Comparison of intracapsular and extracapsular cataract extraction with and without intraocular lens implantation

comparison of intracapsular and extracapsular cataract extraction with and without intraocular lens implantation Steven N. Benjamin, M.D. Oscar R. Sherman, M.D. Fort Lauderdale, Florida The purpose of this paper is to review the clinical results of our experience of cataract surgery, both with and without intraocular lens implantation. The cataract surgery without lens implantation consists of 100 cases of routine intracapsular cataract extractions; 19 cases of extracapsular cataract extraction with the posterior capsule left intact, and 8 cases of extracapsular cataract extraction with the posterior capsule opened at the time of surgery. The cataract surgery with lens implantation consists of 75 cases of intracapsular cataract extraction with the implantation of the Copeland lens; 29 cases of intracapsular cataract extraction with the Worst iris suture lens; 26 cases of extracapsular cataract with the platina clip or Hoop Binkhorst lens in which the posterior capsule was left intact and 5 cases of extracapsular cataract surgery with the platina clip or Hoop Binkhorst lens in which the posterior capsule was opened at the time of surgery. The hap tics of all the intraocular lenses are made of polymethylmethacrylate (PMMA). The Copeland lens is a maltese cross made entirely of PMMA. The loops of the 2-100p Binkhorst, platina clip, and iris suture lenses are all Supramide. The suture used for the Worst iris suture lens was 9-0 Supramide. In selecting the cases for this review, all cataract surgery involving vitreous loss and macular degeneration was eliminated. All. pre-operative visions were 20/200 or J8 or less. The follow-up time, as of the writing of this paper, was from 12 months to 24 months. The following points from the chart are of great interest. In this series, the use of the Copeland lens is associated with an 18.6% (24175) inclidence of cystoid macular edema (CME). 57.14% (8/14) of these cases never cleared. By combining all of the other surgical categories, we find the incidence of CME to be 3.2%. (6/187); 0.53% (11187) did not clear. It is our feeling that the CME that occurs with the Copeland lens is a "malignant" form in which the macula more often does not recover. In addition, 5.3% (4175) of cases of cataract surgery using the Copeland lens resulted in a persistent iritis, uveitis, or cyclitis, causing these corneas to irreversibly decom202

pensate with corneal edema, requmng penetrating corneal transplantation. In no other surgery in this series did this occur. The incidence of retinal detachment using the Copeland lens was higher 4% (3175), than all of the other surgical categories combined, 1.6% (3/187). Perhaps this is related to the chronic irritation associated with the use of the Copeland lens. The intracapsular cataract extraction with the use of the Worst iris suture lens may be associated with some irritation as evidenced by the need for 6.9% (2/29) discissions of the anterior hyaloid pupillary membranes (retropseudophakos). The incidence of vision made worse by intracapsular cataract extraction with the use of a Copeland lens 8.6% (14175) compared with all other types of cataract extraction and any other types of intraocular lenses used in this series 1.66% (1/60) is significant. There is no significant difference between the visual results from an intracapsular cataract extraction without a lens implantation [98% (98/100) success rate] and any other type of cataract extraction with the use of any other intraocular lenses in this series [98.3% (57/60) success rate] (excluding the Copeland lens) It is of note that there were no other post-operative complications in this series other than those mentioned in the chart. This series is too small to answer questions such as whether or not an extracapsular cataract extraction with the capsule intact gives less incidence of cystoid macular edema or retinal detachment than intracapsular cataract extraction. Summary The results of our study indicate a caution in the use of the Copeland intraocular lens because of the comparitively high complication rate associated with irritation causing uveitis, resulting in irreversible cystoid macular edema, irreversible corneal edema, Ild retinal detachment. Our results indicate that the use of any other type of cataract extraction with the other types of intraocular lenses used in this review show no higher incidence of complications than a routine intracapsular cataract extraction.

Pre·operative

Post·operative

All cases vision 20/200 or less or J8 or less

Final visual improvement 20/40 or better

# Cases Surgery

I

Total

Cleared

Never cleared

Persistent Retinal Detachment uveitis

Severe corneal edema unresolved

Discission of retropseudophakos, membranes

%

No.

%

No.

%

ICCE

98/100 98.0

2

2

1

1

1

1

2

2

0

0

0

0

0

75

ICCE & Copeland

61/75

81.3

14

18.6

6

4

8

10

3

4

4

5.3%

4

5.3%

1

29

ICCE & Worst suture lens

28/29

96.55

1

3.4

1

3.4

0

1

3.5

0

0

0

0

2

19

ECCE - Cap intact

19/19

100

0

0

0

0

0

0

0

0

0

0

0

0

8

ECCE - Cap opened at surgery

8/8

100

1

12.5

1

12.5

0

0

0

0

0

0

0

ECCE - IOL * & Cap intact

26/26

100

2

7.7

2

7.7

0

0

0

0

0

0

5/5

100

0

0

0

0

0

0

0

0

0

100

26 5

ECCE - IOL * & Cap opened at surgery

No.

I

Cystoid macular edema

No. %

No. %

No.

%

0

0

0

1

0

0

2

0

0

0

0

2

10

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

No. %

No. %

No. %

Posterior capsulotomies needed post·operative

i

127

Without Lens (All Cases)

125/127 98.4

3

2.4

2

1.6

1

1

2

1.6

0

0

0

0

0

0

2

1.6

13b

With Lens (All Cases)

120/135 88.9

17

12.6

9

7

8

6.0

4

3.0

4

3.0

4

3.0

3

2.2

0

0

* IOL used Platina Clip or Binkhorst irridocapsular two loop.

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