This retrospective clinical study includes 299 eyes (238 patients) who underwent cataract surgeries with in-the-bag implantation of an Akreos MI60 (Bausch and Lomb, Rochester, New York, USA) IOL, at our clinic between January 2010 and December 2016.
One surgeon (S.W.M) had performed the surgical procedure under 0.5% proparacaine hydrochloride topical anesthesia. The procedure was performed after creating a self-sealing 2.80 mm superior clear corneal incision adjacent to the limbus. The size of the continuous curvilinear capsulorhexis was approximately 5.5 – 6.0 mm in diameter. Phacoemulsification was performed with the phaco chop technique using the AMO Sovereign Compact-WhiteStar System (Advanced Medical. Optics, Santa Ana, CA) followed by in-the-bag implantation of a single-piece hydrophilic IOL (Akreos MI60).
Mann-Whitney U-tests were used to compare age, axial length, anterior chamber depth, and pre- and postoperative refractive spherical equivalent (SE) between patients with and without CCS. We also compared the refractive changes, UCVA, and BCVA of patients with CCS and those without CCS.
Of the 299 eyes, 4 eyes of 4 patients had been diagnosed with CCS. There was no statistically significant difference in demographics, ocular parameters, pre- and postoperative SE between patients with CCS (n = 4) and patients without CCS (n = 295)(Table 1). The demographics, refractive changes, UCVA, and BCVA of patients with CCS were summarized in table 2. Mean SE was -0.91 ± 1.29 D after cataract surgery and 0.88 ± 0.91 D after CCS occurrence which showed hyperopic shift compare with postoperative value. After the Nd: YAG laser anterior capsulotomy, it was decreased to -0.47 ± 1.14D.
Case 1
A 60-year-old woman presented with decreased visual acuity in the right eye. She was on regular follow-up at our clinic due to non-proliferative diabetic retinopathy and hypertension. She had undergone microincision phacoemulsification and an in-the-bag implantation of an Akreos MI60 IOL at our clinic 11 months ago.
At 1 month after the cataract surgery, her UCVA and BCVA was 20/20 with a SE of − 0.125 D. At the time of presentation, her UCVA was 20/32 and BCVA was 20/25, in the right eye. In the refraction test, the SE showed a hyperopic shift of + 1.375 D. Her intraocular pressure (IOP) was within the normal limit. A slit lamp examination after pupil dilation revealed anterior capsule contraction syndrome with a markedly thickened anterior capsule (Fig. 1). The IOL remained stable centrally in the capsular bag; however, it showed a slight posterior vaulting (Fig. 1). The fundus examination showed no definite change in the retina. The Nd:YAG laser anterior capsulotomy was performed by creating symmetrical incisions along four axes that radiated from the pupil center under local anesthesia in the right eye (laser energy = 1.5 mJ). The capsulotomy was created from the continuous curvilinear capsulorhexis margin to the IOL optical margin. Radial tearing should be considered when performing the initial incision. The incision was performed up to 0.5-1.0 mm from the IOL optical margin. Incisions over IOL haptics should be avoided because asymmetrical lens tilting can occur. One month after the Nd:YAG treatment, her UCVA and BCVA improved to 20/20, and the SE reduced to + 0.25 D. Six months later, her BCVA was 20/20 in the right eye, without any CCS.
Case 2
A 65-year-old man complained of a progressive decrease in vision in his right eye. The patient had undergone phacoemulsification and hydrophilic acrylic IOL (Akreos MI60) implantation in his right eye 18 months ago. At 1 month after the cataract surgery, his UCVA was 20/63 and his BCVA was 20/20 with an SE of − 2.00 D. At the time of presentation, his UCVA and BCVA were 20/250 and 20/100, respectively, and his SE was + 0.375 D. The IOP and anterior ocular surface did not show any abnormality. Slit lamp examination after dilation revealed marked shrinking of the anterior capsular opening. An Nd:YAG laser anterior capsulotomy was performed. One month after the Nd:YAG laser treatment, his UCVA and BCVA improved to 20/100 and 20/20, respectively, and his SE value returned to – 1.375, which was similar to the value after the cataract surgery. Twelve months later, his BCVA was 20/20 in the right eye, without recurrence.
Case 3
A 66-year-old woman with no systemic disease visited our clinic due to decreased visual acuity in her right eye. She underwent phacoemulsification surgery with IOL (Akreos MI60) implantation 2 months ago. Her postoperative UCVA and BCVA were 20/100 and 20/25, respectively, and her SE was − 2.00 D. At the time of presentation, her UCVA and BCVA were 20/100 and 20/50 respectively. On a refraction test, her SE was − 0.125 D, which showed a hyperoptic shift compared to the value immediately after her cataract surgery. Dilated slit lamp examination revealed phimosis of the anterior capsule with posterior vaulting of the IOL optic. Laser anterior capsulotomy was performed with an Nd:YAG laser in the right eye. One month after the Nd:YAG treatment, her UCVA and BCVA improved to 20/63 and 20/32, respectively. On a refraction test, the SE was − 1.50 D. Eight months later, her UCVA and BCVA were 20/63 and 20/32, respectively, in the right eye, without any complications.
Case 4
A 76-year-old woman who had phacoemulsification cataract extraction 6 months ago was referred to our clinic due to decreased visual acuity in the right eye. She had controlled hypertension and diabetes. At the time of the cataract surgery, a Akreos MI-60 IOL was implanted in the capsular bag. Postoperative UCVA and BCVA were 20/32 and 20/20, respectively. The postoperative refraction test showed that her SE was +0.50 D. At the time of presentation, UCVA and BCVA were 20/50 and 20/25, respectively, and the SE showed a hyperoptic shift of + 1.875 D. Dilated slit lamp examination revealed 360 degrees of anterior capsular phimosis. Nd:YAG laser anterior capsulotomy was used to create a radial opening in the capsular phimosis. One month after the Nd:YAG treatment, her UCVA and BCVA improved to 20/25 and 20/20. The refraction test showed an SE of + 0.75 D. Twelve months later, her UCVA and BCVA were 20/20 in the right eye. There was no sign of anterior capsular contraction in the right eye.