Posterior Capsule Opacification (Secondary Cataract)

Effect of anti-TGF-β2 surface modification of polydimethylsiloxane on lens epithelial cell markers of posterior capsule opacification

Posterior capsule opacification is the most common complication of cataract surgery. Lens epithelial cells remaining in the capsular bag following surgery can undergo epithelial-to-mesenchymal transition and migrate from the anterior to the posterior capsule, leading to fibrosis, capsular wrinkling, and ultimately vision loss. Transforming growth factor-beta 2 has been shown to play a major role in epithelial-to-mesenchymal transition. Covalent tethering of anti-transforming growth factor-beta 2 to the surface of the intraocular lens material may inhibit epithelial-to-mesenchymal transition and the subsequent events, thus leading to a reduction in posterior capsule opacification. In this work, the antibody was tethered to the surface of polydimethylsiloxane as a model lens material via a poly(ethylene) glycol spacer. Surface characterization using a variety of methods demonstrated successful modification. The surface density of the anti-transforming growth factor-beta 2 was approximately 0.5 µg/cm2. The presence of transforming growth factor-beta 2 in cell culture medium stimulated production of extracellular matrix components such as collagen, fibronectin, laminin, and the fibrotic marker α-smooth muscle actin, by HLE-B3 cells. These effects were decreased but not completely eradicated by the presence of the anti-transforming growth factor-beta 2 antibody on the polydimethylsiloxane surface. These results suggest that surface modification with appropriate antifibrotic molecules has the potential to modulate cellular changes following cataract surgery and lead to a reduction in posterior capsule opacification.

Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement

BACKGROUND

This paper attempts to clarify the usefulness of various simple pre-operative measures in estimating the potential for a visually successful capsulotomy.

METHODS

24 patients attending for capsulotomy had pre-operative measures of glare with BAT tester, visibility of posterior pole and grading of posterior capsular pearls and fibrosis seen at slit lamp. Visual function was measured before and after standardised capsulotomy. Correlations of the various preoperative measures with eventual visual function improvements were calculated.

RESULTS

Pearls at slit lamp and poor posterior pole visualisation were all correlated with improvements in visual acuity and contrast sensitivity after capsulotomy. Amount of fibrosis visible at slit lamp and glare assessment were not correlated with vision improvements after laser.

CONCLUSION

Of the various measures that are taken prior to Nd : YAG capsulotomy, some correlate with eventual visual improvement but for others no clinical utility was found. Practitioners should note these findings as they are especially of use in more questionable or high-risk cases to help determine whether referral for PCO treatment by Nd: YAG capsulotomy is likely to benefit the patient.

Anterior capsule relationship of the AcryS of intraocular lens optic and posterior capsule opacification

OBJECTIVE

To evaluate the relationship of the anterior capsule and the AcrySof MA30BA intraocular lens (IOL) and its impact on the development of central posterior capsule opacification (PCO).

DESIGN

Prospective, randomized, controlled trial.

PARTICIPANTS

Two hundred two patients with senile cataracts received an AcrySof IOL between July and December 1998 at Iladevi Cataract and IOL Research Center, Ahmedabad, India.

INTERVENTION

Patients were randomized prospectively to receive 1 of the 3 possibilities of anterior capsule and IOL optic relationship: group 1, total anterior capsule cover (360 degrees ) of the optic; group 2, no anterior capsule cover (360 degrees ) of the optic; group 3, partial anterior capsule cover (<360 degrees ) of the optic. After surgery, slit-lamp video photography was performed every 6 months for 3 years. Analyses of variance and chi-square tests were used to compare treatment groups.

MAIN OUTCOME MEASURES

Incidence of PCO in the 3 groups. The posterior capsule was divided into 3 zones: peripheral, central 3 mm, and midperipheral (the space between the peripheral and the central zones).

RESULTS

The average follow-up was 35.3 +/- 1.52 months in all the groups. At 3 years, the rate of central PCO was 6.4% in group 1, 7.1% in group 2, and 5.9% in group 3 (P = 0.9). Midperipheral PCO was present in 24.2% in group 1, 16% in group 2, and 20.6% in group 3 (P = 0.9). Peripheral PCO was seen in 100% of patients in all groups. The neodynium:yttrium-aluminum-garnet laser (Nd:YAG) posterior capsulotomy rate was 0% in all groups.

CONCLUSIONS

There was no significant difference in the incidence of development of central PCO among the 3 groups. No patient experienced central PCO that required Nd:YAG capsulotomy. When using the AcrySof IOL model MA30BA, the relationship of the anterior capsule and the IOL does not seem to be a factor that relates to the development of central PCO.