Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification
Identifieur interne : 002386 ( Istex/Corpus ); précédent : 002385; suivant : 002387Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification
Auteurs : Jagat Ram ; Suresh K. Pandey ; David J. Apple ; Liliana Werner ; Gagandeep S. Brar ; Ramandeep Singh ; Kulbhushan P. Chaudhary ; Amod GuptaSource :
- Journal of Cataract & Refractive Surgery [ 0886-3350 ] ; 2000.
Abstract
Purpose: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. Setting: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. Methods: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. Results: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P < .001, chi-square test) after a mean follow-up of 2.4 years ± 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P < .001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P < .05, chi-square test). Conclusions: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.
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DOI: 10.1016/S0886-3350(00)00841-5
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</title><author><name sortKey="Ram, Jagat" sort="Ram, Jagat" uniqKey="Ram J" first="Jagat" last="Ram">Jagat Ram</name><affiliation><mods:affiliation>E-mail: medinst@pgi.chd.nic.in</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author><author><name sortKey="Pandey, Suresh K" sort="Pandey, Suresh K" uniqKey="Pandey S" first="Suresh K" last="Pandey">Suresh K. Pandey</name><affiliation><mods:affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</mods:affiliation></affiliation></author><author><name sortKey="Apple, David J" sort="Apple, David J" uniqKey="Apple D" first="David J" last="Apple">David J. Apple</name><affiliation><mods:affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</mods:affiliation></affiliation></author><author><name sortKey="Werner, Liliana" sort="Werner, Liliana" uniqKey="Werner L" first="Liliana" last="Werner">Liliana Werner</name><affiliation><mods:affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</mods:affiliation></affiliation></author><author><name sortKey="Brar, Gagandeep S" sort="Brar, Gagandeep S" uniqKey="Brar G" first="Gagandeep S" last="Brar">Gagandeep S. Brar</name><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author><author><name sortKey="Singh, Ramandeep" sort="Singh, Ramandeep" uniqKey="Singh R" first="Ramandeep" last="Singh">Ramandeep Singh</name><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author><author><name sortKey="Chaudhary, Kulbhushan P" sort="Chaudhary, Kulbhushan P" uniqKey="Chaudhary K" first="Kulbhushan P" last="Chaudhary">Kulbhushan P. Chaudhary</name><affiliation><mods:affiliation>Indira Gandhi Medical College Shimla, Shimla, India(Chaudhary)</mods:affiliation></affiliation></author><author><name sortKey="Gupta, Amod" sort="Gupta, Amod" uniqKey="Gupta A" first="Amod" last="Gupta">Amod Gupta</name><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:55A32D59B3CD1F141067F80E079BC6FF04175ECB</idno><date when="2001" year="2001">2001</date><idno type="doi">10.1016/S0886-3350(00)00841-5</idno><idno type="url">https://api.istex.fr/document/55A32D59B3CD1F141067F80E079BC6FF04175ECB/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002386</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</title><author><name sortKey="Ram, Jagat" sort="Ram, Jagat" uniqKey="Ram J" first="Jagat" last="Ram">Jagat Ram</name><affiliation><mods:affiliation>E-mail: medinst@pgi.chd.nic.in</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author><author><name sortKey="Pandey, Suresh K" sort="Pandey, Suresh K" uniqKey="Pandey S" first="Suresh K" last="Pandey">Suresh K. Pandey</name><affiliation><mods:affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</mods:affiliation></affiliation></author><author><name sortKey="Apple, David J" sort="Apple, David J" uniqKey="Apple D" first="David J" last="Apple">David J. Apple</name><affiliation><mods:affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</mods:affiliation></affiliation></author><author><name sortKey="Werner, Liliana" sort="Werner, Liliana" uniqKey="Werner L" first="Liliana" last="Werner">Liliana Werner</name><affiliation><mods:affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</mods:affiliation></affiliation></author><author><name sortKey="Brar, Gagandeep S" sort="Brar, Gagandeep S" uniqKey="Brar G" first="Gagandeep S" last="Brar">Gagandeep S. Brar</name><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author><author><name sortKey="Singh, Ramandeep" sort="Singh, Ramandeep" uniqKey="Singh R" first="Ramandeep" last="Singh">Ramandeep Singh</name><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author><author><name sortKey="Chaudhary, Kulbhushan P" sort="Chaudhary, Kulbhushan P" uniqKey="Chaudhary K" first="Kulbhushan P" last="Chaudhary">Kulbhushan P. Chaudhary</name><affiliation><mods:affiliation>Indira Gandhi Medical College