Preventing PCO after cataract surgery in developing countries a goal

Lisbon, Portugal – Cataract surgery in developing countries is a massive problem, but the cost of performing phacoemulsification in these countries is highly prohibitive.  For that reason, extracapsular cataract surgery is performed with implantation of a polymethymethacrylate (PMMA) IOL.

Posterior capsule opacification (PCO) causes vision to deteriorate after cataract, and using IOLs with the best design to prevent PCO in third-world countries, according to David Spalton, MD, of St. Thomas’ Hospital, London, who spoke Saturday at the European Society of Cataract and Refractive Surgeons.

He described the Dholka Project, under way in India, in which patients received either a square- or round-edged IOL after extracapsular cataract surgery. One year after surgery, 115 patients were available for follow-up evaluation. Those implanted with the square-edged IOL had an area of PCO that was smaller by 13% compared with the patients who received the round-edge IOL. The visual acuity in both groups remained unchanged. At the 2-year evaluation, the area of PCO in the patients with the square-edged IOL was significantly smaller than in the patients with the round-edged IOL (p = 0.002).

“The area of PCO in patients with a square-edged IOL was less compared with patients with a round-edged IOL, but the decrease in PCO was not equal to that obtained after phacoemulsification in developed countries.  The reasons for this are that it is difficult to create a large rhexis, and PMMA is a poor intraocular material,” Dr. Spalton reported.

The use of square-edged IOLs makes sense, he maintained, but they are difficult to manufacture, because the haptics must have a round edge to avoid chaffing of the iris.

“It is possible to use high-tech techniques to assess PCO development in developing countries. There is a small decrease in PCO with use of the square-edged IOL. Changes in IOL design for cataract surgery can be used in third-world countries to achieve lower rates of PCO,” he concluded.