Effect of primary posterior continuous curvilinear capsulorrhexis with posterior optic buttonholing on pilocarpine-induced IOL shift

J Cataract Refract Surg. 2012 Nov;38(11):1895-901. doi: 10.1016/j.jcrs.2012.06.044. Epub 2012 Aug 2.


Purpose: To assess intraocular lens (IOL) shift along the visual axis induced by ciliary muscle contraction with pilocarpine after cataract surgery and to compare primary posterior continuous curvilinear capsulorrhexis (CCC) and posterior optic buttonholing with IOLs implanted in the bag.

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

Design: Clinical trial.

Methods: Eyes with age-related cataract had cataract surgery with implantation of a nonaccommodating IOL (AF-1 YA-60BB). Surgery was performed with primary posterior CCC and posterior buttonholing in 1 eye (study eyes) and with conventional in-the-bag implantation in the contralateral eye (control eyes). After a minimum of 6 months postoperatively, the anterior chamber depth was assessed with partial coherence interferometry before and after application of pilocarpine 2.0% and, after a washout interval of 1 week, before and after the application of cyclopentolate 1.0%.

Results: Forty eyes of 20 patients were enrolled. A slight backward shift of the IOL (+78 μm) in study eyes and in control eyes (+118 μm) was detected after pilocarpine application (both P<.05). No significant difference in IOL shift was found between study eyes and control eyes (P=.19).

Conclusions: Combined primary posterior CCC and posterior optic buttonholing did not affect IOL shift during pharmacologically stimulated ciliary muscle contraction compared with in-the-bag implanted IOLs. Capsule fibrosis diminished with primary posterior CCC but did not seem to be the only limiting factor in the accommodative IOL shift.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anterior Chamber
  • Artificial Lens Implant Migration*
  • Capsulorhexis / methods*
  • Ciliary Body / drug effects
  • Cyclopentolate / administration & dosage
  • Female
  • Humans
  • Interferometry
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Male
  • Middle Aged
  • Miotics / administration & dosage*
  • Muscle Contraction / physiology
  • Muscle, Smooth / drug effects
  • Mydriatics / administration & dosage
  • Phacoemulsification*
  • Pilocarpine / administration & dosage*
  • Prospective Studies
  • Pupil / drug effects


  • Miotics
  • Mydriatics
  • Pilocarpine
  • Cyclopentolate