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Incidence of Posterior Capsular Opacification in Rigid PMMA IOLs Dr. Anand Sudhalkar
Literature Review <ul><li>Ram Pandey, Apple et al  JCRS  2001;27:1039-1046  (Visually Significant PCO) </li></ul><ul><li>O...
Purpose  : Compare incidence of PCO in following groups : <ul><li>Age and Sex. </li></ul><ul><li>ECCE / Phaco </li></ul><u...
Study Design  : <ul><li>Retrospective analysis of 2500  RIGID   PMMA  IOLs done over last 14 years done by the  same surge...
Methods: ECCE  <ul><li>Canopener,  > 7mm  capsulotomy, </li></ul><ul><li>8mm limbal incision, </li></ul><ul><li>Hydroprola...
Methods: Phaco <ul><li>Rhexis, 5.5mm  or less, 3mm direct entry phaco incision </li></ul><ul><li>Hydrodissection, delineat...
Methods : All cases <ul><li>Viscoelastics : Methyl cell. Or Healon used. </li></ul><ul><li>NO CAPSULAR POLISHING . </li></...
Study Design :  Case Selection   <ul><li>Inclusion criteria  : Uncomplicated cataract cases, uneventful surgeries, Immedia...
Age And Sex Association Chi-square = 8.68  Degree of freedom =3 ,  P=0.0338 14.98% 317 2116 18.18% 68 374 2490 TOTAL 13.81...
ECCE : III Piece PMMAConvex-Plano Single Piece Biconvex
ECCE : IOL Designs Chi-square =12.39 Degree of freedom = 3  P = 0.0061   14.03% 260 1852 17.5% 58 330 14.5% 318 2182 Total...
ECCE : Surface Modifications  HSM AGAINST NON HSM Single Piece Biconvex
ECCE : HSM AGAINST NON HSM Chi-square = 7.93  Degree of freedom = 3  P = 0.0474   14.9% 232 1551 19.4% 51 261 15.5% 282 18...
PHACO : Biconvex IOL NON HSM v/s HSM
PHACO :  NON HSM v/s HSM Chi-square = 7.08,  Degree of freedom = 3,  P= 0.06931   20.5% 54 263 33.3% 15 45 22.4% 69 308 TO...
ECCE V/S PHACO
ECCE V/S PHACO  Chi-square = 12.85  Degree of freedom = 3  P = 0.00496   15.7% 286 1815 20.9% 64 305 18.1% 385 2120 Total ...
Conclusions  <ul><li>1. There was a statistically significant relation between the two genders, males had a higher inciden...
Summary : Choice for Rigid PMMA <ul><li>Convex –Plano design </li></ul><ul><li>Heparin Surface Modification </li></ul><ul>...
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Incidence of posterior capsular opacification in rigid pmma

Posterior capsular opacification after cataract surgery with IOL implantation depends on the IOLdesign, material and type of surgery

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Incidence of posterior capsular opacification in rigid pmma

