Posterior optic buttonholing prevents intraocular pressure peaks after cataract surgery with primary posterior capsulorhexis

  • Eva Stifter
  • Rupert MenapaceEmail author
  • Katharina Kriechbaum
  • Alexandra Luksch



The performance of a primary posterior capsulorhexis (PPC) with and without posterior optic buttonholing (POBH) may significantly influence the intraocular pressure (IOP) after cataract surgery in age-related cataract patients.


The prospective randomized clinical study was performed at the department of Ophthalmology, Medical University of Vienna, Austria. Thirty consecutive cataract patients with bilateral same-day cataract surgery (60 eyes) under topical anesthesia were enrolled. In randomized order, cataract surgery with combined PPC/POBH was performed in one eye; in the other eye, cataract surgery was performed with PPC and in-the-bag implantation of the intraocular lens (IOL). Standardized IOP measurements by Goldmann applanation tonometry were performed preoperatively, 1, 2, 4, 6, 8 and 24 hours postoperatively, as well as 1 week and 1 month postoperatively.


During the first 24 hours after surgery, all IOP measurements were significantly lower in eyes with combined PPC/POBH when compared to eyes with solitary PPC (p < 0.001). No IOP peaks of more than 27 mmHg were observed with combined PPC/POBH. In contrast, in eyes with PPC and in-the-bag IOL implantation, seven patients had an IOP peak of more than 27 mmHg and four IOP peaks of more than 30 mmHg. One week and 1 month postoperatively, IOP measurements were statistically comparable, and no significant differences could be observed between the two groups (p > 0.05).


Postoperative IOP peaks after cataract surgery with sole PPC can be effectively prevented by the buttonholing of the IOL through the posterior capsulorhexis.


Cataract surgery Primary posterior capsulorhexis Posterior optic buttonholing 


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Eva Stifter
    • 1
  • Rupert Menapace
    • 1
    Email author
  • Katharina Kriechbaum
    • 1
  • Alexandra Luksch
    • 1
    • 2
  1. 1.Department of Ophthalmology and OptometryMedical University of Vienna, AustriaViennaAustria, Europe
  2. 2.Department of OphthalmologySanatorium HeraViennaAustria

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