Shimla, Shimla, India(Chaudhary)</mods:affiliation></affiliation></author><author><name sortKey="Gupta, Amod" sort="Gupta, Amod" uniqKey="Gupta A" first="Amod" last="Gupta">Amod Gupta</name><affiliation><mods:affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Cataract & Refractive Surgery</title><title level="j" type="abbrev">JCRS</title><idno type="ISSN">0886-3350</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2000">2000</date><biblScope unit="volume">27</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="1039">1039</biblScope><biblScope unit="page" to="1046">1046</biblScope></imprint><idno type="ISSN">0886-3350</idno></series><idno type="istex">55A32D59B3CD1F141067F80E079BC6FF04175ECB</idno><idno type="DOI">10.1016/S0886-3350(00)00841-5</idno><idno type="PII">S0886-3350(00)00841-5</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0886-3350</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Purpose: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. Setting: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. Methods: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. Results: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P < .001, chi-square test) after a mean follow-up of 2.4 years ± 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P < .001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P < .05, chi-square test). Conclusions: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Jagat Ram MD</name><affiliations><json:string>E-mail: medinst@pgi.chd.nic.in</json:string><json:string>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</json:string></affiliations></json:item><json:item><name>Suresh K Pandey MD</name><affiliations><json:string>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</json:string></affiliations></json:item><json:item><name>David J Apple MD</name><affiliations><json:string>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</json:string></affiliations></json:item><json:item><name>Liliana Werner MD, PhD</name><affiliations><json:string>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</json:string></affiliations></json:item><json:item><name>Gagandeep S Brar MD</name><affiliations><json:string>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</json:string></affiliations></json:item><json:item><name>Ramandeep Singh MD</name><affiliations><json:string>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</json:string></affiliations></json:item><json:item><name>Kulbhushan P Chaudhary MD</name><affiliations><json:string>Indira Gandhi Medical College Shimla, Shimla, India(Chaudhary)</json:string></affiliations></json:item><json:item><name>Amod Gupta MD</name><affiliations><json:string>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</json:string></affiliations></json:item></author><language><json:string>eng</json:string></language><abstract>Purpose: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. Setting: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. Methods: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. Results: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P > .001, chi-square test) after a mean follow-up of 2.4 years ± 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P > .001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P > .05, chi-square test). Conclusions: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.</abstract><qualityIndicators><score>7.089</score><pdfVersion>1.2</pdfVersion><pdfPageSize>586 x 785 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2162</abstractCharCount><pdfWordCount>4089</pdfWordCount><pdfCharCount>25331</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>320</abstractWordCount></qualityIndicators><title>Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</title><pii><json:string>S0886-3350(00)00841-5</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>27</volume><pii><json:string>S0886-3350(00)X0027-2</json:string></pii><pages><last>1046</last><first>1039</first></pages><issn><json:string>0886-3350</json:string></issn><issue>7</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>Journal of Cataract & Refractive Surgery</title><publicationDate>2001</publicationDate></host><categories><wos><json:string>OPHTHALMOLOGY</json:string><json:string>SURGERY</json:string></wos></categories><publicationDate>2000</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1016/S0886-3350(00)00841-5</json:string></doi><id>55A32D59B3CD1F141067F80E079BC6FF04175ECB</id><score>1</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/55A32D59B3CD1F141067F80E079BC6FF04175ECB/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/55A32D59B3CD1F141067F80E079BC6FF04175ECB/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/55A32D59B3CD1F141067F80E079BC6FF04175ECB/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/55A32D59B3CD1F141067F80E079BC6FF04175ECB/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>2001</date></publicationStmt><notesStmt><note>Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, USA.