Study finds less postop intraocular flare from cataract surgery with posterior optic buttonholing

Cataract surgery performed with primary posterior capsulorrhexis and posterior optic buttonholing in adults induced slightly less anterior chamber reaction during the first 4 weeks postop compared with conventional in-the-bag IOL implantation, a prospective study by researchers in Austria found.

The finding indicates that posterior optic buttonholing may induce less of an inflammatory response, the study authors noted.

"Combining primary posterior capsulorrhexis and posterior optic buttonholing in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the IOL," the authors said.

Eva Stifter, MD, and colleagues randomly assigned one eye of 50 consecutive cataract surgery patients to undergo surgery involving primary posterior capsulorrhexis and posterior optic buttonholing. Each patient's fellow eye underwent conventional surgery with in-the-bag lens placement. The researchers compared the degree of postoperative intraocular flare between the two techniques, according to the study.

Topical anesthesia was used in both eyes, and the posterior lens capsule was kept intact during IOL implantation.

The researchers used an FC-1000 laser flare cell meter (Kowa) to measure intraocular flare at various times up to 24 hours postop and at 1 week and 1 month follow-up.

In all eyes, investigators observed the highest degree of intraocular flare at 1 hour postop, which steadily decreased thereafter, according to the study.

However, at 24 hours postop, eyes in the in-the-bag IOL implantation group had statistically significantly higher flare measurements compared with eyes treated with primary posterior capsulorrhexis and posterior optic buttonholing (P < .05).

"This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion," the authors said.

Intraocular flare measurements were again comparable between the two groups at 1 week and 1 month follow-up, the authors noted.

The study is published in the November issue of British Journal of Ophthalmology.