. Effect of
  intraocular lens and anterior capsule opening
  type on posterior capsule opacification. J
  Cataract Refract Surg 199925 1140-6.
• Ümit Übeyt Inan, Faruk Öztürk, Süleyman
  Kaynak, Emin Kurt, Levent Emiroglu, Erdener Özer,
  Süleyman Sami Ilker, Cenap Güler. Prevention of
  posterior capsule opacification by intraoperative
  single-dose pharmacologic agents. J Cataract
  Refract Surg 2001 2710791087
• Viviana Fernandez, Miryam A., Christian
  Billotte, Peggy Lamar, Marcia A. Orozco, Sander
  Dubovy, Mark Willcox, Jean-Marie Parel. Efficacy
  of various drugs in the prevention of posterior
  capsule opacification Experimental study of
  rabbit eyes. J Cataract Refract Surg 2004
  3025982605

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POSTERIOR CAPSULE OPACIFICATION (PCO)

• Several agents were used to stop the activity of
  LECs. The common feature of these agents is their
  toxicity to ocular tissues especially the
  endothelium.
• To eliminate the toxic effects and to increase
  the intracapsular concentrations with limited
  doses Maloof et al. developed a mechanical
  device for selective irrigation of the lens
  capsule, that will allow selective and specific
  isolation of the LECs within the capsular bag
  during cataract surgery.
• Anthony Maloof, Geoff Neilson, E. John
  Milverton, Suresh K. Pandey. Selective and
  specific targeting of lens epithelialcells during
  cataract surgery using sealed capsule irrigation.
  J Cataract Refract Surg 2003 2915661568

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SEALED CAPSULE IRRIGATION SYSTEM
(PERFECTCAPSULE)

• Circular shape
• Silicone
• Foldable
• 7mm outer diameter
• 5 m inner diameter
• 2 canals for irrigation and aspiration

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PURPOSE

• To evaluate the usage, the efficacy and the
  safety of sealed capsule irrigation system
  (PerfectCapsule) in myopic eyes

6
METHODS

• Between January 2006 and March 2006 perfect
  capsule, with 2 minutes distilled water
  intracapsular irrigation, was used following
  conventional phacoemulsification ,performed by
  using the AMO-Sovereign Whitestar surgical
  system, in 3 eyes of 3 fort myopic patients.
• The patients were examined for
• post-operative corneal edema,
• anterior chamber reactions.
• The usage of the system and the complications
  that might happen were investigated in a step by
  step manner.
• Lastly, the efficacy and the safety of the system
  were evaluated.

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RESULTS

• In all of the cases, the perfect capsule system
  was used without any complication.
• Most difficult step was found to be the
  implantation and placement of the SCI on the
  nasally placed capsulorhexsis.
• Before the vacuum built the device was hold tight
  on the capsule by two canules which were placed
  on the circular portion and in the irrigation
  port of the SCI.

Nasally placed capsulorhexsis and MICS
Filling the bag with viscoelastics after phaco
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RESULTS

• Intracapsular irrigation was performed very
  gently for 2 mins.
• No stromal corneal edema was observed
  postoperatively.
• Also the anterior chamber reactions were very
  mild.
• There was no sign of ocular toxicity of distilled
  water (used for intracapsuler irrigation) in the
  ocular tissues in the post-operative
  examinations.

Filling of AC with viscoelastics, placement of
SCI
Irrigation of bag with SCI, placement of IOL
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DISCUSSION

• SCI provides a mechanism for precise evaluation
  of suitable agents and has the potential to
  significantly increase the dosage safety profile
  of these agents.
• The purpose of this system is to provide a clear
  capsular bag and to give better quality of vision
  as long as possible.
• We believe the safety of this system is very
  important for myopic patients who are younger
  candidates for cataract (clear lens extraction)
  surgery
• Anthony Maloof, Geoff Neilson, E. John
  Milverton, Suresh K. Pandey. Selective and
  specific targeting of lens epithelialcells during
  cataract surgery using sealed capsule irrigation.
  J Cataract Refract Surg 2003 2915661568

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DISCUSSION

• We could face some problems while we are using
  this system in myopic eyes
• The low tonus or low ocular rigidity of the axial
  myopic patients makes the anterior chamber
  instable even in the presence of viscoelastics.
• The deep anterior chamber of these patients
  forces us to place the capsulorhexsis nasally.
• Lastly deep anterior chambers show us the
  necessity of having a device with a longer neck

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DISCUSSION

• Beside these problems, SCI could be used in
  myopic eyes with proper manipulations
• Pressing the device with two canules let us build
  the vacuum without further increasing the depth
  of the anterior chamber thus making proper space
  for the neck of the device.
• Gentle intracapsular irrigation is quite
  important since sudden filling of the bag might
  result in loss of vacuum and result in a leak.

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CONCLUSIONS

• PCO, the most common reason of decrease in vision
  after cataract surgery, is more prone to occur in
  myopic patients since they are younger candidates
  for cataract and clear lens extraction surgeries.
  
• These case series showed that the SCI system
  could be used safe and efficiently in myopic
  eyes.