</note><note type="content">Figure 1: (Ram) Diagrams comparing the incidence of PCO after ECCE (top) with that after phacoemulsification (bottom) with IOL implantation emphasize the importance of surgical factors, especially in-the-bag fixation, in reducing PCO.</note><note type="content">Figure 2: (Ram) Slitlamp photograph of the right eye of a 63-year-old woman 2 years after ECCE with S-S fixation of a single-piece PMMA IOL shows visually significant PCO (Elschnig pearls).</note><note type="content">Figure 3: (Ram) Clinical photographs of 3 cases after phacoemulsification and in-the-bag IOL fixation. Note the CCC with slight anterior capsule opacification. There is no PCO. A: a 65-year-old man with a B-B fixated 3-piece PMMA IOL. B: A 55-year-old man with a B-B fixated silicone IOL with polypropylene haptics (SI-30NB). C: A 52-year-old man with a B-B fixated hydrophobic acrylic IOL (AcrySof).</note><note type="content">Figure 4: (Ram) Schematic showing the basis of the IOL barrier effect. Top: With in-the-bag fixation of an IOL with a square-edged (truncated) optic, there is tight contact between the IOL optic and posterior capsule, helping prevent LEC migration onto the visual axis. Bottom: Fixation of 1 or both haptics out of the bag creates a space behind the optic, which may allow LEC migration from the equatorial lens bow onto the posterior capsule in the visual axis.</note><note type="content">Table 1: Posterior capsule opacification rates by IOL fixation.legend</note><note type="content">Table 2: Posterior capsule opacification rates in the eyes having phacoemulsification (n = 318) according to IOL type.legend</note><note type="content">Table 3: Posterior capsule opacification rates in the eyes having phacoemulsification (n = 318) according to IOL type and fixation. legend</note><note type="content">Table 4: Factors that reduce PCO.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</title><author><persName><forename type="first">Jagat</forename><surname>Ram</surname></persName><roleName type="degree">MD</roleName><email>medinst@pgi.chd.nic.in</email><note type="biography">Reprint requests to Jagat Ram, MD, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India</note><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>Reprint requests to Jagat Ram, MD, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India</affiliation><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation></author><author><persName><forename type="first">Suresh K</forename><surname>Pandey</surname></persName><roleName type="degree">MD</roleName><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</affiliation></author><author><persName><forename type="first">David J</forename><surname>Apple</surname></persName><roleName type="degree">MD</roleName><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</affiliation></author><author><persName><forename type="first">Liliana</forename><surname>Werner</surname></persName><roleName type="degree">MD, PhD</roleName><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</affiliation></author><author><persName><forename type="first">Gagandeep S</forename><surname>Brar</surname></persName><roleName type="degree">MD</roleName><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation></author><author><persName><forename type="first">Ramandeep</forename><surname>Singh</surname></persName><roleName type="degree">MD</roleName><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation></author><author><persName><forename type="first">Kulbhushan P</forename><surname>Chaudhary</surname></persName><roleName type="degree">MD</roleName><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>Indira Gandhi Medical College Shimla, Shimla, India(Chaudhary)</affiliation></author><author><persName><forename type="first">Amod</forename><surname>Gupta</surname></persName><roleName type="degree">MD</roleName><note type="biography">None of the authors has a financial or proprietary interest in any material or method mentioned.</note><affiliation>None of the authors has a financial or proprietary interest in any material or method mentioned.</affiliation><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation></author></analytic><monogr><title level="j">Journal of Cataract & Refractive Surgery</title><title level="j" type="abbrev">JCRS</title><idno type="pISSN">0886-3350</idno><idno type="PII">S0886-3350(00)X0027-2</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2000"></date><biblScope unit="volume">27</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="1039">1039</biblScope><biblScope unit="page" to="1046">1046</biblScope></imprint></monogr><idno type="istex">55A32D59B3CD1F141067F80E079BC6FF04175ECB</idno><idno type="DOI">10.1016/S0886-3350(00)00841-5</idno><idno type="PII">S0886-3350(00)00841-5</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Purpose: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. Setting: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. Methods: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. Results: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P < .001, chi-square test) after a mean follow-up of 2.4 years ± 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P < .001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P < .05, chi-square test). Conclusions: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.