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Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases.
J Cataract Refract Surg. 2006 Jun; 32(6):929-43.JC

Abstract

PURPOSE

To study the efficacy of posterior optic buttonholing (POBH) through a primary posterior capsulorhexis (PPCCC) to preserve full capsular transparency, and its potential as a routine alternative to standard in-the-bag implantation of sharp-edged optic intraocular lenses (IOLs).

SETTING

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

METHODS

After standard cataract removal, a PPCCC 4.0 to 5.0 mm in diameter was performed and the optic of a 3-piece IOL buttonholed posteriorly. One third of the eyes additionally had extensive anterior capsule polishing. All surgeries were performed under topical anesthesia.

RESULTS

The first 500 consecutive surgeries were evaluated. In 11 eyes, POBH was not performed as planned. In 4 cases, anterior capsulorhexis fixation of the optic was used as an alternative. In the early series, vitreous entanglement was seen in 5 eyes, of which 1 case prompted translimbal anterior vitrectomy. No case of cystoid macula edema was observed. One case of peripheral retinal detachment in a highly-myopic eye 4 months postoperatively appeared to be unrelated to the surgery. All lenses were well-centered without tilt, and both capsule leaves remained clear especially after additional polishing.

CONCLUSION

Posterior optic buttonholing precludes lens epithelial cells from accessing the retrolental space. The sandwiched posterior capsule blocks optic contact and thus fibrosis of the anterior capsule. Posterior optic buttonholing avoids after-cataract independent of optic edge design. Anterior capsule polishing adds to its efficacy by excluding any residual fibrosis. Surgery under topical anesthesia was well-controlled and safe. Posterior optic buttonholing may become a routine alternative to standard in-the-bag IOL implantation when supported by a longer follow-up.

Authors+Show Affiliations

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16814050

Citation

Menapace, Rupert. "Routine Posterior Optic Buttonholing for Eradication of Posterior Capsule Opacification in Adults: Report of 500 Consecutive Cases." Journal of Cataract and Refractive Surgery, vol. 32, no. 6, 2006, pp. 929-43.
Menapace R. Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases. J Cataract Refract Surg. 2006;32(6):929-43.
Menapace, R. (2006). Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases. Journal of Cataract and Refractive Surgery, 32(6), 929-43.
Menapace R. Routine Posterior Optic Buttonholing for Eradication of Posterior Capsule Opacification in Adults: Report of 500 Consecutive Cases. J Cataract Refract Surg. 2006;32(6):929-43. PubMed PMID: 16814050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases. A1 - Menapace,Rupert, PY - 2005/04/16/received PY - 2005/04/16/accepted PY - 2006/7/4/pubmed PY - 2006/9/1/medline PY - 2006/7/4/entrez SP - 929 EP - 43 JF - Journal of cataract and refractive surgery JO - J Cataract Refract Surg VL - 32 IS - 6 N2 - PURPOSE: To study the efficacy of posterior optic buttonholing (POBH) through a primary posterior capsulorhexis (PPCCC) to preserve full capsular transparency, and its potential as a routine alternative to standard in-the-bag implantation of sharp-edged optic intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: After standard cataract removal, a PPCCC 4.0 to 5.0 mm in diameter was performed and the optic of a 3-piece IOL buttonholed posteriorly. One third of the eyes additionally had extensive anterior capsule polishing. All surgeries were performed under topical anesthesia. RESULTS: The first 500 consecutive surgeries were evaluated. In 11 eyes, POBH was not performed as planned. In 4 cases, anterior capsulorhexis fixation of the optic was used as an alternative. In the early series, vitreous entanglement was seen in 5 eyes, of which 1 case prompted translimbal anterior vitrectomy. No case of cystoid macula edema was observed. One case of peripheral retinal detachment in a highly-myopic eye 4 months postoperatively appeared to be unrelated to the surgery. All lenses were well-centered without tilt, and both capsule leaves remained clear especially after additional polishing. CONCLUSION: Posterior optic buttonholing precludes lens epithelial cells from accessing the retrolental space. The sandwiched posterior capsule blocks optic contact and thus fibrosis of the anterior capsule. Posterior optic buttonholing avoids after-cataract independent of optic edge design. Anterior capsule polishing adds to its efficacy by excluding any residual fibrosis. Surgery under topical anesthesia was well-controlled and safe. Posterior optic buttonholing may become a routine alternative to standard in-the-bag IOL implantation when supported by a longer follow-up. SN - 0886-3350 UR - https://www.unboundmedicine.com/medline/citation/16814050/Routine_posterior_optic_buttonholing_for_eradication_of_posterior_capsule_opacification_in_adults:_report_of_500_consecutive_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0886-3350(06)00236-7 DB - PRIME DP - Unbound Medicine ER -