Surgical prevention of posterior capsule opacification Part 1: Progress in eliminating this complication of cataract surgery

Purpose: To evaluate over almost 2 decades the success of a component of cataract surgery that represents a critical step in reducing the incidence of posterior capsule opacification (PCO); namely, the efficacy of cortical cleanup. Setting: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA. Methods: Accessioned from the early 1980s to 1997, 3320 eyes obtained postmortem with posterior chamber intraocular lenses were analyzed with respect to formation of a postoperative Soemmering's ring. This anatomic lesion, the precursor of clinical PCO, represents an important and measurable indication of the quality of cortical cleanup. Its formation was documented using Miyake-Apple posterior photographic analysis. Results: The quality and thoroughness of cortical cleanup and overall effectiveness in eliminating retained and/or regenerating cortical cells, as measured by scoring of Soemmering's rings, showed virtually no net change since the early 1980s, The intensity of Soemmering's ring was higher in the most recent specimens than in those in the early 1980s. Conclusion: The results indicate that renewed attention to cortical cleanup in cataract surgery is warranted for significant reduction in incidence or the elimination of PCO. More attention to the hydrodissection (cortical cleaving hydrodissection) step of the procedure is likely a practical, immediately implementable, and inexpensive remedy. (C) 2000 ASCRS and ESCRS.