Purpose To evaluate over almost 2 decades the success of a component of cataract surgery that represents a critical step in reducing the incidence of posterior capsule opacification (PCO); namely, the efficacy of cortical cleanup. Setting Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA. Methods Accessioned from the early 1980s to 1997, 3320 eyes obtained postmortem with posterior chamber intraocular lenses were analyzed with respect to formation of a postoperative Soemmering’s ring. This anatomic lesion, the precursor of clinical PCO, represents an important and measurable indication of the quality of cortical cleanup. Its formation was documented using Miyake–Apple posterior photographic analysis. Results The quality and thoroughness of cortical cleanup and overall effectiveness in eliminating retained and/or regenerating cortical cells, as measured by scoring of Soemmering’s rings, showed virtually no net change since the early 1980s. The intensity of Soemmering’s ring was higher in the most recent specimens than in those in the early 1980s. Conclusion The results indicate that renewed attention to cortical cleanup in cataract surgery is warranted for significant reduction in incidence or the elimination of PCO. More attention to the hydrodissection (cortical cleaving hydrodissection) step of the procedure is likely a practical, immediately implementable, and inexpensive remedy.

Surgical prevention of posterior capsule opacification. Part 1: Progress in eliminating this complication of cataract surgery.

Use of Nd:YAG laser capsulotomy.

Purpose To compare the results of posterior capsule opacification (PCO) quantification and the repeatability of a fully automated analysis system (Automated Quantification of After-Cataract [AQUA]) with that of 2 other quantification methods and subjective grading of PCO. A test set of digital retroillumination images of 100 eyes with PCO of varying degrees was used. Setting Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods One hundred digital retroillumination images of eyes (100 patients) with PCO were selected to attain an even distribution from mild to severe cases. The images were evaluated by 4 methods: subjective grading by 4 experienced and 4 inexperienced examiners, the subjective Evaluation of Posterior Capsular Opacification (EPCO) system, posterior capsule opacification (POCO) software, and the AQUA system. Ten images were presented twice to assess the reproducibility of the analysis systems. Results Subjective grading correlated best with the subjective EPCO system and the objective AQUA system ( r = 0.94 and r = 0.93, respectively). The POCO system showed very early saturation and therefore a much weaker correlation ( r = 0.73). The POCO scores reached the maximum of 100% in several minimal to mild PCO cases. The reproducibility of the AQUA software was perfect and that of the other analysis systems, comparably satisfactory. Conclusion The objective AQUA score correlated well with subjective methods including the EPCO system. The POCO system, which assesses PCO area, did not adequately describe PCO intensity and includes a subjective step in the analysis process. The AQUA system could become an important tool for randomized masked trials of PCO inhibition.

Comparison of 4 methods for quantifying posterior capsule opacification

PURPOSE. To investigate how posterior capsule opacification (PCO) affects visual function in pseudophakic eyes. METHODS. One hundred and six eyes that had undergone uncomplicated phacoemulsification were recruited sequentially. Patients with surgical complications or other ocular disease were excluded. PCO was assessed by a digital retroillumination camera using a software program based on the analysis of texture in the image, and the percentage area within the central 3-mm zone of the posterior capsule was calculated. Visual function assessment included Early Treatment Diabetic Retinopathy Study (ETDRS) high- and low-contrast visual acuity, contrast sensitivity with the Pelli-Robson and CSV-1000 grating charts, and forward light-scatter by the direct-compensation method (van den Berg). RESULTS. The percentage PCO required for decline in high-contrast ETDRS was 78%; for low-contrast acuity and Pelli-Robson, 46%; for CSV-1000 contrast sensitivity, 38% to 51%; and for forward light-scatter, less than 1% PCO. CONCLUSIONS. Central PCO affects psychophysical test results with differing degrees of sensitivity. Forward light-scatter is the most sensitive, followed by contrast sensitivity and visual acuity.

The effect of posterior capsule opacification on visual function

Quantification of posterior capsule opacification with round and sharp edge intraocular lenses.

Purpose: To describe a morphological scoring system of posterior capsule opacification (PCO) that is not based on visual acuity testing. Setting: Department of Ophthalmology, University of Heidelberg, Germany. Methods: Following dilation of the pupil, standardized photographs of the pseudophakic anterior segments were obtained using a photo slitlamp. Posterior capsule opacification was scored by evaluating retroillumination photographs. The individual PCO score was calculated by multiplying the density of the opacification (graded from 0 to 4) by the fraction of capsule area involved behind the intraocular lens (IOL) optic. To evaluate the reliability of the morphological scoring system, six observers examined photographs of five eyes each (Experiment A, interindividual reliability). The same observer scored the PCO in three eyes on five different days (Experiment B, intraindividual reliability). Results: Morphological PCO scores were very reliable. With PCO scoring from 0 to 4, the interindividual reliability showed standard deviations between 0.08 and 0.25. The intraindividual reliability showed standard deviations between 0.06 and 0.19 of the mean individual PCO scores. Standard deviation was 0.12 when different photographs of the same eye were scored. Conclusion: The morphological scoring system evaluates the entire area behind the IOL optic and thus includes a larger area of the posterior capsule than does visual acuity testing. The method revealed high reliability and insignificant investigatordependent variations. When using a standardized photographic setup, systematic errors by the photographic technique were not relevant. This method may be an important tool to accurately test for differences in PCO formation with various IOL styles and surgical methods.

Photographic image analysis system of posterior capsule opacification

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Photographic image analysis system of posterior capsule opacification