Fluid-jet technique to polish the posterior capsule for phacoemulsification surgeries: efficacy and safety evaluation

Purpose: To compare the efficacy and safety of a fluid-jet technique with capsular polish in reducing residual lens fibers (RLFs) in phacoemulsification surgery. Setting: Single center. Design: Prospective nonrandomized comparative study. Methods: Patients receiving phacoemulsification were included. Consecutive eligible patients alternately underwent either removal of RLFs on the posterior capsule using capsular polish after irrigation and aspiration, and before intraocular lens (IOL) implantation, or RLF removal using a fluid-jet technique after IOL implantation. Posterior capsular images were used to quantify RLFs. Visual parameters were evaluated at 1 day, 1 week, and 1 year postoperatively. The proportion of capsule occupied by posterior capsule opacification (PCO) (area %) and incidence of protocol-driven laser posterior capsulotomy were recorded at 1 year in masked fashion. Results: Seven hundred forty eyes were allocated to polishing (n = 370) or fluid-jet technique (n = 370). Polishing required 70.4 +/- 17.5 seconds and fluid-jet 32.2 +/- 9.9 seconds (P <= 0.001). Compared with the polishing group, capsular area occupied by RLFs in the fluid-jet group was significantly smaller (3.5% vs 0.5%, P = .031) at the end of surgery. One day postoperatively, the fluid-jet group had more desirable corrected distance visual acuity, objective scattering index, and Strehl ratio (all P < .05). PCO area percentage did not differ between groups (6.5% vs 4.5%, P = .252) 1 year postoperatively, but incidence of posterior capsulotomy was lower in the fluid-jet group (3.2% vs 0.8%, P = .019). Conclusions: Fluid-jet removed RLFs effectively and had lower incidence of postoperative capsulotomy than capsular polishing.