Outcome and safety of secondary pars plana capsulotomy in patients with posterior capsular opacity following extracapsular cataract extraction
Authors: Tenmang Panshak Elisha , Ramyil Alice Venyir , Wabare Salome Zajeme , Gondim Seyilnen Kopse , Wade Patricia Delsat , Alada Joel James 
Published: September 2023

Objectives:
Posterior capsular opacity is a major delayed complication seen in patients following cataract extraction. Neodymium-doped Yttrium Aluminium Garnet laser capsulotomy is the standard procedure for capsulotomy; however, its high cost and unavailability in the developing countries makes it important for us to find an alternative, effective and safe method that will help reduce the burden of severe visual impairment and blindness in individuals who have had cataract extraction. The aim of the study was to showcase the effectiveness, outcome and safety of pars plana capsulotomy in reducing the burden of visual impairment and blindness occurring after cataract extraction due to posterior capsular opacity amongst patients.

Materials and Methods:
This is a hospital-based retrospective study, where the clinic, ward and theatre registers of patients who had secondary pars plana capsulotomy in the past 3 years (2019–2022) due to posterior capsular opacity were reviewed. Patient’s folders who had pars plana capsulotomy with incomplete records were excluded as well as patients who had diabetes, glaucoma, corneal opacity and age-related macular degenerations. The frequency, age distribution, duration from cataract extraction to presentation with posterior capsule opacification (PCO), the grading and morphology of PCO were all noted. The pre- and post-operative visual acuity (VA) was also recorded alongside the pre- and post-operative intraocular pressure (IOP). We also documented intra- and post-operative complications that were seen in these patients. Data were analysed using SPSS package version 23 (SPSS Inc. Illinois, Chicago), and values were expressed as simple frequencies and proportions. Paired t-test was used to test the statistical significance with P < 0.05.

Results:
A total of 36 patients records were reviewed; capsulotomy was performed in all age groups with the majority done in individuals 60–69 years – 11 eyes (26.8%). A total of 41 eyes of 36 patients had undergone secondary pars plana capsulotomy. Five (13.9%) patients had bilateral pars plana capsulotomy on different occasions. The mean age was 45.3 ± 26.9 years. There were 22 (53.7%) females and 19 (46.3%) males. Female-to-male ratio was 1.2:1. About 75.6% presented between 1 and 5 years after cataract surgery; mean duration for presentation with posterior capsular opacity after cataract extraction was 2.0 years ± 1.6 months. The majority 31 (75.6%) had their pars plana capsulotomy done under topical anaesthesia. VA at presentation was found to be below 3/60 in 17 (41.5%) eyes. After pars plana capsulotomy, VA improvement was seen – 6/6–6/12 in 23 (56.1%) eyes. Grade of PCO revealed that 15 (36.6%) eyes had Grade 2 PCO and the Elschnig pearls were the most common morphological form seen in 30 (73.2%) eyes. Most eyes had normal IOP post-operatively 38 (92.7%); there was a transient increase in IOP in 3 (7.3%) eyes. There were no complications recorded in most eyes 27 (66%). The most common of the few complications seen was subconjunctival haemorrhages in 6 (14.6%) eyes which resolved within a week of follow-up.

Conclusion:
Pars plana capsulotomy is a safe, easy and effective alternative for posterior capsulotomy and will be useful in resource-poor settings.