Intumescent Cataract Surgery Combination Technique Reduces Complications

A combined anterior chamber maintainer and spiral capsulorhexis technique reduces cataract surgery complications.

During surgical removal of intumescent cataracts, an anterior chamber maintainer and spiral capsulorhexis combined technique can reduce the complication rate compared with a capsulorhexis after ophthalmic viscosurgical device injection approach, according to a study published in the Journal français d’ophthalmologie.

Patients (N=128) with intumescent cataracts without red reflex undergoing phacoemulsification and intraocular lens (IOL) implantation at the Necmettin Erbakan University in Turkey between 2015 and 2020 were reviewed in this study. Eyes treated prior to December 2017 (controls; n=64; mean age, 60.5 years; 49.2% men) underwent capsulorhexis after ophthalmic viscosurgical device injection into the anterior chamber and eyes treated since 2018 (intervention; n=67; mean age 62.8 years; 52.3% men) underwent spiral capsulorhexis with anterior chamber maintainer with continuous fluid pressure. Outcomes and the safety were compared between groups.

Surgical outcomes were similar between the 2 groups, except that the participants in the intervention group had significantly fewer radial tear events (0 vs 8; P =.003) and progression to periphery in the capsule (3 vs 11; P =.019) compared with those in the control group, respectively.

In addition, researchers noted no instances of posterior capsular tear, vitreous loss, dropped nucleus, IOL decentration, or extracapsular cataract extraction observed in the intervention group. The final mean anterior chamber depth was 2.19 mm and lens thickness was 4.68 mm in the intervention cohort.

The combination technique of anterior chamber maintainer and spiral capsulorhexis provides a controlled and safe capsulorhexis, reduces intraoperative and postoperative complications, and does not require any additional cost in intumescent cataracts.

The intervention and control cohorts had similar endothelial cell loss (mean, 201.8 vs 186.3 cells/mm2; P =.49), respectively.

The major limitation of this study was the small sample size and the lack of randomization.

“The combination technique of anterior chamber maintainer and spiral capsulorhexis provides a controlled and safe capsulorhexis, reduces intraoperative and postoperative complications, and does not require any additional cost in intumescent cataracts,” according to the researcher “Additionally, it reduces the intense consumption of viscoelastic agents as well as the operation costs in clinics where many cataract surgeries are performed. No special tools or instruments are required except those currently used in classical phacoemulsification surgery.”

References:

Ucar F. Spiral capsulorhexis technique with anterior chamber maintainer under continuous fluid pressure in intumescent cataracts and its clinical outcomes. J Fr Ophtalmol. 2022;S0181-5512(22)00264-9. doi:10.1016/j.jfo.2022.04.013