In modern day cataract surgery, we remove the lens material which keeping the capsular bag to hold the IOL. How important is it to fully polish the capsule, particularly the undersurface of the anterior capsular rim in order to give our patients the best outcomes? And is there an additional risk involved in doing this maneuver? Will the routine post-operative inflammatory process help remove these tiny bits of micro-debris? Should all surgeons do this or just the more advanced ones?
These are all great questions and there is no definitive answer. A widely cited study (J Cataract Refract Surg. 2010 Feb;36(2):208-14. doi: 10.1016/j.jcrs.2009.08.020.) concluded that:
Anterior capsule polishing, although it removed many LECs (lens epithelial cells), did not decrease residual cell growth and, conversely, enhanced cell proliferation in capsular bag cultures. This might explain why polishing does not reduce PCO (posterior capsule opacification) in clinical studies.
Another study (Int J Clin Exp Med. 2015; 8(8): 13769–13775.) determined that the effective lens position (ELP) was not any different between polished versus not, but then postulated that there may be an “improved axial position stability of the IOL in the long term.”
In the case presented here, we use the irrigation / aspiration probe to remove the majority of the micro-debris from the undersurface of the anterior capsular rim. However, there is an area that is difficult to access using the coaxial probe so that is left alone. Use of a bimanual irrigation / aspiration set-up would allow full 360 degree access but would necessitate making a third incision in the eye. The red reflex in the video is also heavily enhanced in order to improve visualization of the micro-debris. With typical microscope settings, it would be much more difficult to see.
The best advice is for you to do what is best in your hands. Polishing the capsule must be done carefully because if we damage the capsule or break zonular attachments, then the net result is worse than leaving a lot of micro-debris. What is your opinion?
Click below to see capsule polishing (forward to 2:45) in this cataract surgery:
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