OSCA: a comprehensive open-access system of analysis of posterior capsular opacification

Evaluation of Nd:YAG Laser Capsulotomy Rates in a Real-Life Population

Objective

The objective of this study was to assess the rate of posterior capsule opacification (PCO), under “real-life” conditions, as measured by rates of Nd:YAG laser intervention, rather than from a controlled study from which patients with conditions predisposing to PCO have been excluded.

Methods and Analysis

This was a retrospective, multicenter study in an unselected consecutive cohort of patients undergoing surgery for senile cataract. Patients aged 18 years and older, previously implanted with the CT LUCIA 611P IOL, were contacted at 12, 18 and 24 months to ascertain if they had received Nd:YAG laser treatment. There was an additional assessment at 36 months at the Austrian centre.

Results

A total of 200 patients were recruited at two centers. Laser capsulotomy rates were 4.5% at 1 year and 10% by year 2 and 12% by year 3. Three Nd:YAG capsulotomies, carried out at other external centers, were performed for reasons other than PCO, including astigmatism, epiretinal membrane and ARMD. If these patients are excluded, the true rate of Nd:YAG carried out for PCO at 1 year was 3.5% and at 2 years was 8.5%.

Conclusion

It is critical to ensure that Nd:YAG capsulotomies are being performed only for the correct clinical reason. Carrying out unnecessary procedures places the patient at risk of adverse events, is a cost to the healthcare system, and is likely to have no direct visual benefit for the patient. In PCO studies, it should be a requirement to document the fibrosis grade to confirm that Nd:YAG capsulotomy was correctly indicated.

Long-term follow-up of posterior capsule opacification after AquaLase and NeoSoniX phacoemulsification

AIM

To compare the degree of posterior capsule opacification (PCO) after AquaLase and NeoSoniX phacoemulsification methods during an 8-year follow-up period using two types of software.

DESIGN

Prospective, randomized clinical trial.

METHODS

AquaLase was used in the right eye and NeoSoniX in the left eye of each patient with bilateral cataract.

RESULTS

Fifty patients were analyzed 1 year, 46 patients 3 years, and 37 patients 8 years after cataract surgery. Mean EPCO 2000 values were for the AquaLase group 0.324 ± 0.305 and for the NeoSoniX group 0.298 ± 0.341 (P = 0.53) 1 year after surgery, for the AquaLase group 0.582 ± 0.506 and for the NeoSoniX group 0.594 ± 0.515 (P = 0.87) 3 years after surgery, and for the AquaLase group 0.648 ± 0.567 and for the NeoSoniX group 0.673 ± 0.542 (P = 0.30) 8 years after surgery. The OSCA results were for the AquaLase group 0.7097 ± 0.3778 and for the NeoSoniX group 0.8584 ± 0.4323 (P = 0.046) 1 year after surgery, for the AquaLase group 0.9667 ± 0.736 and for the NeoSoniX group 0.9540 ± 0.5250 (P = 0.91) 3 years after surgery, and for the AquaLase group 1,035 ± 0,952 and for the NeoSoniX group 1,103 ± 0,741 (P = 0.44) 8 years after surgery.

CONCLUSION

There was minimal PCO difference between these 2 approaches, AquaLase and NeoSoniX. Neither AquaLase nor NeoSoniX technique was able to prevent a natural progression of PCO.

The effect of femtosecond laser capsulotomy on the development of posterior capsule opacification

PURPOSE

To evaluate and compare the effects of femtosecond laser-assisted anterior capsulotomy and manual anterior capsulorhexis on posterior capsule opacification (PCO) development.

METHODS

Femtosecond laser-assisted anterior capsulotomy was performed in 40 eyes of 40 patients (FS group) and manual anterior capsulorhexis was performed in 39 eyes of 39 patients (CCC group). An AcrySof one-piece hydrophobic acrylic intraocular lens (Alcon Laboratories, Inc., Fort Worth, TX) was implanted in all eyes. The PCO level was measured using Open-Access Systematic Capsule Assessment (OSCA) software 18 to 26 months after surgery. Postoperative intraocular lens position (ie, tilt and decentration) was measured using Scheimpflug images (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany).

RESULTS

There was no statistically significant difference in age, axial length, and follow-up time between the two groups (P > .05). Vertical tilt, horizontal and total decentration of intraocular lenses, and PCO proved to be significantly higher in the CCC group (P = .03, .04, .03, and .01, respectively). After adjusting for axial length and follow-up time, manual anterior capsulorhexis was found to be a significant predictor of higher PCO scores in the multivariable regression model (β: 0.33; 95% CI: 0.01 to 0.65; P = .04). Vertical tilt affected PCO scores after adjusting for axial length and follow-up time (β: 0.07; 95% CI: 0.01 to 0.12; P = .02). No capsulotomies were performed during follow-up in either group.

CONCLUSIONS

Femtosecond laser-assisted anterior capsulotomy proved to be a safe procedure for postoperative PCO rates. Due to better intraocular lens position, femtosecond laser-assisted anterior capsulotomy resulted in slightly decreased PCO scores; however, evaluating its clinical significance requires further studies.

Three-year follow-up of posterior capsule opacification after AquaLase and NeoSoniX phacoemulsification

PURPOSE

To prospectively compare the degree of posterior capsule opacification (PCO) after AquaLase and NeoSoniX phacoemulsification methods during the 3-year follow-up period.

