This article is more than 5 years old. Information may no longer be current.
PCCC still a valuable procedure in some cases
Topical anesthesia and foldable implants rendered the technique unsuitable as a routine procedure, but it is still helpful in a number of different scenarios.
MILAN — Although recent developments in cataract surgery have made primary posterior continuous curvilinear capsulorrhexis unsuitable as a routine procedure, the technique is still a valuable option in a number of cases, according to Albert Galand, MD, of Liège University Hospital, Belgium, speaking at the Satelcataract meeting here.
Soon after his first experiences with primary posterior continuous curvilinear capsulorrhexis (PCCC) as an alternative to Nd:YAG laser capsulotomy in cases of posterior capsule opacification or congenital cataract, Prof. Galand introduced some modifications and used it almost routinely in his cataract patients.
A routine procedure
|
|
|
|
|
|
“It was 1993, and the technique was new. I found it fairly easy to master, safe and effective. Intraoperative risks were very low and, compared with YAG laser capsulotomy, it had the great advantage of leaving the vitreous intact,” Prof. Galand said.
“Postoperative complications were also very few. The rate of cystoid macular edema was in the average range, as it was in cataract extractions without PCCC. The rate of retinal detachment was also very low. Again, this was probably due to the fact that we didn’t expose the vitreous to potentially harmful surgical maneuvers.”
On the whole, PCCC worked well and safely as a preventive maneuver; patients could be sent away without worrying about secondary opacification. Only in a few cases, as Prof. Galand pointed out, something similar to opacification took place not on the capsule but on the anterior surface of the vitreous, due to cell proliferation that closed the opening of the posterior capsule.
Technique
An important factor in the success of the technique was that Dr. Galand used general or local anesthesia in cataract surgery at that time. In either case, the surgeon was operating on immobile eye globes.
“When topical anesthesia and foldable implants were introduced in cataract surgery, I encountered the two factors that discouraged me from continuing with PCCC,” Prof. Galand said.
PCCC prolonged surgery by 3 to 4 minutes, an increase in time that was enough to make the maneuver too risky under topical anesthesia. Eye movements could seriously jeopardize the outcome of the operation, he explained.
“The second drawback came from the dynamics of foldable lens insertion. When I pushed the lens through my 3 mm incision into the capsular bag, the lens unfolded and sometimes the tip of the loop fell into the posterior capsule opening. I was obliged to inject more viscoelastic, rescue the loop and reposition it in the capsular bag,” Prof. Galand said.
Still useful
“The new situation required a reappraisal of my conviction that PCCC could to be used routinely. This was not the case anymore. However, I continue to use it in many cases, one in 12 on average,” Prof. Galand said.
“I use it when the capsule presents signs of central opacification due to growing fibrous material. I use it with patients who might prove difficult to place in front of a YAG device if opacification occurs; among them, young children and all other categories of uncooperative patients, and also institutionalized patients who are unlikely to return for a second operation. In these cases, it is better to get rid of the center of the capsule, preventing the possibility of secondary opacification.”
Since 1993, Prof. Galand has performed nearly 2,100 cases of PCCC. Most of them were carried out in the first 5 years.
“There are still some indications for posterior capsulorrhexis,” he reaffirmed, “and it is therefore important that all surgeons gain the necessary skills and experience to perform the procedure correctly.”
For Your Information:
- Albert Galand, MD, can be reached at Centre Hospitalier Universitaire, B-4000 Liège, Belgium; +(32) 4-3667899/95; fax: +(32) 4-3667274. Dr. Galand has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.