Influence of intraocular lens implantation on anterior capsule contraction and posterior capsule opacification

Effectiveness of prophylactic capsular tension ring implantation during cataract surgery in highly myopic eyes

PURPOSE

To assess the effectiveness of prophylactic capsular tension ring (CTR) implantation during cataract surgery in highly myopic eyes.

SETTING

Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.

DESIGN

Prospective cohort study.

METHODS

Consecutive highly myopic patients treated with cataract surgery were recruited and randomized to undergo CTR implantation or not. The outcomes compared between the 2 groups included axial lens position (ALP), intraocular lens (IOL) decentration and tilt, area of anterior capsule opening, severity of anterior capsular opacification (ACO), and posterior capsular opacification (PCO) at 1 year postoperatively.

RESULTS

A total of 55 highly myopic eyes with CTRs implanted and 55 without were included in the analysis. At 1 year postoperatively, no significant differences were detected between the CTR and non-CTR groups for the mean ALP, IOL decentration, or tilt (all P > .05). However, the CTR group had a significantly larger area of anterior capsule opening (23.62 ± 3.30 mm2 vs 21.85 ± 2.30 mm2, P = .003), and less severe ACO (P = .033) and PCO (PCO-3 mm: 0.06 ± 0.13 vs 0.13 ± 0.20, P = .038; PCO-C: 0.15 ± 0.18 vs 0.25 ± 0.26, P = .026) than the non-CTR group. The corrected distance visual acuity, prediction error, and higher-order aberrations did not differ between the 2 groups (all P > .05).

CONCLUSIONS

In highly myopic eyes, although prophylactic CTR implantation can reduce the severity of capsular contraction and opacification, it does not significantly affect postoperative IOL stability or visual outcomes.

Inhibition of anterior capsule opacification and contraction by the elevated anterior rim of the intraocular lens optic

PURPOSE

To verify the anterior capsule opacification (ACO) and contraction (ACC) of the ZCB00V intraocular lens (IOL), made of the same material as the AR40e with a high ACC rate.

STUDY DESIGN

Retrospective cohort study.

METHODS

We evaluated 35 patients at 1 week, 1, 3 and 6 months post phacoemulsification with either a ZCB00V (n = 35) or FY-60AD (n = 34) IOL implantation. The ACC rate was calculated using retroillumination images of the anterior segment, and the ACO was measured using anterior segment photographs and image analysis software. The contact grade between the IOL and anterior capsule was estimated from the Pentacam® images.

RESULTS

The postoperative ACC rates (mean ± standard deviation) at 3 months were 1.03%±2.54% for the ZCB00V and, and 7.12%±9.47% for the FY-60AD. The ZCB00V-implanted eyes showed a significantly lower postoperative ACC at 1 week, 3 months, and 6 months (P < 0.01). On the other hand, the FY-60AD-implanted eyes had more pronounced ACO, and a significantly larger area of opacification (62.24%±21.32% vs. 16.90%±8.34%; P = 0.0005). Pentacam® analysis revealed a space between the anterior capsule and IOL surface in the ZCB00V-implanted eyes, whereas the anterior capsule firmly adhered to the IOL surface in the FY-60AD-implanted eyes.

CONCLUSION

The ACC and ACO were significantly lower in eyes with ZCB00V IOLs compared to those with the FY-60AD. The anterior segment image analysis revealed that the elevated anterior rim of the ZCB00V IOL prevented adhesion between the anterior capsule and IOL optic surface, suggesting an open capsule effect.

Zonular and capsular bag disorders: a hypothetical perspective based on recent pathophysiological insights

The purpose of this article was to look at the pathophysiology behind and devise a classification system for the causes of zonular apparatus-capsular bag (ZACB) insufficiency. Also discussed is dystrophic bag syndrome, including clinical cases and addressing where it lies on the ZACB spectrum. There has been interest in the emergence of in-the-bag intraocular lens (IOL) subluxation, the prevalence of which is increasing. There has also been a recent report of dead bag syndrome, which the authors believe is part of the same disease spectrum. The authors put these phenomena into perspective and provide a classification system based on the possible causes of what they have termed ZACB insufficiency. The basic aspects of capsular bag-IOL ocular pathophysiology are summarized with a focus on functional aspects and the consequences for IOL fastening. Within this framework, dystrophic bag syndrome is a form of primary capsular ZACB insufficiency. The contribution of factors such as intraocular drugs may suggest a reconsideration of agents used and their mode of application.

Morphological comparison between three-dimensional structure of immortalized human lens epithelial cells and Soemmering's ring

The incidence rate of post-cataract surgery posterior capsule opacification (PCO) and lens turbidity is about 20% in 5 years. Soemmering's ring, which is a type of PCO also called a regenerated lens with similar tissue structure to that of a human lens, is an important proxy for elucidating the mechanism of lens regeneration and maintenance of transparency. The authors created new human immortalized crystalline lens epithelial cells (iHLEC-NY1s) with excellent differentiation potential, and as a result of culturing the cells by static and rotation-floating methods, succeeded in producing a three-dimensional cell structure model (3D-iHLEC-NY1s) which is similar to Soemmering's ring in tissue structure and expression characteristics of αA-crystalline, βB2-crystalline, vimentin proteins. 3D-iHLEC-NY1s is expected to be a proxy in vitro experimental model of Soemmering's ring to enable evaluation of drug effects on suppression of cell aggregate formation and transparency. By further improving the culture conditions, we aim to control the cell sequence and elucidate the mechanism underlying the maintenance of lens transparency.

