Long term follow up of Impact of Cortico Cleaving Hydrodissection on Posterior

Capsule Opacification (PCO) after paediatric cataract surgery

Samaresh Srivastava, DNBVaishali Vasavada, MSSajani K. Shah, DO, MS

Rupal Trivedi, MD, MSCR*Abhay R. Vasavada, MS, FRCS (England)

M.R. Praveen , DOIladevi Cataract & IOL Research Centre, Ahmedabad, India

* Storm Eye Institute, MUSC, USAThe authors have no financial interest in this presentation

Vasavada AR, Dholakia SA, Raj SM et al. Effect of cortical cleaving hydrodissection on posterior capsule opacification in age-related nuclear cataracts.J Cataract Refract Surg; 2006; 32:145-150

In eyes with multiquadrant cortical cleaving hydrodissection, a significantly lower percentage of the area of central posterior capsule was involved in the development of PCO

Vasavada AR, Trivedi RH, Apple DJ, et al.Randomized clinical trial of multiquadrant hydrodissection in pediatric cataract surgeryAm J Ophthalmol 2003; 84-88

Cortex removal was easier and faster after multiquadrant cortical cleaving hydrodissection.

To evaluate the impact of multiquadrant hydrodissection on posterior capsule opacification (PCO) after pediatric

cataract intraocular lens (IOL) implantation surgery

•Prospective, randomized, controlled trial•This study comprised 43 eyes of children undergoing pediatric cataract surgery with IOL implantation

Aim

Study Design and Population

Randomization

Hydrodissectionn = 21 eyes

No Hydrodissectionn = 22 eyes

•Single surgeon, Standardized surgical procedure •PCCC < 2 years•PCCC + Vitrectomy - 2-6 years•Intact PC > 6 years •3-piece AcrySof IOL implantation

Materials and methods

Hydrodissection No Hydrodissection P-Value

Mean age at surgery (mths)

55.9 + 38.5 65.2 + 40.5 0.44

Mean Follow-Up (mths)

80.38 + 19.8 80.6 + 16.3 0.96

Secondary Procedure for PCO (n, %)

9 (42.8%) 16 (73%) 0.09

Results

P value <0.05 statistically significant

Results

P = 0.03

• 83 MONTHSHYDRODISSECTION GROUP

• 59 MONTHSNO HYDRODISSECTION

GROUP

Mean Survival Time from Cataract Surgery to Secondary Intervention

(PCO) with hydrodissection (A), and without hydrodissection (B) in eyes with PCCC anterior vitrectomy.

(PCO) with hydrodissection (A), and without hydrodissection (B) in eyes with PCCC

Development of PCO between the two groups was not statistically significant

• However, we report the trend towards decreasing incidence and delay in developing visually significant PCO

Strengths : Longer follow-upLimitation : Smaller sample size

Conclusion

Implications

Despite of lack of statistical significance, we believe that it is clinically important and will recommend multiquadrant hydrodissection during pediatric cataract surgery, unless

contraindicated due to questionable posterior capsule integrity