DESIGN

Prospective, randomized clinical trial.

METHODS

Setting at the Department of Ophthalmology, University Hospital in Hradec Králové. Patients with bilateral cataract were included. AquaLase was used in the right eye and NeoSoniX in the left eye of each patient. The AcrySof SA60AT intraocular lens (Alcon Laboratories, Fort Worth, Texas, USA) was implanted in all eyes. The Evaluation of Posterior Capsule Opacification (EPCO) 2000 software (Developed by Tetz MR and associates, Berlin, Germany) and the Open-Access Systematic Capsule Assessment (OSCA) system (Devised by Aslam TM, Edinburgh, United Kingdom) were used for PCO assessment 1, 2, and 3 years after cataract surgery.

RESULTS

Fifty patients were analyzed 1 year, 47 patients 2 years, and 46 patients 3 years after cataract surgery. Mean EPCO 2000 values were for the AquaLase group 0.324 +/- 0.305 and for the NeoSoniX group 0.298 +/- 0.341 (P = .53) 1 year after surgery, for the AquaLase group 0.429 +/- 0.322 and for the NeoSoniX group 0.478 +/- 0.337 (P = .30) 2 years after surgery, and for the AquaLase group 0.582 +/- 0.506 and for the NeoSoniX group 0.594 +/- 0.515 (P = .87) 3 years after surgery. The OSCA results were for the AquaLase group 0.7097 +/- 0.3778 and for the NeoSoniX group 0.8584 +/- 0.4323 (P = .046) 1 year after surgery, for the AquaLase group 0.7515 +/- 0.4555 and for the NeoSoniX group 0.8103 +/- 0.4498 (P = .44) 2 years after surgery, and for the AquaLase group 0.9667 +/- 0.736 and for the NeoSoniX group 0.9540 +/- 0.5250 (P = .91) 3 years after surgery. Neodymium-yttrium-aluminun-garnet capsulotomy rate for AquaLase vs NeoSoniX was 0:1 eyes 1 year, 1:3 eyes 2 years, and 1:4 eyes 3 years after surgery. No significant difference between those 2 groups was established, except the OSCA outcomes 1 year postoperatively.

CONCLUSION

There was only minimal PCO difference between these 2 approaches, AquaLase and NeoSoniX. Neither AquaLase nor NeoSoniX technique was able to prevent a natural progression of PCO.

Comparison of posterior capsule opacification after two different surgical methods of cataract extraction

PURPOSE

To compare the extent of posterior capsule opacification (PCO) after AquaLase and NeoSoniX phacoemulsification methods using two types of software for PCO quantification.

DESIGN

Prospective, randomized clinical trial.

METHODS

At the Department of Ophthalmology, University Hospital in Hradec Králové, 50 patients (100 eyes) were analyzed one year after surgery. AquaLase was used in the right eye and NeoSoniX in the left eye of each patient. One year after surgery, digital retroillumination photographs of anterior segments were obtained. The Evaluation of Posterior Capsule Opacification (EPCO) 2000 software (Berlin, Germany) and the Open-Access Systematic Capsule Assessment (OSCA) system (Edinburgh, United Kingdom) were used for PCO assessment. Best-corrected Snellen visual acuity (BCVA) was evaluated before and after surgery. Statistical analysis was performed using parametric tests.

RESULTS

The EPCO 2000 results were as follows: mean value for right eyes, 0.324+/-0.305; mean value for left eyes, 0.298+/-0.341; no difference was proved (P=.532). The OSCA results were as follows: for right eyes, 0.7097+/-0.3777; for left eyes, 0.8584+/-0.4323; significant difference (P=.046), worse for left eyes. No correlation between EPCO 2000 and OSCA results was established (P>.001; correlation coefficient, 0.347). BCVA for the right eyes was 0.837+/-0.262 and for the left eyes was 0.849+/-0.224. Neodymium:yytrium-aluminum-garnet capsulotomy was performed in one eye in the NeoSoniX group, and in no eyes in the AquaLase group.

CONCLUSIONS

There was no significant difference in PCO measured by EPCO 2000, however, PCO after AquaLase as assessed by EPCO 2000 was slightly denser. The OSCA system gave significantly higher scores in the NeoSoniX group. No correlation between EPCO 2000 and OSCA outcomes was proved.

Post-operative capsular opacification: a review

Post-operative capsular opacification is a multifactorial physiological consequence of cataract surgery. Opacification involving the central posterior capsule has a significant impact on high and low contrast acuity and low contrast sensitivity. The assessment of Posterior Capsule Opacification (PCO) on cadaver eyes, experimental studies, culture models and in clinical studies has provided an understanding of its pathogenesis. The proliferation, migration and abnormal differentiation of residual lens epithelial cells and fibers in the capsular bag have been implicated in the pathogenesis of PCO. The incidence and severity of PCO correlates to the meticulous use of surgical techniques, IOL optic edge designs and IOL materials. This article summarizes the clinical studies with recommendations for retarding the development of central PCO. It discusses experiments with pharmacological agents broadly categorized as anti-inflammatory, immuno-modulating, antiproliferative, antiadhering, antitransdifferentiating agents for the prevention of PCO. These studies will remain critical for future endeavors undertaken for eradication of PCO.