Role of vitrectomy with optic capture

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery

Posterior capsule opacification 3 years after implantation of an AcrySof and a MemoryLens in fellow eyes

To evaluate the application of anterior segment-optical coherence tomography (AS-OCT) in posterior capsule opacification (PCO) severity assessment and analyse the relationship between PCO severity and intraocular lens (IOL) characters. PCO patients were prospectively recruited. Cross-sectional images of the anterior segment at horizontal and vertical meridians were acquired with AS-OCT. The area of the IOL-PC (posterior capsular) space and PCO severity (area, thickness, and density at 3 mm and 5 mm IOL optic regions) were measured. The relationship between PCO severity and visual acuity, comparisons of PCO severity and IOL-PC space using varied IOL designs were analysed. One hundred PCO eyes were enrolled. IOL-PC space, PCO thickness and area were positively correlated with axial length. In addition, PCO area and thickness were positively correlated with visual acuity when it was ≤0.52 logMAR. The cut-off level of visual acuity should be 0.52 logMAR. With varied IOL designs, 3-piece C haptic IOL showed a smaller PCO area and thickness than the 1-piece 3 haptic IOL and 1-piece 4 haptic IOL. PCO area and thickness values for an IOL with a diameter ≤11.0 mm was greater than for an IOL with a diameter of 12.5 mm, and the differences were statistically significant. PCO area and thickness increased when IOL haptic angulation increased (from 0 to 12 degrees). In PCO eyes, cut-off level of visual acuity is 0.52 logMAR. With more severe PCO, visual acuity maybe not enough to describe the visual function impairment. PCO severity and IOL-PC space are significantly correlated with axial length and IOL design and material.

Postoperative capsular opacification is a multifactorial physiological consequence of cataract surgery. Opacification involving the central posterior capsule has a significant impact on high- and low-contrast acuity and low-contrast sensitivity. The proliferation, migration and abnormal differentiation of residual lens epithelial cells and fibers in the capsular bag have been implicated in the pathogenesis of posterior capsule opacification (PCO). The incidence and severity of PCO correlates to the use of surgical techniques, intraocular lens optic edge designs and intraocular lens materials. This article summarizes the clinical studies with recommendations for retarding the development of central PCO. These studies will remain critical for future endeavors undertaken for the eradication of PCO.

To evaluate the effect of multiquadrant cortical cleaving hydrodissection on the development of posterior capsule opacification (PCO) after phacoemulsification. Iladevi Cataract and IOL Research Center, Ahmedabad, India. A prospective randomized triple blind clinical trial was conducted in 86 eyes (86 patients) having phacoemulsification. Eyes were assigned randomly to Group 1, multiquadrant cortical cleaving hydrodissection and hydrodelineation (n = 48 eyes), or Group 2, no multiquadrant cortical cleaving hydrodissection, only hydrodelineation (n = 38 eyes). Age-related nuclear sclerosis (grading system of 1 to 5) and age greater than 50 years were included. Diabetes mellitus and associated eye diseases were excluded. Standard phacoemulsification with implantation of an AcrySof MA30BA intraocular lens (IOL) was done in both groups. High-resolution digital retroillumination images of the posterior capsule were analyzed at 4 years using POCOman software. Seven patients dropped out (8.1%). Outcome measures were incidence and percentage area of PCO. Test of proportions, independent sample t test, and 95% confidence intervals (CIs) were noted. In Groups 1 and 2, the mean age was 58 years +/- 4 (SD) and 57 +/- 5 years, respectively (P = .702; 95% CI, 1.90-2.81); mean follow-up was 48.4 +/- 2.5 months and 49.3 +/- 1.9 months, respectively (P = .687; 95% CI, 1.186-0.7856); incidence of PCO was 11 of 44 (25%) and 12 of 35 (34.3%), respectively (P = .317; 95% CI, 0.359-0.0889); percentage area of PCO was 14.3% and 25.6%, respectively (P = .006; 95% CI, -19.19 to -3.44). One of 44 eyes (2.27%) and 2 of 35 eyes (5.7%) in the groups, respectively, had a neodymium:YAG capsulotomy. Although no difference was noted in the incidence of PCO, in eyes that had PCO, the percentage of the area of the central posterior capsule involved by PCO was significantly lower in eyes that had multiquadrant cortical cleaving hydrodissection than in those that did not.

