Fluid-jet technique to polish the posterior capsule for phacoemulsification surgeries: efficacy and safety evaluation

Abstract

Purpose: To compare the efficacy and safety of a fluid-jet technique with capsular polish in reducing residual lens fibers (RLFs) in phacoemulsification surgery. Setting: Single center. Design: Prospective nonrandomized comparative study. Methods: Patients receiving phacoemulsification were included. Consecutive eligible patients alternately underwent either removal of RLFs on the posterior capsule using capsular polish after irrigation and aspiration, and before intraocular lens (IOL) implantation, or RLF removal using a fluid-jet technique after IOL implantation. Posterior capsular images were used to quantify RLFs. Visual parameters were evaluated at 1 day, 1 week, and 1 year postoperatively. The proportion of capsule occupied by posterior capsule opacification (PCO) (area %) and incidence of protocol-driven laser posterior capsulotomy were recorded at 1 year in masked fashion. Results: Seven hundred forty eyes were allocated to polishing (n = 370) or fluid-jet technique (n = 370). Polishing required 70.4 ± 17.5 seconds and fluid-jet 32.2 ± 9.9 seconds (P ≤ 0.001). Compared with the polishing group, capsular area occupied by RLFs in the fluid-jet group was significantly smaller (3.5% vs 0.5%, P = .031) at the end of surgery. One day postoperatively, the fluid-jet group had more desirable corrected distance visual acuity, objective scattering index, and Strehl ratio (all P < .05). PCO area percentage did not differ between groups (6.5% vs 4.5%, P = .252) 1 year postoperatively, but incidence of posterior capsulotomy was lower in the fluid-jet group (3.2% vs 0.8%, P = .019). Conclusions: Fluid-jet removed RLFs effectively and had lower incidence of postoperative capsulotomy than capsular polishing.

Early-Onset Posterior Capsule Opacification: Incidence, Severity, and Risk Factors

“…It not only significantly reduces PCO formation and the need for Nd:YAG laser capsulotomy but also has a low rate of complications such as retinal detachment and endophthalmitis [9][10][11]. Although surgery age, intraocular lens (IOL) material and design, and surgical technique are associated with long-term PCO, the incidence of early-onset PCO and its risk factor are still unknown [1,[12][13][14]. Therefore, figuring out the risk factors for early-onset PCO and performing PCCC combined with phacoemulsification for such patients may help to reduce the need of Nd:YAG treatment in the early postoperative period and improve patient satisfaction.…”

Removing residual cortical material during cataract surgery: Visco polishing and the grindstone effect as a new surgical technique

“…The idea of using the fluid stream going from the irrigation cannula attached to the balanced salt solution (BSS) syringe for cleaning the capsule from the residual cortical material goes back to the late 1990s (Arshinoff S, Neuhann T). Its safety and efficacy were recently studied by Liu et al 8 coining the name "fluid-jet technique". The main difference in between our and the fluid-jet technique is that we are not using the stream of BSS but rather the bolus of OVD.…”

The dead bag syndrome

“…5 There has been a recent emphasis on polishing techniques to prevent capsular bag fibrosis and opacification, especially in association with premium IOLs. [6][7][8][9] However, even extensive polishing cannot completely remove all LECs, and polishing is usually not performed at the capsular bag equator, as this region is not readily visible. Therefore, to date, there is no established association between capsular polishing and this condition.…”