Study Of Preventing Traumatic Cataract After Surgery Posterior Capsule Opacification.

With the continuing popularity of modern cataract surgery, and the continuous improvement of surgical techniques and equipments is continuously updated. Many surgical complications are reducing gradually. Posterior Capsular Oacification (PCO) has become one of the predominant factors in the aspect of improving visual acuity. The current study showed that the formation of PCO is due to the blood-aqueous barrier destruction lead to the endogenous cytokines and inflammatory mediators into the capsular bag after cataract extraction, and acting on the anterior capsule residual lens epithelial cells. The cells happened fibroblast-like changes, the cells migrate and proliferate rapidly on the posterior capsule and secret a lot of collagen protein and extracellular matrix, residual lens epithelial cells collagen protein and fibroblast-like cells mixed with each other. Opacification occurs as a result of the formation of fibrotic membranes on the posterior capsule. It could cause the shrinkage deformation, forming light scattering. Ultimately lead to a serious decline in visual acuity. PCO of formation closely related with age, body conditions (for example, diabetes, autoimmune diseases, etc), IOL type,surgical methods and surgical techniques. At present, the major treatment of PCO is Capsulotomy of Nd : YAG laser .However, The treatment needs usually twice or more times. The hospital has not been extensively carried out in the grass roots, and will occur in certain surgical complications(for example,high IOP and the destroy of IOL,etc); In addition. he medicines of prevention of PCO not yet were used extensively in clinical .Therefore ,in clinical some preventive measures should be taken. One of the most important aspects is the continuous improvements in surgical techniques.The case with traumatic cataract patients were children and young adults usually, the lens epithelial cell of proliferation ability is stronger, and the eye injury reaction is heavier, therefore,the occurrence of PCO is higher, the rate of occurrence is almost 100% in children. To reduce the formation of PCO, particular, the central posterior capsular opacification impact the visual acuity seriously, Many people continue to explore new methods of prevention, including the posterior capsule opacification drug research, the artificial lens material, shape and surface of special treatment; Meanwhile, many domestic and overseas scholars continuously improve the technology of capsulorhexis. From the initial open-filling capsulotomy to continuous circular capsulorhexis, and posterior capsular capsulorhexis combining with anterior vitrectomy prevent the formation of PCO. Posterior capsulorhexis has been reported by many domestic and overseas scholars, again capsulorhexis was depicted only by domestic scholar HeShouzhi. However, again capsulorhexis combining with posterior capsulorhexis prevent PCO at home and abroad have not yet commented. During cataract surgery impossible polishing the posterior capsule traumatic cataract of children and adults or elderly patients with posterior capsular opacity trends, pupil not folly dispersed Preoperative, again capsulorhexis combining with posterior capsulorhexis of the 32 cases of traumatic cataract showed a prospective study. The effect of again capsulorhexis combining with posterior capsulorhexis was observed.Materials and Methods1. Information and group: Both groups of traumatic cataract are carried out cataract extraction and intraocular lens implantation in our hospital between June 2003 with September 2006 .32 patient 32(eye) of again capsulorhexis combining with posterior capsulorhexis showed the observed group,Traumatic category includes injuries of eyeball contusion corneal perforation and perforation of the sclera; Excluding central corneal opacity patients , The patient's pupil of observed group are not dilated (≤4.5mm), randomly selected from the without posterior capsulorhexis and again capsulorhexis traumatic cataract 32 patients (32 eyes), as a control group. The patient's papit of are dileted (>7.0mm)2. Preoperative examination : visual inspection; Slit lamp microscopy inspect cornea iris and lens opacity;B-ultrasonic explores vitreous opacities and whether the existence of retinal detachment; Visual evoked potential (VEP) checks whether the optic nerve exists contusion.3. Surgical methods :If the patients's age are younger than 12 years, the basic anesthesia (ketamine 5mg/kg)will be applied. If the patients's age are older than 12 years,who can not be very good cooperation with the surgery ,the conventional posteyeball anesthesia is necessary; the observed group and the control group use the same anesthesia ,For the other patients only need the superficies anesthesia. Both groups of cases were carried out the conventional phacoemulsification cataract surgery. The oserved group were applied again capsulorhexis combining with posterior capsulorhexis. Posterior capsulorhexis: in the center of posterior capsular tears about 2-3mm diameter of a circular defect; Again capsulorhexis. Because the patient' pupil were not dilated before surgery. Capsulorhexis was applied after intraocular lens implantation. In the control group. Which were not applied again capsulorhexis combining with posterior capsulorhexis.4. Follow-up and records:When one week,one month,three months,six months, one year and two years after surgery or the visual acuity decreased seriously,or eye obviously unwell,The reexamination is necessary. Changes in visual acuity and the PCO were recorded, the central PCO records showed the clinical classification. The central PCO is 0-4 grade : grade 0 is no turbidity level, and grade 1 is a small amount of opacity. Posterior capsule visible wrinkles or micro-lens epithelial cells thin, grade 2 is the mildly turbidity, posterior capsular opacity and visible honeycomb thick lens epithelial cell sheets , grade 3 is fiber membrane moderate turbidity. Visibility compact Elschnig pearl-like body or compact fiber membrane, grade 4 is serious opacification,compact Elschnig pearl-like body, with "Shade" effect.Results1 .Visual acuityAfter 1 week, 1 month, 3 months, 6 months, 1 and 2 years. The average visual of twogroups will be applied t-test respectively.six months ago the difference between the two groups was not significant (P>0.05). After six months the average vision between two groups is statistical significance (P<0.05).2. Peripheral turbidity of posterior capsuleThe cycloplegic peripheral posterior capsule opacification was checked in the last follow-up.The observed group there were 15 cases of dense fibrous membrane, 11 cases were found to the moderate Soemmering ring, 6 cases there Elschnig pearl-like body. In the control group, there were 21 cases of dense fibrous membrane, 5 cases of moderate degree Soemmering ring, 6 cases there Elschnig pearl-like body (x~2=11.02 ,P>0.05).3. The central PCO classificationThe Observed group and the control group in a week, 1 month, 3 months, 6 months, 1 and 2 years. The average Central PCO-level were applied the t-test. in 3 months (t=3.17. 0.05)the difference was not statistically significant; in six months (t =3.48 P<0.05) the difference was statistically significant; in 1 year (t=7.36, P<0.05)the difference was statistically significant; In 2 years (t=4.27,P<0.05)the difference was not statistically significant.Conclussions1. The second capsulorhexis combining with posterior capsule capsulorhexis in traumatic cataract surgery was applied,central posterior capsular opacification will abated in a certain period of time significantly.2. Second capsulorhexis combing posterior capsulorhexis in the phacoemulsification cataract surgery, which offers a safe and effective method for the small pupil phacoemulsification cataract surgery.