Comparison of posterior capsule opacification between the 1-piece and 3-piece Acrysof intraocular lenses: Two-year results of a randomized trial

A 3D in vitro model for assessing the influence of intraocular lens: Posterior lens capsule interactions on lens epithelial cell responses

Long-term Effect of 1-Piece and 3-Piece Hydrophobic Acrylic Intraocular Lens on Posterior Capsule Opacification: A Randomized Trial

Evaluation of neodymium:yttrium-aluminum-garnet capsulotomies in eyes implanted with AcrySof intraocular lenses

To evaluate whether the position of the anterior continuous curvilinear capsulorhexis influences the rate of posterior capsule opacification (PCO). A total of 119 patients, aged 61-86 years, underwent cataract surgery with phacoemulsification performed by a single surgeon. The patients were randomized to implantation with either a silicone intraocular lens (IOL) (SI40NB, Allergan) or an AcrySof IOL (MA60BM, Alcon). Three years after surgery, the rate of PCO was analysed using the evaluation of posterior capsule opacification computer software (EPCO). The results were related to the capsulorhexis position, which was assessed with a retroillumination photograph. If the capsulorhexis was located partially or completely off the optics of the IOL, compared to totally on the IOL, significantly more PCO was found (p = 0.0014). When comparing within each IOL type, patients with AcrySof IOLs were found to have significantly less PCO when the capsulorhexis was totally on the optic (p = 0.0048). This difference was also significant in the silicone group (p = 0.041). A relatively small and central capsulorhexis allowing for the complete covering of the IOL optics by the rhexis edges seems to protect against PCO in cataract surgery, with both round-edged silicone IOLs and sharp-edged hydrophobic acrylic IOLs.

Posterior capsular opacification (PCO) is a common long-term complication of cataract surgery. Intraocular lens design and material have been implicated in influencing the development of PCO. This study evaluated the association of hydrophobic and hydrophilic intraocular lenses on preventing PCO. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until August 3, 2016, using the following search terms: cataract, posterior capsule opacification, and intraocular lens. Eligible studies included randomized controlled trials (RCTs), retrospective, and cohort studies. Eleven studies were included in the study with a total of 889 eyes/patients. The overall analysis revealed that hydrophobic intraocular lenses were associated with lower Nd:YAG laser capsulotomy rates than hydrophilic lenses [odds ratio (OR) = 0.38, 95% confidence interval (95% CI) = 0.16-0.91, P = .029]. Hydrophobic intraocular lenses were also associated with lower subjective PCO score (diff. in means: -1.32, 95% CI = -2.39 to -0.25, P = .015) and estimated PCO score (diff. in means: -2.23; 95% CI, -3.80 to -0.68, P = .005) as compared with hydrophilic lenses. Objective PCO score was similar between lens types. (diff. in means: -0.075; 95% CI, -0.18 to 0.035; P = .182). Pooled analysis found that visual acuity was similar between hydrophobic and hydrophilic intraocular lenses (diff. in means: -0.016; 95% CI, -0.041 to 0.009, P = .208). In general, PCO scores and the rate of Nd:YAG laser capsulotomy were influenced by intraocular lens biomaterial. Lens made of hydrophobic biomaterial were overall superior in lowering the PCO score and the Nd:YAG laser capsulotomy rate, but not visual acuity.

The history of cataract has been of continual evolution towards smaller and smaller incision sizes, but there is, however, little point in reducing incision size unless intraocular lenses (IOLs) can be designed to be inserted without the need to enlarge the incision. The demands are great because the microincision cataract surgery (MICS) IOLs must perform as well as a conventional IOL. They must be able to withstand the pressures and forces required to compress it enough to withstand the trauma of injection. They must also be rigid enough to withstand the forces of postoperative bag contraction. IOL design and materials, as well as inserter technology, using coatings to facilitate injection, have advanced so that IOLs can now be inserted through 1.8 mm incisions or even 1.4 mm using wound-assisted techniques. Early MICS IOLs used hydrophilic polymers as these are more compressible and have a plate-haptic configuration, but clinical experience has shown these suffered from high rates of posterior capsule opacification (PCO). More recently hydrophobic materials and open-loop haptic designs have become available but still have increased PCO compared to conventional IOLs, possibly due to their reduced thickness.

Effect of total lens epithelial cell destruction on intraocular lens fixation in the human capsular bag

Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses

Long-term Effect of Sharp Optic Edges of a Polymethyl Methacrylate Intraocular Lens on Posterior Capsule Opacification: A Randomized Trial