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Study: Novel technique using capsulorrhexis flap to protect endothelium shows good results
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MAASTRICHT, Netherlands — A novel technique using the capsulorrhexis flap to protect the endothelium during phacoemulsification cataract surgery proved effective in reducing cell loss and minimizing corneal edema in a study.
The technique was first described in 2015 by Giorgio La Rocca, MD, who named it “endothelial protection by closed eye repositioning of anterior capsule,” or EPAC. At the European Society of Cataract and Refractive Surgeons winter meeting, the group of Oliver Findl, MD, presented preliminary results of their own study to evaluate the benefits, success rate and feasibility of the protection shield.
Sahand Amir-Asgari
The study has so far included 50 patients who were randomized 2:1 to have surgery with or without the protection shield. In the EPAC group, the anterior capsulorrhexis flap was pushed against the endothelium using a high dispersive ophthalmic viscosurgical device (Eyefill HD, Bausch + Lomb).
“We used intraoperative OCT (Rescan 700, Carl Zeiss Meditec) to verify the position of the flap and to measure and categorize the lens fragments according to size, position, contact area and contact time. During phacoemulsification, the fragments hit the flap but never the cornea,” Sahand Amir-Asgari, MD, said.
A learning curve is required to maintain the flap during the procedure, he said. Although all surgeries were performed by an experienced surgeon, loss of the flap occurred in eight patients: in six cases during OVD injection or positioning of the flap and in two cases during hydrodissection and phacoemulsification.
In the cases in which it was successfully maintained, the flap showed advantages.
“Though not statistically significant, there was a tendency towards even less endothelial cell loss in the EPAC group. The difference in central corneal thickness between preop and 1 hour and preop and 2 months was highly statistically significant,” Amir-Asgari said. – by Michela Cimberle
Reference:
Amir-Asgari S, et al. Anterior capsule rhexis flap as endothelial protection shield : a novel technique. European Society of Cataract and Refractive Surgeons winter meeting; Feb. 10-12, 2017; Maastricht, Netherlands.
Disclosures: Amir-Asgari reports no relevant financial disclosures. Findl reports he is scientific advisor/member of the advisory board of Carl Zeiss Meditec and Bausch + Lomb.