</p></abstract></profileDesc><revisionDesc><change when="2000-11-09">Registration</change><change when="2000">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="GR1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="GR2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="GR3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="GR4"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>JCRS</jid><aid>1013</aid><ce:pii>S0886-3350(00)00841-5</ce:pii><ce:doi>10.1016/S0886-3350(00)00841-5</ce:doi><ce:copyright type="full-transfer" year="2001">Elsevier Science Inc.</ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, USA.</ce:note-para></ce:article-footnote><ce:title>Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</ce:title><ce:presented>Presented in part at the 56th All India Ophthalmological Society Conference, Guwahati, India, February 1998.</ce:presented><ce:author-group><ce:author><ce:given-name>Jagat</ce:given-name><ce:surname>Ram</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref><ce:cross-ref refid="CORR1">*</ce:cross-ref><ce:e-address>medinst@pgi.chd.nic.in</ce:e-address><ce:e-address>jagatram@hotmail.com</ce:e-address><ce:e-address>eyepgi@ch1.dot.net.in</ce:e-address></ce:author><ce:author><ce:given-name>Suresh K</ce:given-name><ce:surname>Pandey</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="AFF3"><ce:sup>c</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>David J</ce:given-name><ce:surname>Apple</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="AFF3"><ce:sup>c</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Liliana</ce:given-name><ce:surname>Werner</ce:surname><ce:degrees>MD, PhD</ce:degrees><ce:cross-ref refid="AFF3"><ce:sup>c</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Gagandeep S</ce:given-name><ce:surname>Brar</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Ramandeep</ce:given-name><ce:surname>Singh</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Kulbhushan P</ce:given-name><ce:surname>Chaudhary</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="AFF2"><ce:sup>b</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Amod</ce:given-name><ce:surname>Gupta</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Indira Gandhi Medical College Shimla, Shimla, India(Chaudhary)</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>c</ce:label><ce:textfn>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Reprint requests to Jagat Ram, MD, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India</ce:text></ce:correspondence><ce:footnote id="FN1"><ce:label>1</ce:label><ce:note-para>None of the authors has a financial or proprietary interest in any material or method mentioned.</ce:note-para></ce:footnote></ce:author-group><ce:date-accepted day="9" month="11" year="2000"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:bold>Purpose:</ce:bold> To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence.</ce:simple-para><ce:simple-para><ce:bold>Setting:</ce:bold> Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.</ce:simple-para><ce:simple-para><ce:bold>Methods:</ce:bold> This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic.</ce:simple-para><ce:simple-para><ce:bold>Results:</ce:bold> Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (<ce:italic>P</ce:italic> < .001, chi-square test) after a mean follow-up of 2.4 years ± 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (<ce:italic>P</ce:italic> < .001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; <ce:italic>P</ce:italic> < .05, chi-square test).</ce:simple-para><ce:simple-para><ce:bold>Conclusions:</ce:bold> In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification</title></titleInfo><name type="personal"><namePart type="given">Jagat</namePart><namePart type="family">Ram</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>E-mail: medinst@pgi.chd.nic.in</affiliation><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation><description>Reprint requests to Jagat Ram, MD, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India</description><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Suresh K</namePart><namePart type="family">Pandey</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</affiliation><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David J</namePart><namePart type="family">Apple</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</affiliation><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Liliana</namePart><namePart