Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

J Cataract Refract Surg. 2008 May;34(5):749-54. doi: 10.1016/j.jcrs.2007.12.035.


Purpose: To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small-incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in-the-bag IOL implantation.

Setting: Department of Ophthalmology, Medical University of Vienna, Austria.

Methods: This prospective comparative study comprised 23 patients (46 eyes) with age-related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA-60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in-the-bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high-resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients.

Results: Ten patients completed 10 to 12 months of follow-up. Postoperatively, the axial IOL position was stable in eyes with PPCCC-POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC-POBH (P<.001).

Conclusion: Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anterior Chamber / pathology*
  • Capsulorhexis / methods*
  • Female
  • Foreign-Body Migration / prevention & control*
  • Humans
  • Lens Capsule, Crystalline / pathology
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Male
  • Microsurgery
  • Phacoemulsification*
  • Postoperative Complications / prevention & control*
  • Prospective Studies