Macular morphology after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing.

Purpose: To evaluate possible changes in macular morphology after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in comparison to conventional in-the-bag intraocular lens (IOL) implantation.

Design: Prospective randomized study.

Methods: Fifty consecutive age-related cataract patients with normal macular morphology and function waiting for bilateral cataract surgery were enrolled. Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing was performed in one eye; in the fellow eye cataract surgery was performed with in-the-bag IOL implantation, leaving the posterior lens capsule untouched. Optical coherence tomography measurements were performed one week and one month postoperatively.

Results: During follow-up, no statistically significant changes of macular morphology could be observed in any of the tested patients. Mean central retinal thickness, minimum and maximum retinal thickness, and central retinal volume were all statistically comparable between the eyes with combined primary posterior capsulorhexis and posterior optic buttonholing and the control eyes (P > .05). Best-corrected visual acuity was full in all patients (Snellen 20/25 and better). No cases of subclinical macular edema were observed.

Conclusion: Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing apparently does not increase the risk for postoperative macular edema in patients with a normal macula, since no cases of biomicroscopically noticeable macular edema with visual loss were observed in the first 1,000 eyes with primary posterior capsulorhexis/posterior optic buttonholing cataract surgery and no case of subclinical macular edema was found in this prospective randomized study.