Czech and Slovak Ophthalmology 367 10.31348/2025/21 Case report Failure of Primary Posterior Continuous Curvilinear Capsulorhexis? A Case Report Novák Jan Otrošinová Marianna https://orcid.org/0000-0002-4279-8976 Kubíková Lucie Krásnik Vladimír 23 5 2025 4 6

The aim of the study is to present the possible development of proliferative secondary cataracts in the unique case of a patient having undergone premium cataract surgery with preventive primary posterior continuous curvilinear capsulorhexis (PCCC). Due to the negative effect on visual functions, it was decided to treat the patient with an Nd:YAG laser, which was successful with minimal energy but resulted in damage to the anterior hyaloid membrane. Case reportIn 2020, a 65-year-old man underwent uncomplicated cataract surgery in both eyes at our clinic bilaterally with primary PCCC with implantation of a tension ring and an artificial intraocular lens into the capsule. In February 2023, on the recommendation of the area ophthalmologist, he was examined at our outpatient clinic due to a decrease of visual acuity in the right eye. Blurred vision predominated. A diagnosis of proliferative form of secondary cataract was confirmed and documented using a photo of the anterior segment in retroillumination and anterior segment OCT (Optovue, Avanti RTVue XR). The patient was indicated for Nd:YAG laser disruption by proliferation in the PCCC space in the right eye. The return of visual acuity to its original state confirmed the correct diagnosis. The literature review and discussion summarize the current issue of secondary cataracts and the use of primary PCCC. Conclusion: Secondary cataract is the main long-term complication of modern cataract surgery. One of the possible solutions is the preventive implementation of a simple PCCC, which may be accompanied by isolated failure.Key words: primary posterior continuous curvilinear capsulorhexis, PCCC, proliferations, Nd:YAG laser

 primary posterior continuous curvilinear capsulorhexis PCCC proliferations Nd:YAG laser References McDonnell PJ, Zarbin MA, Green WR. Posterior capsule opacification in pseudophakic eyes. Ophthalmology. 1983;1983:901548- 901553. Kappelhof JP, Vrensen GFJM. The pathology of after cataract; a minireview. Acta Ophthalmol Suppl. 1992;1992:20513-20524. Sundelin K, Almarzouki N, Soltanpour Y, et al. Five-year incidence of Nd: YAGlaser capsulotomy and association with in vitro proliferation of lens epithelial cells from individual specimens: a case control study. BMC Ophthalmol. 2014;14:116. Ursell PG, Dhariwal M, O’Boyle D, et al. 5-year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes. Eye. 2020;34:960-968. Maloof A, Neilson G, Milverton EJ, Pandey SK. Selective and specific targeting of lens epithelial cells during cataract surgery using sealed-capsule irrigation. J Cataract Refract Surg. 2003;29:1566‑1568. Menapace R. Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases. J Cataract Refract Surg. 2006;32:929-943. Menapace R, Schriefl S, Lwowski C, Leydolt C. Impact of primary posterior capsulorhexis on regeneratory after-cataract and YAG laser rates with an acrylic micro-incision intraocular lens with plate haptics: 1-year and 3-year results. Acta Ophthalmol. 2019;97:1130- 1135. Castaneda VE, Legler UF, Tsai JC, et al. Posterior continuous curvilinear capsulorhexis. An experimental study with clinical applications. Ophthalmology. 1992;99:45-50. Galand A, Cauwenberge F, Moosavi J. Posterior capsulorhexis in adult eyes with intact clear capsules. J Cataract Refract Surg. 1996;1996:22458-22461. Van Cauwenberge F, Rakic JM, Galand A. Complicated posterior capsulorhexis: aetiology, management, and outcome. Br J Ophthalmol. 1997;81:195-198. Studeny P, Benda T. Primary Posterior Continuous Circular Capsulorhexis without the Use of Ophthalmic Viscosurgical Device. Clin Ophthalmol. 2023;17:441-444. Arbisser LB. Review of primary posterior capsulorhexis in cataract surgery. Saudi J Ophthalmol. 2022;36:149-156. Menapace R. After‑cataract; final eradication in sight? Clin Exp Ophthalmol. 2008;36:810‑811. Devranoğlu K, Kılıç A, Özdamar A, et al. Intraocular lens optic capture in eyes with zonular weakness in cataract patients. J Cataract Refract Surg. 2013;39:669‑672. Tassignon MJ, De Groot V, Vervecken F, et al. Secondary closure of posterior continuous curvilinear capsulorhexis in normal eyes and eyes at risk for postoperative inflammation. J Cataract Refract Surg. 1998;2:1333-1338. De Groot V, Vrensen GF, Willekens B et al. In vitro study on the closure of posterior capsulorhexis in the human eye. Invest Ophthalmol Vis Sci. 2003;44:2076‑2083. Menapace R. Posterior capsulorhexis combined with optic buttonholing: An alternative to standard in‑the‑bag implantation of sharp‑edged intraocular lenses? A critical analysis of 1000 consecutive cases. Graefes Arch Clin Exp Ophthalmol. 2008;246:787‑801. Saika S, Werner L, Lovicu FJ, et al. Lens Epithelium and Posterior Capsular Opacification. Springer; 2014. doi: 10.1007/978-4-431- 54300-810.1007/978-4-431- Stifter E, Luksch A, Menapace R. Postoperative course of intraocular pressure after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing. J Cataract Refract Surg. 2007;33:1585-1590. Tassignon MJ, Van den Heurck JJ, Boven KB, et al. Incidence of rhegmatogenous retinal detachment after bag‑in‑the‑lens intraocular lens implantation. J Cataract Refract Surg. 2015;41:2430‑2437. Stifter E, Menapace R, Neumayer T, et al. Macular morphology after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing. Am J Ophthalmol. 2008;146:15-22. Stifter E, Menapace R, Luksch A, et al. Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults. Br J Ophthalmol. 2007;91:1481-1484. Groot V, Hubert M, Van Best JA, et al. Lack of fluorophotometric evidence of aqueous–vitreous barrier disruption after posterior capsulorhexis. J Cataract Refract Surg. 2003;29:2330-2338. Dick HB, Schultz T. Primary posterior laser‑assisted capsulotomy. J Refract Surg. 2014;30:128‑133.