Intraocular lens stability and refractive outcomes after cataract surgery using primary posterior continuous curvilinear capsulorrhexis

Abstract

Purpose: To evaluate the amount of intraocular lens (IOL) decentration and refractive changes after cataract surgery using posterior continuous curvilinear capsulorrhexis (PCCC).

Design: Prospective comparative case series.

Participants: We included 86 eyes of 77 patients who had cataract surgery using PCCC (the PCCC group), and 79 eyes of 68 patients treated without PCCC (the control group).

Methods: Foldable IOLs with polymethylmethacrylate haptics (VA-60BB, Hoya Corporation, Tokyo, Japan) were implanted in both groups. The best-corrected visual acuity (BCVA) was assessed. Automated refractokeratometry, Scheimpflug imaging (Pentacam; Oculus, Wetzlar, Germany), and slit-lamp photography with retroillumination were performed at each follow-up visit over 6 months. The axial shift of each IOL was measured as the distance between the corneal endothelium and the anterior surface of the IOL on Scheimpflug images. The horizontal shift was assessed as the distance between the geometric center of the IOL and the centers of the pupil and the limbus.

Main outcome measures: Best-corrected visual acuity, horizontal and axial shift of the IOL, and automated refraction.

Results: There was no difference between the 2 groups in the mean BCVA before surgery and at any postoperative follow-up. The mean horizontal shift of the IOL after 6 months was 0.25 ± 0.14 mm for the pupil and 0.31 ± 0.17 mm for the limbus in the PCCC group (P = 0.315), and 0.26 ± 0.09 mm and 0.31 ± 0.13 mm, respectively, in the control group (P = 0.115). These were not different from the measurement on the postoperative day 1 (P = 0.515, P = 0.263, P = 0.421, and P = 0.875, respectively). At each follow-up visit over 6 months, there was no difference in the horizontal shift between the 2 groups (P > 0.05). The IOL shifted insignificantly in the PCCC group (-0.08 ± 0.24 mm anterior shift), but the shift was significant in the control group (-0.42 ± 0.27 mm anterior shift; P = 0.009). The mean postoperative refractive shift 6 months after surgery compared with refraction on the first day after surgery was -0.16 ± 0.67 diopter (D) in the PCCC group and -0.60 ± 0.70 D in the control group (P = 0.042).

Conclusions: During cataract surgery, PCCC is useful to stabilize and minimize postoperative refractive changes. The IOL displacement attributable to capsular contraction is less when cataract surgery involves PCCC.