  1. 1. Incidence of Posterior Capsular Opacification in Rigid PMMA IOLs Dr. Anand Sudhalkar
  2. 2. Literature Review <ul><li>Ram Pandey, Apple et al JCRS 2001;27:1039-1046 (Visually Significant PCO) </li></ul><ul><li>Oliver Findl et al JCRS: Vol. 29 No.1, Jan 2003 (PCO Quantification by automated system) </li></ul><ul><li>Tetz-M,Sperker-M et al Heidelberg Germany Ophthalmologe. 1996 Feb; 93(1) : 33-7) (Morphological PCO scoring) </li></ul><ul><li>Ravalico, Tognetto, Italy JCRS 1996. Jan-Feb; 22(1):98-103 (Rhexis size and PCO) </li></ul><ul><li>Yamada-K, Nagamoto-T et al JCRS Nov 1995; 21(6) : 697-700 (IOL design and PCO) </li></ul><ul><li>Mamalis, Crandall et al JCRS 1995 Jan; 21(1): 99-102 (IOL size) </li></ul><ul><li>Anna Lundvall JCRS 2003 29:159-163 (HSM IOL) </li></ul><ul><li>Nishi O, Nishi K JCRS 1995 Sep 21(5) : 574-8 (Indomethacin Coating) </li></ul>
  3. 3. Purpose : Compare incidence of PCO in following groups : <ul><li>Age and Sex. </li></ul><ul><li>ECCE / Phaco </li></ul><ul><li>IOL designs : Convex-Plano / Biconvex, sizes : 6.5 / 5.5 mm and </li></ul><ul><li>Surface modifications : HSM / NONHSM </li></ul>
  4. 4. Study Design : <ul><li>Retrospective analysis of 2500 RIGID PMMA IOLs done over last 14 years done by the same surgeon with ECCE or Phaco. </li></ul><ul><li>PCO considered visually significant when vision dropped to 6/18 over three year post op followup </li></ul>
  5. 5. Methods: ECCE <ul><li>Canopener, > 7mm capsulotomy, </li></ul><ul><li>8mm limbal incision, </li></ul><ul><li>Hydroprolapse of nucleus in AC & Viscoexpression of nucleus. </li></ul><ul><li>Cortical removal by Simcoe canula </li></ul><ul><li>Implantation of 6.5mm PMMA IOL Convex-Plano or Biconvex design . </li></ul><ul><li>5, 10/0 interrupted Nylon sutures </li></ul>
  6. 6. Methods: Phaco <ul><li>Rhexis, 5.5mm or less, 3mm direct entry phaco incision </li></ul><ul><li>Hydrodissection, delineation and nucleus rotation. </li></ul><ul><li>4 quad. Divide and conquer technique (Storz Protégé) of nucleus emulsification. </li></ul><ul><li>Bimanual cortical aspiration. </li></ul><ul><li>Incision enlarged by 5.5mm </li></ul><ul><li>5.5mm rigid all PMMA biconvex IOL implantaion under viscoelastics. </li></ul><ul><li>Wound left unsutured or with one 10/0 suture, after testing wound integrity with Q-tips. </li></ul>
  7. 7. Methods : All cases <ul><li>Viscoelastics : Methyl cell. Or Healon used. </li></ul><ul><li>NO CAPSULAR POLISHING . </li></ul><ul><li>Post op Steroids, Antibiotics and cycloplegics for two months </li></ul><ul><li>Follow ups 1 st , 7 th day, 1month and three monthly for 3 years. BCVA recorded each visit. </li></ul><ul><li>Drop in BCVA due to PCO, by two or more Snellen lines considered for yag laser </li></ul><ul><li>Post YAG vision tested for full recovery. </li></ul>
  8. 8. Study Design : Case Selection <ul><li>Inclusion criteria : Uncomplicated cataract cases, uneventful surgeries, Immediate post op vision 6/9 or better. </li></ul><ul><li>Exclusion criteria : Associated conditions like glaucoma, iritis, maculopathies, corneal opacities. </li></ul><ul><li>Delayed exclusions : Failure to regain pre-yag vision (CME, Diabetic maculopathy etc) </li></ul>
  9. 9. Age And Sex Association Chi-square = 8.68 Degree of freedom =3 , P=0.0338 14.98% 317 2116 18.18% 68 374 2490 TOTAL 13.81% 154 1115 14.85% 30 202 1317 FEMALE 16.28% 163 1001 22.09% 38 172 1173 MALE % YAG YAG AGE >50 % YAG YAG AGE <50 TOTAL SEX
  10. 10. ECCE : III Piece PMMAConvex-Plano Single Piece Biconvex
  11. 11. ECCE : IOL Designs Chi-square =12.39 Degree of freedom = 3 P = 0.0061 14.03% 260 1852 17.5% 58 330 14.5% 318 2182 Total 14.8% 231 1550 19.5% 51 261 15.5% 282 1811 Biconvex 9.6% 29 302 10.4% 7 69 9.7% 36 371 Convex Plano % Yag Yag cases % Yag Yag cases % Yag Yag Cases Age > 50 Years Age < 50 Years
  12. 12. ECCE : Surface Modifications HSM AGAINST NON HSM Single Piece Biconvex
  13. 13. ECCE : HSM AGAINST NON HSM Chi-square = 7.93 Degree of freedom = 3 P = 0.0474 14.9% 232 1551 19.4% 51 261 15.5% 282 1812 Total 0% 0 22 0% 0 2 0% 0 24 HSM 15.17% 232 1529 19.6% 51 259 15.7% 282 1788 Non HSM % Yag Yag cases % Yag Yag Cases % Yag Yag Cases Age > 50 Years Age < 50 Years
  14. 14. PHACO : Biconvex IOL NON HSM v/s HSM
  15. 15. PHACO : NON HSM v/s HSM Chi-square = 7.08, Degree of freedom = 3, P= 0.06931 20.5% 54 263 33.3% 15 45 22.4% 69 308 TOTAL 0 0 13 40% 2 5 11% 2 18 HSM 21.6% 54 250 32.5% 13 40 23.1% 67 290 Non HSM %yag yag cases % Yag Yag Cases % Yag Yag Cases Age > 50 Years Age < 50 Years
  16. 16. ECCE V/S PHACO
  17. 17. ECCE V/S PHACO Chi-square = 12.85 Degree of freedom = 3 P = 0.00496 15.7% 286 1815 20.9% 64 305 18.1% 385 2120 Total 20.4% 54 264 29.5% 13 44 21.7% 67 308 Phaco 14.9% 232 1551 19.5% 51 261 17.5% 318 1812 ECCE % yag yag cases % Yag Yag Cases % Yag Yag cases Age > 50 Years Age < 50 Years
  18. 18. Conclusions <ul><li>1. There was a statistically significant relation between the two genders, males had a higher incidence of yag laser for PCO than females (P = 0.338) </li></ul><ul><li>2. In ECCE group, comparison between Three Piece against Single Piece all PMMA IOLs, with 13mm length and 6.5mm optic, showed highly significant decrease in PCO in the former group. (P=0.00061) </li></ul><ul><li>3.. In ECCE group alone, using all PMMA IOls, with or without Heparin Surface Modifications, showed statistically significant decrease in Yag Rate in HSM IOL subgroup (P = 0.0474) </li></ul><ul><li>4. In comparison between ECCE and Phaco groups using single piece all PMMA IOLs, the yag rate was higher in Phaco group (P= 0.00496) </li></ul><ul><li>5. In Phaco group, comparison between Single Piece all PMMA IOLs with and without Heparin surface modification, showed significant decrease in PCO with HSM group at 10% probability (P = 0.69) </li></ul>
  19. 19. Summary : Choice for Rigid PMMA <ul><li>Convex –Plano design </li></ul><ul><li>Heparin Surface Modification </li></ul><ul><li>Large capsulotomy </li></ul>
  20. 20. Thank You

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