Does Capsule Polishing prevent capsular opacity?

There has been much debate around the issue of polishing of the undersurface of the anterior capsular rim, yet there has been no consensus. A peer-reviewed, prospective, randomized trial was performed by Abhay Vasavada MD and colleagues and published in Eye.

This study showed that there was no benefit of polishing the anterior capsule in terms of preventing capsule opacification. This has been echoed by many other publications which came to the same or similar conclusions.

There was a noted difference in anterior segment inflammation seen on the first post-op day. This makes sense because this haze is composed of cells from the crystalline lens which induce a strong inflammatory response.

In all patients who undergo modern techniques of cataract surgery, our goal is to remove as much of the crystalline lens as possible while keeping the capsular bag and zonular attachments intact and strong.

I certainly encourage all cataract surgeons to be thorough in the removal of these lens cells, but with balance to be gentle to the ocular tissues and to still maintain efficiency. If any of these cells are left behind, the inflammatory cascade will clear them within the first post-operative week, after which the capsule will look pristine. Note that we are not encouraging surgeons to leave pieces of lens cortex in the eye at the end of the surgery, and we are encouraging thorough cleaning of the capsular bag. The extent of this cleaning should be left to the surgeon’s discretion.

 In the videos that we show here, adjustments have been made in post-production in order to make the video more suitable for posting on YouTube and viewing on mobile devices such as smart phones. This involves enhancing the red reflex and adjusting the sharpness, brightness, and contrast settings to bring out certain details like the edge of the capsulorhexis. These adjustments also increase the visibility of the slight residual lens material that is seen under the anterior capsular rim in this video and others. Under the normal microscope lighting used during cataract surgery, this slight haze is very difficult to see.

Let’s all be thorough in our cleaning of the capsular bag during cataract surgery. And let’s all be kind and accepting of each other and the different surgical styles and approaches used during cataract surgery. Please comment below to let me know your thoughts.

Click below to learn about the studies concerning anterior capsular polishing:

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