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Rotating the Intraocular Lens to Prevent Posterior Capsular Opacification in Cataract Surgeries

Published: July 7th, 2023



1Department of Ophthalmology, Peking University Third Hospital, 2Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital
* These authors contributed equally

The present protocol describes removing residual epithelial cells by rotating the intraocular lens in extracapsular cataract surgery without extra tools for preventing posterior capsular opacification.

Posterior capsule opacification (PCO) is a common postoperative complication of extracapsular cataract surgery, which is caused by the proliferation and migration of lens epithelial cells and can affect long-term visual outcomes significantly. The most effective treatment for PCO is neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy; however, this treatment is associated with posterior segment complication and can break the stability of capsular bag, affecting the position and function of trifocal or toric intraocular lenses (IOLs). Advances in surgical procedures, IOL design, and pharmacy have reduced the rate of PCO in recent years, concentrating on the inhibition of proliferative lens epithelial cells (LECs). This protocol aimed to clear LECs more thoroughly during phacoemulsification and IOL implantation. The first several steps, including clear corneal incision, continuous circular capsulorhexis, hydrodissection, hydrodelineation, and phacoemulsification, were completed as conventional procedures. After placing the IOL into the capsular bag, rotation of the IOL by at least 360° was performed using an irrigation/aspiration tip or a hook, with slight stress on the posterior capsule. Some residuals occurred in the originally transparent capsular bag after rotation of the IOLs. Then, these materials and the viscoelastic were cleared completely using an irrigation/aspiration system. A clear posterior capsule was observed after the surgery in patients undergoing this method. This method of rotating IOLs is a simple, effective, and safe way to prevent PCO by clearing residual LECs and can be carried out without extra tools or skills.

Cataracts are the most common cause of blindness worldwide, characterized by a clouding of the lens. The only means of treating cataracts is surgical intervention by removing the opaque lens, which restores high visual quality. However, a secondary reduction of visual quality, termed posterior capsule opacification (PCO), develops in 20%-40% of patients within 2 to 5 years after surgery1. This article introduces a method to further remove residual lens epithelial cells (LECs) left in the capsular bag in cataract surgery by rotating the intraocular lens (IOL) to prevent PCO.

PCO is a process caused by LECs, which are ....

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This study adhered to the tenets of the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board of Peking University Third Hospital. It should be noted that the novel procedure here is the step of rotating the IOL. The inclusion criteria are cataract patients over 50 years of age willing to undergo cataract surgery in Peking University Third Hospital. The exclusion criteria are the presence of eye diseases that may affect the stability of the suspensorium and capsular bag, such as patho.......

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A clear capsular bag was formed after the I/A step (Figure 1A). However, some cortical fragments were observed in the capsular bag after rotating and polishing the IOL (Figure 1B).

This process can also be performed using a hook. Similarly, the posterior capsule was clear after capsular polishing by the I/A tip (Figure 2A). Through fast rotation and movement of the IOL, some residuals appeared in the caps.......

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There are some benefits to this method. Firstly, residual LECs in the capsule bag were reduced further, especially those in the equatorial area, and the possibility of PCO occurrence was reduced rationally. Secondly, a reduced possibility of PCO means a lower rate of Nd:YAG laser treatment, providing the opportunity to maintain the integrity of the capsule bag and effective lens positions and functions. Thirdly, this method can be achieved with available instruments in cataract surgery without additional preparation. In .......

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This article is funded by Beijing Haidian Innovation and Transformation Project, HDCXZHKC2021212.


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NameCompanyCatalog NumberComments
20 G Sideport MVR KnifeBVI378231To make corneal incision
3.2 mm Slit BladeBVI378232To make corneal incision
Balanced salt solutionXingqiH19991142Compound electrolyte intraocular irrigating solution
Centurion vision system Alcon Laboratories8065753057The Centurion Vision System is indicated for emulsification, separation, irrigation, and aspiration of cataracts, residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intraocular lens injection.
Compound tropicamide eye dropsXingqiZhuobianTo dilate the pupils before the surgery
Disposable sterile irrigatorWEGO100038404339To complete hydrodissection and hydrodelineation 
Fenzl lens insertion hook and manipulatorBelleifIF-8100IOL positioning hook
Levofloxacin eye dropsSantenCravitTo prevent ocular infection before the surgery
Mini-flared Kelman tip 30DGAlcon Laboratories8065750852To complete phacoemulsification
One piece intraocular LensZeissAT TORBI 709MIntraocular lens
Oxybuprocaine hydrochlorideSantenBenoxilTopical anesthesia
Phaco handpieceAlcon Laboratories8065751761To complete phacoemulsification 
Sinskey hookBelleifIF-8013For chop
Ultraflow II I/A tipAlcon Laboratories8065751795To complete irrigation and aspiration 
Utrata capsulorhexis forcepsBelleifIF-3003CTo complete continuous circular capsulorhexis
Viscoelastics/Medical sodium hyaluronate gelBausch&lombivizMaintaining the anterior chamber and capsular bag

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