Adhesion of the posterior capsule to different intraocular lenses following cataract surgery

Purpose: To investigate the prevalence and morphologic and clinical features of posterior capsule-optic inadhesion following cataract surgery.

Methods: In this prospective cohort study, we examined 518 consecutive patients who had undergone uneventful phacoemulsification and posterior chamber intraocular lens (IOL) implantation. They were assigned into five groups based on the type of IOL used: MC X11 ASP, Rayner 920H A, ZCB00, SN60WF and KS-3Ai. Routine ophthalmic examinations were performed. Patients were followed up at 1 day, 1 week, and 1 and 2 months postsurgery. Anterior segment photography, Scheimpflug imaging and KR-1W aberrometry were conducted after the patients' pupils were dilated.

Results: The overall rate of posterior capsule-optic inadhesion on the first day after surgery was 215/518 (41.5%), and it decreased to 37/518 (7.1%) at 2 months postsurgery. Posterior capsule-optic inadhesion can be morphologically classified into five types with three outcomes, of which gradual absorption of the accumulated fluid predominated for all IOLs. The clinical characteristics of patients with inadhesion varied with IOL type. Notably, visual quality data (Strehl ratios and modulation transfer function) were poorer in patients with posterior capsule-optic inadhesion, especially in those with irregular forms of suspension. Four cases of capsular contraction syndrome were identified among the patients with inadhesion.

Conclusions: Posterior capsule-optic inadhesion is a prevalent capsule-IOL interaction following cataract surgery. Although the accumulated fluid is absorbed in the majority of patients, its adverse effects on visual outcomes, especially visual quality in the operated eye(s), must not be underestimated in patients with persistent inadhesion.