Liquifaction Method and Extent of Liquifaction Method and Extent of Posterior Capsule Opacification: Posterior Capsule Opacification:

Two-Year Follow-upTwo-Year Follow-up

Marie KalfertovaMarie Kalfertova, Mariya Burova, Pavel Rozsival,, Mariya Burova, Pavel Rozsival,

Nada JiraskovaNada JiraskovaDepartment of Ophthalmology, Charles University in Prague, University Hospital in Department of Ophthalmology, Charles University in Prague, University Hospital in

Hradec Kralove, Czech RepublicHradec Kralove, Czech Republic

The authors have no financial interest in the subject of this The authors have no financial interest in the subject of this posterposter

Supported in part by Charles University Grant Agency, Supported in part by Charles University Grant Agency,

No. 103809No. 103809

PurposePurpose

posterior capsule opacification (PCO) is still one of the posterior capsule opacification (PCO) is still one of the most common complication following cataract surgery most common complication following cataract surgery with IOL implantation with IOL implantation

we evaluate the extent of PCO after cataract surgerywe evaluate the extent of PCO after cataract surgery Right eye: torsional phacoemulsification and AquaLase Right eye: torsional phacoemulsification and AquaLase

removal of the epithelial cells removal of the epithelial cells Left eye: torsional phacoemulsification without AquaLaseLeft eye: torsional phacoemulsification without AquaLase

we examine the safety of this method for intraocular we examine the safety of this method for intraocular tissue – follow endothelial cell count (ECC), pachymetrytissue – follow endothelial cell count (ECC), pachymetry

MethodsMethods prospective clinical study prospective clinical study we examine patients 3, 6, 12 and 24 months after surgery, we examine patients 3, 6, 12 and 24 months after surgery,

digital retroillumination photographs of the anterior digital retroillumination photographs of the anterior segment, pachymetry, endothelial cell count (ECC) and segment, pachymetry, endothelial cell count (ECC) and best corrected visual acuity are obtainedbest corrected visual acuity are obtained

ECC and pachymetry were obtained preoperatively tooECC and pachymetry were obtained preoperatively too Evaluation of posterior capsule opacificationEvaluation of posterior capsule opacification - - EPCO 2000 software (Evaluation of Posterior Capsule EPCO 2000 software (Evaluation of Posterior Capsule

Opacification)Opacification) OSCA software (Open-Access Systematic Capsule OSCA software (Open-Access Systematic Capsule

Assessment)Assessment)

the comparison of PCO between right eye (with liquifaction the comparison of PCO between right eye (with liquifaction method) and left eye is done: paired t test analysismethod) and left eye is done: paired t test analysis

MethodsMethods

Liquifaction Method:Liquifaction Method: uses warm pulses (57°C) of balanced salt uses warm pulses (57°C) of balanced salt

solution (BSS) to strain and dissolve the lens for solution (BSS) to strain and dissolve the lens for aspirationaspiration

we use the pulses for removal of the epithelial we use the pulses for removal of the epithelial cellscells

within the AquaLase handpiece, 4within the AquaLase handpiece, 4µµL fluid pulses L fluid pulses are generated as current passes between are generated as current passes between electrodeselectrodes

the BSS pulses are delivered at a maximum rate the BSS pulses are delivered at a maximum rate of 50 Hzof 50 Hz

Methods - patientsMethods - patients 50 patients (mean age 69.66 50 patients (mean age 69.66 ±± 9.1 years) 9.1 years) 34 women (70.68 34 women (70.68 ±± 7.5 years) 7.5 years) 16 men (67.5 16 men (67.5 ±± 11.5 years) 11.5 years) patients with bilateral cataract, preferably with patients with bilateral cataract, preferably with

similar density gradessimilar density grades patients with corneal and retinal disease were patients with corneal and retinal disease were

excludedexcluded informed consent was obtained from all selected informed consent was obtained from all selected

patientspatients two years after surgery were 48 patients examined two years after surgery were 48 patients examined

(two patients haven´t underwent the last (two patients haven´t underwent the last examination)examination)

MethodsMethods EPCO 2000EPCO 2000 - Evaluation of - Evaluation of

Posterior Capsule Posterior Capsule Opacification softwareOpacification software

computer-assisted system computer-assisted system of PCO morphologic of PCO morphologic assessment, introduced in assessment, introduced in 1997 by Tetz1997 by Tetz

incorporates planimetric incorporates planimetric and grading assessmentand grading assessment

the density of the the density of the opacification is graded opacification is graded clinically from 0 to 4clinically from 0 to 4

the selection process and the selection process and grading of areas are grading of areas are subjective subjective

OSCA systemOSCA system - Open- - Open-Access Systematic Access Systematic Capsule Assessment Capsule Assessment

is based on location-is based on location-sensitive entropy-based sensitive entropy-based texture analysistexture analysis

presented by Aslam (2006)presented by Aslam (2006) most objective system most objective system possible OSCA scores possible OSCA scores

range from 0 (no PCO) to range from 0 (no PCO) to approximately 15 approximately 15 (expected maximum PCO)(expected maximum PCO)

typical OSCA value for typical OSCA value for images with very little or no images with very little or no PCO is approximately 0.5PCO is approximately 0.5

