The authors have no financial interest Opacity of the Anterior Vitreous Surface after the Cataract Surgery with Primary Posterior Continuous Curvilinear Capsulorrhexis Wan-Soo Kim, MD, PhD 1,2 , Kyeong-Hwan Kim, MD 1 Maryknoll Hospital 1, Busan, Korea Pusan National University 2, Busan, Korea The authors have no financial interest

Purpose Posterior capsular opacification(PCO) is one of the most common causes of reduced visual prognosis after cataract surgery. Several authors suggested that PCO could be prevented with posterior continuous curvilinear capsulorrhexis(PCCC) technique during the cataract surgery. We report a case of the opacity of the anterior vitreous surface after the cataract surgery with primary PCCC.

Method A 68 year old woman was referred for the evaluation of decreased vision. She was diagnosed as senile nuclear cataract in both eyes. OD : NO3 / NC3, C2, P2 OS : NO2 / NC3, C1, P1 LOCS III classification There was no finding suggestive of ocular inflammatory disease after completing ocular and systemic evaluation.

Surgical Technique Topical anesthesia with Proparacaine 2.8mm Clear Corneal Incision Round and Well centered Continuous Curvilinear Capsulorrhexis (CCC) Phacoemulsification after Hydrodelineation Capsule was filled with OVD

( Intraoperative photograph ) Posterior Continuous Curvilinear Capsulorrhexis Posterior capsule was punctured with 26-gauge bent needle OVD was injected through the puncture site of the posterior capsule to push vitreous body posteriorly Round and well centered posterior CCC was done meticulously with capsular forceps The size is a little smaller than anterior CCC Posterior Continuous Curvilinear Capsulorrhexis ( Intraoperative photograph )

Result Preoperative best corrected visual acuity in LogMAR scale was 0.22 in her right eye ,0.05 in left eye and 0.00 in both eyes at every follow up visits for 2 months At 2 months of follow up, although she didn’t complain any visual symptoms, the opacity of the anterior vitreous surface was found and there was continuity of the posterior capsule to the anterior vitreous face at the slitlamp examination

Clear PCCC Closure of PCCC ( POD 1 Month ) Closure of PCCC ( POD 2 Months ) We found the posterior CCC margin was in contact with anterior vitreous face during follow up

Discussion Posterior capsular opacity is one of the frequently encountered complication after cataract surgery, with a reported incidence of 4 to 50 %. Risk factors are known such as young age, complicated or traumatic surgery, uveitis, and diabetes. Several authors, such as Gimble, Neuhann, and Castaneda, insisted that posterior CCC can prevent posterior capsular opacification.

Little is known about the role of posterior CCC in the prevention of PCO Tassignon et al reported a case of young patient with posterior capsular opacity due to a reclosure of posterior CCC and supposed that closure is caused by new tissue formation within the PCCC area. They distinguished 3 types of secondary proliferation : Multilayered cellular proliferation Monolayered cellular proliferation Fibrotic proliferation

In this case, type of secondary proliferation in the process of PCCC reclosure is not entirely understood. However, it seems that the continuity of anterior vitreous face with posterior capsule could be the pathway for migration of lens epithelial cell from the equatorilal region.

Conclusion Although the PCCC is very useful technique to reduce posterior capsular opacity after cataract surgery, attachment of anterior vitreous face to the posterior capsule must be evaluated in order to prevent PCO which might occur by migrating lens epithelial cells from posterior capsule.

It is important to break the continuity of posterior capsule with highly reactive anterior vitreous face to secure visual axis preservation. Buerger’s Space in Other PCCC Case ( No Continuity of Posterior Capsule with Anterior Vitreous Face )