Primary posterior capsular opacification in Indian rural population undergoing cataract surgery for hypermature senile cataract

Rajesh Subhash Joshi

Department of Ophthalmology, Vasatrao Naik Government Medical College, Yavatmal, India

Aim: To find out the incidence of primary posterior capsular opacification (PCO) in rural patients with a hypermature senile cataract undergoing cataract surgery.
Settings: Tertiary eye care center in central India.
Design: Prospective, observational, noncomparative study.
Materials and methods: Two-hundred eyes of 200 patients presenting with a hypermature cataract underwent manual small incision cataract surgery. A single surgeon performed all surgeries under peribulbar anesthesia. After cortical clean-up, the capsular bag was inflated with viscoelastic. The presence or absence of opacity on the posterior lens capsule and location was noted. Postoperative follow-up was done for visual acuity and need for neodymium-doped yttrium aluminum garnet (ND:YAG) laser capsulotomy.
Results: Primary PCO occurred in 76 eyes (incidence of 38%). It was peripheral in 58 eyes (76.3%) and central in 18 eyes (23.7%). At 6 weeks postoperatively, best corrected visual acuity for eyes with central primary PCO (n = 18) was 0.2–0.3 logMAR and 0–0.2 logMAR for eyes with peripheral primary PCO (n = 58). Best corrected visual acuity at the 6- and 12-month follow-up was 0–0.2 logMAR in both groups. Fibrotic primary PCO was seen in four patients. No predilection for the development of primary PCO to a particular quadrant of posterior capsule was observed. At 1 year postoperatively, eleven (14.5%) patients required ND:YAG laser capsulotomy, six (7.90%) of whom underwent ND:YAG laser capsulotomy at the 6-month follow-up. Seven patients with central primary PCO and four patients with peripheral primary PCO required ND:YAG laser capsulotomy.
Conclusion: A high incidence of primary PCO was noted in rural patients with a hypermature senile cataract undergoing cataract surgery. No serious intraoperative complications were noted. Visual outcome at 1-year follow-up was satisfactory. Need for early ND:YAG laser posterior capsulotomy should be explained to these patients before cataract surgery. No post ND:YAG capsulotomy complications were noted in any patient.

Keywords: posterior capsular opacification, hypermature cataract, manual small incision cataract surgery