Nekolova J, Pozlerova J, Jiraskova N et al.: Comparison of posterior capsule opacification after Nekolova J, Pozlerova J, Jiraskova N et al.: Comparison of posterior capsule opacification after two different surgical methods of cataract extraction. Am J Ophthalmol 2008;145:493-498two different surgical methods of cataract extraction. Am J Ophthalmol 2008;145:493-498

MethodsMethods

digital retroillumination photographsdigital retroillumination photographs after EPCO 2000 evaluationafter EPCO 2000 evaluation

ResultsResults

Right eye: 0.260 Right eye: 0.260 ±± 0.198 (3M); 0.259 0.198 (3M); 0.259 ±± 0.173 (6M); 0.308 0.173 (6M); 0.308 ±± 0.19 (12M); 0.419 0.19 (12M); 0.419 ±± 0.252 (24M) 0.252 (24M)Left eye: 0.279 Left eye: 0.279 ±± 0.170 (3M); 0.280 0.170 (3M); 0.280 ±± 0.153 (6M); 0.333 0.153 (6M); 0.333 ±± 0.197 (12M); 0.480 0.197 (12M); 0.480 ±± 0.313 (24M) 0.313 (24M)

ResultsResults

Right eye: 0.599 Right eye: 0.599 ±± 0.240 (3M); 0.605 0.240 (3M); 0.605 ±± 0.333 (6M); 0.598 0.333 (6M); 0.598 ±± 0.256(12M); 0.655 0.256(12M); 0.655 ±± 0.402 (24M) 0.402 (24M)Left eye: 0.627 Left eye: 0.627 ±± 0.403 (3M); 0.635 0.403 (3M); 0.635 ±± 0.360 (6M), 0.629 0.360 (6M), 0.629 ±± 0.328 (12M), 0.654 0.328 (12M), 0.654 ±± 0.452 (24M) 0.452 (24M)

ResultsResults

there was no statistical there was no statistical significant difference between significant difference between right eye and left eyeright eye and left eye

there was minimal loss of there was minimal loss of endothelial cell count and endothelial cell count and minimal changes in the corneal minimal changes in the corneal thickness in both eyesthickness in both eyes

Results Nd-YAG laser capsulotomy one year after surgery underwent Nd-YAG laser capsulotomy one year after surgery underwent

one patient (both eyes) and one patient two years one patient (both eyes) and one patient two years postoperatively (right eye)postoperatively (right eye)

BCVA two years postoperatively:BCVA two years postoperatively: Right eye: 0.896 Right eye: 0.896 ±± 0.13 (min.0.6; max.1.2) 0.13 (min.0.6; max.1.2) Left eye: 0.883 Left eye: 0.883 ±± 0.16 (min.0.4; max.1.2) 0.16 (min.0.4; max.1.2) ECC (cells/mmECC (cells/mm²²): ): Right eye - preop.: 2537.6; 3 months postop.: 2354.6 Right eye - preop.: 2537.6; 3 months postop.: 2354.6 Left eye - preop.: 2582.5; 3 months postop.: 2387.0Left eye - preop.: 2582.5; 3 months postop.: 2387.0 Pachymetry (Pachymetry (µµm): m): Right eye – preop.: 565.1; 3 months postop. 561.2Right eye – preop.: 565.1; 3 months postop. 561.2 Left eye – preop.: 562.2; 3 months postop. 557.1Left eye – preop.: 562.2; 3 months postop. 557.1 P-values: P-values: EPCO: 0.1 (3M); 0.29 (6M); 0.052 (12M); 0.153 (24M)EPCO: 0.1 (3M); 0.29 (6M); 0.052 (12M); 0.153 (24M) OSCA: 0.379 (3M); 0.525 (6M); 0.952 (12M); 0.949 (24M)OSCA: 0.379 (3M); 0.525 (6M); 0.952 (12M); 0.949 (24M)

Conclusions an increase in EPCO 2000 indexes and OSCA scores an increase in EPCO 2000 indexes and OSCA scores

found during 24 months in both eyesfound during 24 months in both eyes there was no proven significant difference between right there was no proven significant difference between right

eye and left eye, the mean total EPCO index and OSCA eye and left eye, the mean total EPCO index and OSCA score was slightly better for the right eyescore was slightly better for the right eye

our results show that this method is safe for intraocular our results show that this method is safe for intraocular tissue, our work confirmed previous results Jiraskova et tissue, our work confirmed previous results Jiraskova et al.al.

Jiraskova N, Kadlecova J, Rozsival P et al. Comparison of the effect of AquaLase and NeoSoniX Jiraskova N, Kadlecova J, Rozsival P et al. Comparison of the effect of AquaLase and NeoSoniX phacoemulsification on the corneal endothelium. J Cataract Refract Surg 2008; 34:377-382phacoemulsification on the corneal endothelium. J Cataract Refract Surg 2008; 34:377-382