Blood-aqueous barrier following phacoemulsification with posterior chamberlens-implantation: PMMA-lens versus foldable acrylic lens - a clinical study on 46 eyes

Background: Cataract surgery leads to a more or less pronounced postoperati ve inflammation due to breakdown of the blood-aqueous barrier. This alterat ion of the blood-aqueous barrier can be reduced by minimally invasive surge ry. The purpose of this study was to quantify the early course of the posto perative alteration of the blood-aqueous barrier following phacoemulsificat ion with implantation of conventional PMMA posterior chamber lens (IOL) in comparison with foldable acrylic lens implantation. Patients and Methods: Forty-six eyes of 46 patients (age 63 +/- 8.8 years) without preexisting deficiences of the blood-aqueous-barrier or previous in traocular surgeries were divided into two groups: group 1 (24 patients): ph acoemulsification with one-piece-PMMA-IOL implantation (6.5 mm corneosclera l tunnel incision); group 2 (22 patients): phacoemulsification with foldabl e acrylic-IOL implantation (3.5 mm incision, 15 patients with corneoscleral tunnel and 7 patients with clear cornea incision). All surgical procedures were performed by one surgeon. The postoperative treatment was standardize d. Alteration of the blood-aqueous barrier was quantified by the laser flar e-cell meter (Kowa, FC-1000) preoperatively and on the first and the second day after surgery. Results: Preoperative aqueous flare values (photon counts/ms) were comparab le in both groups (6.7+/-2.7 versus 5.6+/-2.7 respectively, p=0.1). On day 1, aqueous flare in group 1 (9.7+-2.9) was not statistically significantly higher than in group 2 (9.2+/-2.2, p=0.2) and remained relatively constant on day 2 after surgery (9.3+/-3.3), whereas the aqueous flare values in gro up 2 decreased statistically significant (6.7+/-2.3, p=0.01). Postoperative ly, there was no statistically significant difference of aqueous flare valu es between eyes with corneoscleral tunnel incision and eyes with clear corn eal incision (p=0.7) in group 2. Conclusions: Our study shows that phacoemulsification with foldable IOL imp lantation leads to a mild and short-lasting alteration of the blood-aqueous barrier. Thus, implantation of foldable IOL may be useful in eyes especial ly with preexisting alteration of the blood-aqueous-barrier.