Primary posterior capsulorexis: historical aspects and the current state of the issue
Authors:   S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation, Egorova E.V. , Direev A.O. ,   S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation,   Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation
Published: September 2024

Abstract Primary posterior capsulorexis: historical aspects and the current state of the issue E.V. Egorova, A.O. Direev, S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation Purpose. The paper analyzes the data of modern literature (published from 2008 to 2023) on the history and technique of primary posterior capsulorexis (PPC). The fields of application, variations, effectiveness and safety of the procedure are considered. Material and methods. A search for research on the subject of work from 2008 to 2023 was carried out. The search was carried out using Google Academy electronic databases (https://scholar.google.ru/), PubMed (https://www.ncbi.nlm. nih.gov/pubmed/), eLIBRARY.ru (https://www.elibrary.ru/) and foreign and domestic journals devoted to ophthalmology. Results. An analysis of the literature has shown that performing PPC provides high visual results both in comparison with standard cataract surgery and in the case of primary fibrosis of the posterior capsule. The key points of the PPC method are: intact anterior hyaloid membrane, continuous tear-resistant edge of capsulorexis and its size, which allows the preserved part of the PC to provide adequate support for the IOL and form a circular capsule barrier along the edge of its optical part. However, some studies have shown the possibility of partial or complete «closure» of the capsulorexis area by proliferating epithelial cells of the lens (ECL) in adult patients. In pediatric practice, it is well known that posterior hyaloid membrane (PHM) can act as a matrix for the migration of ECL, and the frequency of opacity of the optical axis after PPC reaches 60%. Therefore, in a number of clinics, the standard algorithm for cataract surgery in children includes not only PPC, but also anterior vitrectomy, although this complex approach is not always effective. As a solution to the problem of opacity of the optical axis after PPC, the technique of «capturing the optics» of the IOL was proposed, which permanently eliminates the opacity of the optical axis behind the IOL and significantly reduces fibrosis, especially in combination with polishing the anterior capsule. Conclusion. A large number of studies analyzing the clinical results of the PPC method, performed over several decades with various types of IOLs, leaves no doubt that performing posterior capsulorexis is a well-controlled method that significantly reduces the frequency of secondary cataracts, adding a «second line of defense» without reducing the barrier effect along the optical edge. Key words: anterior hyaloid membrane, Berger’s space, continuous curvilinear capsulorhexis, posterior optic capture