Transcript Opacity of the Anterior Vitreous Surface after the

Wan-Soo Kim, MD, PhD 1,2 ,
Kyeong-Hwan Kim, MD 1
Maryknoll Hospital 1, Busan, Korea
Pusan National University 2, Busan, Korea
The authors have no financial interest
 Posterior capsular opacification(PCO) is one of
the most common causes of reduced visual
prognosis after cataract surgery.
 Several authors suggested that PCO could be
prevented with posterior continuous curvilinear
capsulorrhexis(PCCC) technique during the
cataract surgery.
 We report a case of the opacity of the anterior
vitreous surface after the cataract surgery with
primary PCCC.
 A 68 year old woman was referred for the
evaluation of decreased vision.
 She was diagnosed as senile nuclear cataract in
both eyes.
 OD : NO3 / NC3, C2, P2
 OS : NO2 / NC3, C1, P1
 LOCS III classification
 There was no finding suggestive of ocular
inflammatory disease after completing ocular
and systemic evaluation.
Surgical Technique
 Topical anesthesia with Proparacaine
 2.8mm Clear Corneal Incision
 Round and Well centered Continuous
Curvilinear Capsulorrhexis (CCC)
 Phacoemulsification after Hydrodelineation
 Capsule was filled with OVD
 Posterior Continuous
Curvilinear Capsulorrhexis
 Posterior capsule was
punctured with 26-gauge
bent needle
 OVD was injected through
the puncture site of the
posterior capsule to push
vitreous body posteriorly
 Round and well centered
posterior CCC was done
meticulously with capsular
forceps
 The size is a little smaller
than anterior CCC
Posterior Continuous Curvilinear Capsulorrhexis
( Intraoperative photograph )
 Preoperative best corrected visual acuity in
LogMAR scale was 0.22 in her right eye ,0.05 in
left eye and 0.00 in both eyes at every follow up
visits for 2 months
 At 2 months of follow up, although she didn’t
complain any visual symptoms, the opacity of
the anterior vitreous surface was found and
there was continuity of the posterior capsule to
the anterior vitreous face at the slitlamp
examination
Clear PCCC
( POD 1 Month )
Closure of PCCC
( POD 2 Months )
• We found the posterior CCC margin was in contact with anterior vitreous face
during follow up
 Posterior capsular opacity is one of the frequently
encountered complication after cataract surgery,
with a reported incidence of 4 to 50 %.
 Risk factors are known such as young age,
complicated or traumatic surgery, uveitis, and
diabetes.
 Several authors, such as Gimble, Neuhann, and
Castaneda, insisted that posterior CCC can prevent
posterior capsular opacification.
 Little is known about the role of posterior CCC
in the prevention of PCO
 Tassignon et al reported a case of young patient
with posterior capsular opacity due to a
reclosure of posterior CCC and supposed that
closure is caused by new tissue formation within
the PCCC area.
 They distinguished 3 types of secondary
proliferation :
 Multilayered cellular proliferation
 Monolayered cellular proliferation
 Fibrotic proliferation
 In this case, type of secondary proliferation in
the process of PCCC reclosure is not entirely
understood.
 However, it seems that the continuity of anterior
vitreous face with posterior capsule could be the
pathway for migration of lens epithelial cell from
the equatorilal region.
 Although the PCCC is very useful technique to
reduce posterior capsular opacity after cataract
surgery, attachment of anterior vitreous face to
the posterior capsule must be evaluated in order
to prevent PCO which might occur by migrating
lens epithelial cells from posterior capsule.
It is important to
break the continuity
of posterior capsule
with highly reactive
anterior vitreous face
to secure visual axis
preservation.
Buerger’s Space in Other PCCC Case
( No Continuity of Posterior Capsule with Anterior Vitreous Face )