Posterior optic buttonholing prevents intraocular pressure peaks after cataract surgery with primary posterior capsulorhexis

Graefes Arch Clin Exp Ophthalmol. 2010 Nov;248(11):1595-600. doi: 10.1007/s00417-010-1454-2. Epub 2010 Jul 22.


Background: The performance of a primary posterior capsulorhexis (PPC) with and without posterior optic buttonholing (POBH) may significantly influence the intraocular pressure (IOP) after cataract surgery in age-related cataract patients.

Methods: The prospective randomized clinical study was performed at the department of Ophthalmology, Medical University of Vienna, Austria. Thirty consecutive cataract patients with bilateral same-day cataract surgery (60 eyes) under topical anesthesia were enrolled. In randomized order, cataract surgery with combined PPC/POBH was performed in one eye; in the other eye, cataract surgery was performed with PPC and in-the-bag implantation of the intraocular lens (IOL). Standardized IOP measurements by Goldmann applanation tonometry were performed preoperatively, 1, 2, 4, 6, 8 and 24 hours postoperatively, as well as 1 week and 1 month postoperatively.

Results: During the first 24 hours after surgery, all IOP measurements were significantly lower in eyes with combined PPC/POBH when compared to eyes with solitary PPC (p < 0.001). No IOP peaks of more than 27 mmHg were observed with combined PPC/POBH. In contrast, in eyes with PPC and in-the-bag IOL implantation, seven patients had an IOP peak of more than 27 mmHg and four IOP peaks of more than 30 mmHg. One week and 1 month postoperatively, IOP measurements were statistically comparable, and no significant differences could be observed between the two groups (p > 0.05).

Conclusion: Postoperative IOP peaks after cataract surgery with sole PPC can be effectively prevented by the buttonholing of the IOL through the posterior capsulorhexis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biometry
  • Capsulorhexis*
  • Female
  • Gonioscopy
  • Humans
  • Intraocular Pressure*
  • Lens Capsule, Crystalline / surgery*
  • Lens Implantation, Intraocular
  • Male
  • Phacoemulsification
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Punctures*
  • Tonometry, Ocular
  • Visual Acuity / physiology

Associated data

  • ISRCTN/ISRCTN35593439