Open-capsule intraocular lens to prevent posterior capsule opacification

PURPOSE

To develop a single-piece open-capsule intraocular lens (IOL) that can be inserted through a small incision and that prevents posterior capsule opacification (PCO) by expanding the capsule and circulating aqueous humor into the capsular bag.

SETTING

Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan.

DESIGN

Experimental study.

METHOD

Using the same hydrophobic acrylic material as the NY-60 IOL, a prototype open-capsule IOL was constructed. The IOL has a single optic and 2 haptics, with a 2.8 mm high spacer and holes through which aqueous humor circulates into the capsular bag by separating the anterior capsule from the posterior capsule and expanding the capsule. The open-capsule IOL or NY-60 (as a control group) was inserted in rabbit eyes. Posterior capsule opacification development was evaluated by measuring the thickness of the cell layer at the center of the posterior capsule on histopathologic specimens and statistically comparing the thickness between the open-capsule IOL group and control group.

RESULTS

The open-capsule IOL could be inserted through a 3.2 mm corneal incision using a D cartridge. The mean thickness of the cell layer at the center of the posterior capsule was 4.78 μm ± 2.61 (SD) in the open-capsule IOL group and 101.14 ± 25.19 μm in the control group and was significantly smaller in the open-capsule IOL group.

CONCLUSION

The prototype single-piece IOL could be implanted through a small incision and prevented PCO by expanding the lens capsule and circulating aqueous humor into the capsular bag.

Effect of anterior capsule polish on visual function: A meta-analysis

PURPOSE

To investigate the relationship between anterior capsule polish and visual function.

METHODS

Data were obtained from Pubmed, Embase, Web of Science, WanFang, VIP and CNKI up to the end of May 2018, without any date or language restrictions for trials. The modified Jadad scale and the newcastle-ottawa scale were used to assess the quality of included studies. Uncorrected visual acuity (UCVA) and posterior capsule opacification (PCO) were used as outcome variables. Data on anterior capsule polish were pooled using weighted, random-effect meta-analysis.

RESULTS

One randomized controlled trial and 4 observational cohort studies involving 2533 patients were included in the analyses. There was a statistically significant difference of UCVA (OR 1.92, 95% CI 1.41-2.61) between the polish group and the control group, indicating that anterior capsule polish improved UCVA. Further studies with continuous data also suggested that anterior capsule polish was associated with good UCVA (MD 0.11, 95% CI 0.06-0.16). Posterior capsule opacification rate for 1-year or longer follow-up were extracted for 2561 eyes in 3 studies. Posterior capsule opacification rate was lower in the anterior capsule polish group according to summary odds ratio on PCO rate (OR 0.42 95% CI 0.24-0.73).

CONCLUSIONS

Anterior capsule polish prevents complication of modern cataract surgery and benefits on visual function in short term follow-up period.

The Effect of Anterior Capsule Polishing on Capsular Contraction and Lens Stability in Cataract Patients with High Myopia

Purpose

To evaluate the effect of anterior capsule polishing in patients with high myopia after cataract surgery.

Setting

The Eye Hospital of Wenzhou Medical University, Zhejiang, China.

Design

Prospective study.

Methods

High myopic patients with a bilateral cataract who underwent phacoemulsification with 360° anterior capsular polishing in one eye and without polishing in the contralateral eye were recruited. The following parameters were recorded at 1, 3, and 6 months postoperatively, including the area and diameter of the anterior capsule opening (area and D), IOL tilt and decentration, refraction, and postoperative aqueous depth (PAD).

Results

Paired samples of 38 eyes of 19 patients were enrolled. The area decreased significantly in both the polished group and unpolished group, whereas the diameter reduced more in the unpolished group. The IOL tilt and decentration at 3-month and 6-month follow-up showed significant differences between two groups. In the unpolished group, the IOL decentration firstly appeared between one-month to three-month visit, while the refraction error, PAD, and IOL tilt were significantly different between the three-month and six-month visits.

Conclusion

360° anterior capsule polishing can effectively reduce the extent of the anterior capsule contraction and increase the stability of IOL. The study was registered at http://www.clinicaltrials.gov, and the clinical trial accession number is NCT 03142269.

Effects of Residual Anterior Lens Epithelial Cell Removal on Axial Position of Intraocular Lens after Cataract Surgery

Purpose

The aim of this study was to assess the effects of residual anterior lens epithelial cell (LEC) removal by anterior capsule polishing on the effective lens position (ELP) and axial position stability of the intraocular lens (IOL) after cataract surgery via postoperative measurement of the anterior chamber depth.

