THE OUTCOMES OF SEALEDCAPSULE IRRIGATION PERFECTCAPSULE IN PREVENTING POSTERIOR CAPSULE OPACIFICATIO

1
THE OUTCOMES OF SEALED-CAPSULE IRRIGATION
(PERFECTCAPSULE) IN PREVENTING POSTERIOR CAPSULE
OPACIFICATION AFTER CATARACT SURGERY

• Sadik Sencan, MD, Firat Helvacioglu, 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

3
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

4
SEALED CAPSULE IRRIGATION SYSTEM
(PERFECTCAPSULE)

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

5
PURPOSE

• To evaluate the usage, the efficacy and the
  safety of sealed capsule irrigation system (SCI)
  PerfectCapsule in prevention of posterior
  capsule opacification (PCO)

6
METHODS

• Between January 2006 and March 2006 perfect
  capsule, with 2 minutes distilled water
  irrigation, was used following conventional
  phacoemulsification (G1) in 20 eyes of 20
  patients.
• As a control group, conventional
  phacoemulsification (G2) was performed in 20 eyes
  of 17 patients by using the
• AMO-Sovereign Whitestar surgical system.
• Patients with standard cataracts were randomly
  selected.
• Patients were examined for
• intraoperative complications,
• mean phaco time,
• total phaco ,
• equvalent phaco time (EPT),
• endothelial cell loss,
• postoperative corneal edema,
• anterior chamber reactions,
• mean uncorrected (UCVA) and best corrected visual
  acuities (BCVA) and
• followed up for the PCO development. .

7
RESULTS

• CONVENTIONAL PHACO SCI
• Mean US time (min.)
• 1.32 (SD 0.21)
• Mean total phaco
• 6.3 (SD 1.1)
• Mean EPT (seconds)
• 5.14 (SD 1.68)
• CONVENTIONAL PHACO
• Mean US time (min.)
• 1.44 (SD 0.27)
• Mean total phaco
• 6.8 (SD 1.3)
• Mean EPT (seconds)
• 6.46 (SD 2.12)

8
RESULTS

• Mostly no or mild corneal edema and anterior
  chamber reactions were observed in both groups.
  There was no significant difference between the
  PCO rates of the groups in 6 months.
• The mean UCVA and BCVA 0.48 and 0.82 in snellen
  chart for G1 and 0.57 and 0.89 for G2.

Figure The PCO development of the groups In the
6 months period. P0.36 no statistacal
significance between groups. (Pearson Chi-square)
9
DISCUSSION

• The incidence of PCO Which is one of the main
  complications of the cataract surgery was shown
  as 11.8 in the first year, 20.7 in the third
  year and 28.4 in the fifth year after the
  operations with IOL implantations.
• These rates further increases in the childhood
  cataracts, reaching up to 95.
• PCO is not only an important factor leading to
  visual disturbances, but also is a limiting
  factor for the modern technologies, such as
  accommodative IOLs.
• Bertelmann E, Kojetinsky C. Posterior capsule
  opacificationand anterior capsule opacification.
  Curr Opin Ophthalmol 2001 123540
• Gimbel HV. Posterior continuous curvilinear
  capsulorhexis and optic capture of the
  intraocular lens to prevent secondary
  opacification in pediatric cataract surgery. J
  Cataract Refract Surg 1997 23652656
• Amar Agarwal, Sunita Agarwal, Athiya
  Agarwal, Anthony Maloof. Sealed-capsule
  irrigation device. J Cataract Refract Surg 2003
  2922742276

10
DISCUSSION

• The most important factor leading to PCO
  formation is the activity of LECs that stay
  inside the capsule after the operation.
• In a study of Viviana Fernandez et al. EDTA and
  distilled water were found to be the most
  effective agents in limiting the activity of
  LECs.
• 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

11
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.
• 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

12
CONCLUSIONS

• This study well demonstrated the safety of the
  SCI system.
• Although good results were obtained with
  distilled water in vivo studies, more potent
  irrigation solutions like 5-FU should be used in
  order to increase its efficiency.