Effects on anterior chamber stability during the capsulorhexis using utrata forceps vs. a bent 26G cannula.

PURPOSE: Prospective randomized single-blinded study of 261 cataract patients to investigate the influence of different instruments and techniques in continuous curvilinear capsulorhexis (CCC) on the stability of the anterior chamber using intraoperative rebound tonometry.

METHODS

The study included 261 eyes allocated to six groups according to three ophthalmic viscoelastic device (OVD) conditions-hyaluronic acid (HA), hydroxypropylmethylcellulose (HPMC), and their combination via the soft-shell technique (SST)-and two instruments (Utrata forceps UF and a 26-G cystotome RN). Intraocular pressure (IOP) was measured before and after CCC using rebound tonometry with sterilized probes.

RESULTS

IOP reached 78.6 mmHg in the RN group and 76.5 mmHg in the UF group after OVD instillation and after the creation of the CCC. The mean IOP drop during capsulorhexis was significantly greater with UF (67.1 ± 12.3 mmHg; n = 117) compared to RN (56.5 ± 11.6 mmHg; n = 144) (P < 0.001).

CONCLUSION

The results of this study showed a statistically significant difference in the stability of the anterior chamber depending on the instrument used. The use of different OVDs had no statistically significant influence on anterior chamber stability. Maintaining a more stable IOP with a 26-gauge cystotome may be advantageous in complex cases, such as increased posterior vitreous pressure, zonular weakness or heightened intracapsular pressure.