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Jeanie Y. Paik, Mira Shiloach, Marian S. Macsai-Kaplan; The Effect of Posterior Capsule Polishing on Posterior Capsule Opacification. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6668.
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To compare the efficacy of polishing the posterior capsule in the development of posterior capsule opacification (PCO) rates requiring Neodynium(Nd):YAG capsulotomy (Nd:YAG) between two surgeons, one who routinely polishes the posterior capsule and one who does not. Some surgeons polish the posterior capsule to prevent the proliferation of epithelial cells that cause PCO. However, no clinical evidence exists to determine if polishing the capsule is effective in preventing PCO.
Retrospective review was performed of electronic medical records for patients who underwent cataract surgery with either of two surgeons from July-December 2009. Included patients were 18 years and older who received an Alcon Acrysof sharp-edged acrylic intraocular lens. Patients with less than 6 months of follow up or history of Descemet’s Stripping Endothelial Keratoplasty or penetrating keratoplasty were excluded. Statistical analysis was performed with SAS.
Data was collected on 177 eyes from 124 patients; 94 eyes had the posterior capsule polished and 83 were unpolished. The average length of follow up was 16.5 months (SD 5.6 months). The rate of any PCO occurrence after surgery was 34% for patients without posterior capsule polishing and 20% for those withpolishing (p=.04). The rates of Nd:YAG capsulotomy between surgeons was 12% versus 9% for unpolished versus polished eyes , respectively (non-significant p>0.05). There was no significant difference in rates of intraoperative capsular tears between surgeons. Nd:YAG occurrence was significantly correlated with a younger mean patient age (p<0.05) but did not correlate with other ocular and clinical predictors.
Currently, no prospective randomized clinical trials have been conducted to determine the effect of posterior capsule polishing on PCO. Changing technologies including the use of sharp-edged IOL optics and advances in polishing equipment have warranted a new study on the effect of capsule polishing on Nd:YAG rates. Our study showed that polishing the posterior capsule resulted in less PCO as documented clinically but did not significantly affect rates of Nd:YAG. Additionally, younger patients are more likely to undergo Nd:YAG. Further study including larger sample sizes for adequate statistical power is necessary.
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