Methods

We enrolled 30 patients (60 eyes) requiring bilateral cataract surgery for age-related cataracts. Meticulous anterior capsule polishing and removal of residual LECs under the capsule were performed using a bimanual irrigation/aspiration system for one randomly selected eye in each patient. The eye without polishing served as a control. ELP was measured at five different time points after surgery, and axial shifting of IOL was determined at each visit by comparison with the position at the previous visit.

Results

The polishing and control groups showed significant differences with regard to the mean ELP at 1 (3.40 ± 0.29 versus 3.53 ± 0.32 mm, resp.; p=0.026) and 2 months (3.42 ± 0.32 versus 3.61 ± 0.35 mm, resp.; p=0.001) after surgery, the mean standard deviation for the five ELP values (0.087 ± 0.093 versus 0.159 ± 0.138 mm, p=0.001), and the root mean square of the change in ELP at each follow-up visit (0.124 ± 0.034 versus 0.246 ± 0.038 mm, p=0.047). The eyes in the control group exhibited a tendency for backward IOL movement with a concurrent hyperopic shift in refraction of approximately 0.2 diopter at 2 months after surgery.

Conclusion

Our findings suggest that residual anterior LEC polishing enhances the axial position stability of IOLs, without any complications, after cataract surgery.

Phacoemulsification of bilateral cataracts in two pet rabbits

Two 3 year-old, healthy, client-owned Lop rabbits presented with bilateral cataracts. After performing a physical examination, bloodwork, ocular ultrasonography and electroretinography, both animals were deemed good surgical candidates for phacoemulsification. Bilateral cataract surgery was performed and both rabbits regained vision in both eyes. Both animals developed post-operative ocular hypertension and one animal developed corneal ulcers immediately after surgery. Both surgical complications resolved with medical management. This case series describes phacoemulsification of bilateral cataracts in 2 companion rabbits and the use of an intraocular lens in 1 rabbit. Surgical treatment of cataracts can be considered as a treatment option whenever a healthy rabbit is visually impaired due to cataracts.

Pathology and immunohistochemistry of capsular bag in spontaneously late dislocated capsular bag-intraocular lens complex

Purpose:

Our study aims to evaluate the morphology, histopathology, and immunohistochemistry of the spontaneously late dislocated capsular bag-intraocular lens (CB-IOL) complex. Various etiologies and possible pathogenesis of the event are also discussed.

Methods:

This was a tertiary-care setting and retrospective observational case series. The surgically explanted intact specimens of spontaneously late dislocated CB-IOL complex were studied. The demographics, duration of pseudophakia, IOL design/material, and specimen measurements were noted. Fresh specimens were photographed, and computer software was used for measurements. After processing, a detailed microscopic examination was carried out for three different sections of each specimen with hematoxylin and eosin (H and E), Masson's-trichrome, and immunohistochemistry stain for vimentin. The Mann–Whitney U-test was used for the statistical analysis.

Results:

Of 12 specimens, the mean CB and capsulorhexis opening size were 8.32 ± 0.8 mm and 3.62 ± 0.61 mm, respectively. The average CB-IOL complex size of our study was significantly lower than the studies reported in the literature (P ≤ 0.001). All (n = 12, 100%) were acrylic IOLs with 11 (91.67%) having single-piece design. All specimens on H and E stain showed extensive subepithelial fibrosis while Masson's trichrome staining showed that none had any pseudoexfoliation material. The circumferential sphincter-like fibrous tissue arrangement was seen in all specimens. Immunohistochemical expression of vimentin suggested the mesenchymal metaplasia of epithelial A-cells.

Conclusion:

Significant fibrotic contraction of the CB and phimosis of capsulorhexis may cause a progressive zonular tear. This is probably the most important etiology of spontaneous late dislocation of the CB-IOL complex.

Elevated Transforming Growth Factor-β2 in the Aqueous Humor: A Possible Explanation for High Rate of Capsular Contraction Syndrome in High Myopia

Purpose. The purpose of the study was to elucidate the role of transforming growth factor-beta 2 (TGF-β2) in the development of high myopic capsular contraction syndrome. Methods. Nineteen cases of capsular contraction syndrome, including 14 with high myopia, were collected, and their clinical data were reviewed. Aqueous humor and anterior capsular membranes were obtained during capsulotomy. Hematoxylin-eosin and immunohistochemical staining with anti-TGF-β2 antibody were performed on capsular membranes. TGF-β2 levels in aqueous humor were assayed using ELISA and western blot. Results. High myopia was significantly associated with the incidence of capsular contraction syndrome (odds ratio: 14.74, P < 0.001, 95% CI: 5.29–41.05). Histopathological analysis revealed proliferation of fibroblast-like lens epithelial cells on the shrunken anterior capsule, labeled with TGF-β2 antibodies. ELISA and Western blot showed higher levels of TGF-β2 in aqueous humor of patients with capsular contraction syndrome and high myopia. Conclusions. High myopia is a risk factor for capsular contraction syndrome. Elevated TGF-β2 levels in high myopic cataract patients may play an important role in the pathogenesis of capsular contraction syndrome.