type="family">Werner</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA (Pandey, Apple, Werner)</affiliation><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gagandeep S</namePart><namePart type="family">Brar</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ramandeep</namePart><namePart type="family">Singh</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kulbhushan P</namePart><namePart type="family">Chaudhary</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Indira Gandhi Medical College Shimla, Shimla, India(Chaudhary)</affiliation><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Amod</namePart><namePart type="family">Gupta</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India(Ram, Brar, Singh, Gupta)</affiliation><description>None of the authors has a financial or proprietary interest in any material or method mentioned.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2000</dateIssued><dateValid encoding="w3cdtf">2000-11-09</dateValid><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Purpose: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. Setting: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. Methods: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. Results: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P < .001, chi-square test) after a mean follow-up of 2.4 years ± 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P < .001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P < .05, chi-square test). Conclusions: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.</abstract><note>Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, USA.</note><note type="content">Figure 1: (Ram) Diagrams comparing the incidence of PCO after ECCE (top) with that after phacoemulsification (bottom) with IOL implantation emphasize the importance of surgical factors, especially in-the-bag fixation, in reducing PCO.</note><note type="content">Figure 2: (Ram) Slitlamp photograph of the right eye of a 63-year-old woman 2 years after ECCE with S-S fixation of a single-piece PMMA IOL shows visually significant PCO (Elschnig pearls).</note><note type="content">Figure 3: (Ram) Clinical photographs of 3 cases after phacoemulsification and in-the-bag IOL fixation. Note the CCC with slight anterior capsule opacification. There is no PCO. A: a 65-year-old man with a B-B fixated 3-piece PMMA IOL. B: A 55-year-old man with a B-B fixated silicone IOL with polypropylene haptics (SI-30NB). C: A 52-year-old man with a B-B fixated hydrophobic acrylic IOL (AcrySof).</note><note type="content">Figure 4: (Ram) Schematic showing the basis of the IOL barrier effect. Top: With in-the-bag fixation of an IOL with a square-edged (truncated) optic, there is tight contact between the IOL optic and posterior capsule, helping prevent LEC migration onto the visual axis. Bottom: Fixation of 1 or both haptics out of the bag creates a space behind the optic, which may allow LEC migration from the equatorial lens bow onto the posterior capsule in the visual axis.</note><note type="content">Table 1: Posterior capsule opacification rates by IOL fixation.legend</note><note type="content">Table 2: Posterior capsule opacification rates in the eyes having phacoemulsification (n = 318) according to IOL type.legend</note><note type="content">Table 3: Posterior capsule opacification rates in the eyes having phacoemulsification (n = 318) according to IOL type and fixation. legend</note><note type="content">Table 4: Factors that reduce PCO.</note><relatedItem type="host"><titleInfo><title>Journal of Cataract & Refractive Surgery</title></titleInfo><titleInfo type="abbreviated"><title>JCRS</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">200107</dateIssued></originInfo><identifier type="ISSN">0886-3350</identifier><identifier type="PII">S0886-3350(00)X0027-2</identifier><part><date>200107</date><detail type="volume"><number>27</number><caption>vol.</caption></detail><detail type="issue"><number>7</number><caption>no.</caption></detail><extent unit="issue pages"><start>963</start><end>1140</end></extent><extent unit="pages"><start>1039</start><end>1046</end></extent></part></relatedItem><identifier type="istex">55A32D59B3CD1F141067F80E079BC6FF04175ECB</identifier><identifier type="DOI">10.1016/S0886-3350(00)00841-5</identifier><identifier type="PII">S0886-3350(00)00841-5</identifier><accessCondition type="use and reproduction" contentType="">© 2001Elsevier Science Inc.</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Science Inc., ©2001</recordOrigin></recordInfo></mods></metadata><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/55A32D59B3CD1F141067F80E079BC6FF04175ECB/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">OPHTHALMOLOGY</classCode><classCode scheme="WOS">SURGERY</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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