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AcrySof induces ‘placid’ PCO in children

The three P’s of PCO are prolonged, placid and proliferative.

Issue: September 15, 2000

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BOSTON — The AcrySof lens (Alcon, Fort Worth, Texas) appears to induce a placid, proliferative type of posterior capsular opacification (PCO) instead of a fierce and fibrous type.

---PCCC and anterior vitrectomy with 2 years follow-up.

Lajja R. Shastri, MD, of the Iladevi Cataract and IOL Research Centre in Ahmedabad, India, said, “In spite of advanced techniques, technology and experience in achieving a superior surgical control, congenital cataract surgery with IOL implantation has a unique problem. The whole purpose of trying to achieve a faster visual rehabilitation is defeated due to central axis obscuration, which develops at an alarming speed.”

Abhay Vasavada, MS, FRCS, Director of the Iladevi Cataract and IOL Research Centre, Rupal Trivedi, MS, and Dr. Shastri prospectively evaluated the clarity of the central axis following AcrySof in pediatric eyes. This study was designed and overseen by Dr. Vasavada.

Dr. Shastri spoke about the results in the talk, “AcrySof implantation in congenital cataract surgery: update,” at the annual American Society of Cataract and Refractive Surgery meeting.

Patients enrolled

---No PCCC performed with 2 years follow-up.

Researchers enrolled 103 consecutive eyes divided into two groups according to the age at surgery. In the study, 37 eyes were less than 2 years old and 66 eyes were more than 2 years old. Some patients were as old as 16.

The study groups also were divided by the surgical intervention performed by Dr. Vasavada. In the younger group, Dr. Vasavada always performed a primary posterior continuous curvilinear capsulorrhexis (PCCC) with anterior vitrectomy to prevent PCO.

In the group of older children, the surgeon divided the group based on a randomly assigned PCCC. This group was again subdivided based on a randomly assigned anterior vitrectomy.

So patients less than 2 years old had 37 eyes that underwent PCCC and vitrectomy. Patients more than 2 years old had 37 eyes in which no PCCC was performed and 29 eyes in which PCCC was randomly assigned. Of the 29 eyes that underwent PCCC, 14 did not undergo vitrectomy and 15 eyes did.

“Placid” proliferation

---Randomly assigned PCCC done with 2.5 years follow-up.

Of all the eyes, the incidence of PCO was nearly 11% at a mean follow-up of 16 months. The maximum follow-up was as much as 3 years.

Of the children less than 2 years old, one of 37 eyes developed a central fibrous obscuration, which did not need a secondary procedure. The mean follow-up was 14 months.

Of the children more than 2 years old that did not undergo PCCC, 10 of 37 eyes developed central PCO at a mean follow-up of 17 months. Of the 10 eyes, four needed YAG capsulotomy, which was performed after 1 year of follow-up.

“Based on our experience with PMMA implantation in the congenital cataract eyes, we have found that the PCO development with PMMA is different from that which develops with AcrySof,” Dr. Shastri said.

---PCCC and anterior vitrectomy with 3 years follow-up.

“The PCO with PMMA is fast and fierce in nature and a fibrous type. With the AcrySof, it is delayed or prolonged, placid in nature and of a proliferative type.”

In the group where only PCCC was performed, all 14 eyes had a clear central visual axis at a mean follow-up of 13 months.

In the eyes that had PCCC with vitrectomy, all the eyes remained completely clear at a mean follow-up of as much as 20 months.

“All the eyes of all the children who had either only PCCC or PCCC with vitrectomy, the central axis remained absolutely clear at the last follow-up,” Dr. Shastri said. “When combined with a surgical technique befitting the age of the child, AcrySof has a promising compatibility as an ocular implant in congenital cataract surgery.”

For Your Information:

• Lajja R. Shastri, MD, can be reached at Iladevi Cataract and IOL Research Centre, Gurukul Road, Near Shreeji Complex, Memnagar, Ahmedabad, 380052, India; (91) 79-745-3303; fax: (91) 79-741-1200. Dr. Shastri has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any company mentioned.

• Alcon can be reached at 6201 South Freeway, Fort Worth, TX 76134; (800) 862-5266; fax: (817) 241-0677.