title: Effect of anterior capsule polishing on posterior capsule opacification and neodymium:YAG capsulotomy rates: three-year randomized trial.
abstract: OBJECTIVE
  To compare the long-term effect of extensive polishing and nonpolishing of the anterior lens capsule on posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates.
  
  
  METHODS
  Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
  
  
  METHODS
  This prospective randomized bilateral double-masked study included 108 eyes of 54 consecutive patients with age-related cataract. Following phacoemulsification, 3-piece intraocular lenses (IOLs) with round-edged silicone optics were implanted. Patients received an Allergan SI-40 IOL with a truncated, round optic edge or a Domilens Silens6 IOL with a fully round optic edge. Patients were randomly assigned to have extensive anterior capsule polishing with the Menapace aspiration curette or no treatment in the first eye; the second eye received the opposite treatment. Digital retroillumination images were taken at 1 week, 1 year, and 3 years, and Nd:YAG capsulotomy rates were evaluated. Posterior capsule opacification was objectively scored using automated image analysis software (AQUA) or estimated based on clearly defined assumptions if a capsulotomy had been performed.
  
  
  RESULTS
  Thirty-nine patients (78 eyes) concluded the study. Three-year PCO scores after polishing did not differ significantly (P>.05). However, 21 polished eyes (53.8%) required Nd:YAG laser capsulotomy compared with 14 nonpolished eyes (35.9%). The mismatch between PCO scores and Nd:YAG rates resulted from a change in PCO morphology that is not detected by scoring methods based on retroillumination photography but is visually disturbing to patients.
  
  
  CONCLUSIONS
  Polishing the anterior capsule was effective in reducing fibrotic opacification but ineffective in reducing regeneratory opacification. Changes in regeneratory PCO morphology not picked up by retroillumination photography increased the need for Nd:YAG laser capsulotomy.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. rupert.menapace@meduniwien.ac.at
authors.forename: Rupert
authors.initials: R
authors.lastname: Menapace
authors.forename: Matthias
authors.initials: M
authors.lastname: Wirtitsch
authors.forename: Oliver
authors.initials: O
authors.lastname: Findl
authors.forename: Wolf
authors.initials: W
authors.lastname: Buehl
authors.forename: Katharina
authors.initials: K
authors.lastname: Kriechbaum
authors.forename: Stefan
authors.initials: S
authors.lastname: Sacu
mesh_terms: D002386:Cataract / Q000209:etiology*; D003475:Curettage / Q000379:methods; D004311:Double-Blind Method; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data*; D007903:Lens Capsule, Crystalline / Q000473:pathology* / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D012826:Silicone Elastomers
chemical_list: D012826:Silicone Elastomers