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

Objective analysis of capsulorrhexis factors and posterior capsular opacification in 420 postmortem eyes

OBJECTIVE

To evaluate the capsulorrhexis structure in postmortem eyes and determine factors associated with posterior capsular opacification (PCO).

DESIGN

Experimental study.

PARTICIPANTS

Postmortem pseudophakic human eyes (n = 420).

METHODS

Postmortem eyes were obtained and examined. Photographs were taken of the eyes in Miyake-Apple view and of the extracted lens-capsule complexes. PCO and Soemmering's ring (SR) were quantified using automated detector opacification software as factors of intensity and area. Miyake-Apple views and ImageJ were used to assess capsulorrhexis diameter, area of anterior capsule-optic overlap, length of the shortest anterior capsular leaflet, and area and angle of capsulorrhexis-optic nonoverlap. Linear regression analysis and Welch's t test were used to determine the relationship of these factors with PCO and SR. All analyses were repeated in sample groups specific to the 5 most common intraocular lens models.

RESULTS

Capsule-optic overlap was positively correlated with PCO (P < 0.0001) and SR (P = 0.0016). Capsulorrhexis diameter was negatively correlated with PCO (P < 0.0001) and SR (P = 0.014). Leaflet length was positively correlated with PCO (P = 0.009). Area and angle of capsulorrhexis-optic nonoverlap were not correlated with PCO or SR. Slopes and coefficients of determination were relatively low for all significant results.

CONCLUSIONS

The pathogenesis of PCO development after cataract surgery is multifactorial. This study shows that with modern operating technology, capsulorrhexis factors have at best a modest influence on PCO formation. Factors such as time from surgery to death and intraoperative techniques such as laser capsule polishing, posterior capsule vacuuming, and cortical cleanup are likely to play a more significant role.

Nanoporous Gold Ring-Integrated Photothermal Intraocular Lens for Active Prevention of Posterior Capsular Opacification

Posterior capsular opacification (PCO) is the leading complication after cataract surgery, and is mainly induced by the proliferation and migration of residual lens epithelial cells (LECs). Although numerous attempts have been made to reduce the incidence of PCO, this complication remains a critical challenge in postoperative visual recovery. This study aims to report a functionalized intraocular lens (R-IOL) with a region-confined photothermal effect for the active prevention of PCO after implantation. The outer rim of R-IOL (non-optical area) is decorated with a nanoporous gold (NPG) ring, which can effectively eliminate the LECs around R-IOL, ultimately inhibiting the migration of LECs from the periphery to the visual axis center in the initial stage, and preventing the subsequent PCO. Furthermore, the mechanism of LECs elimination can be attributed to apoptosis induced by mild photothermal therapy. After in vivo implantation for 30 days, PCO is rarely observed in the R-IOL group, whereas the considerably higher incidence of PCO (75%) is found in the pristine IOL (P-IOL) group. The region-confined photothermal effect based on NPG not only provides an active strategy to effectively prevent PCO, but also introduces new opportunities for the treatment of undesirable hyperplasia.

Preserving posterior capsular integrity in post-endothelial keratoplasty posterior capsular opacification

Endothelial keratoplasty (EK) with pseudophakia often presents with late-onset proliferative after-cataract with posterior capsule distension. We performed a modified technique of capsular bag lavage in 11 eyes with late-onset PCO after EK (4 cases: post-DSAEK, 7 cases: post-DMEK). Anterior capsular rim was separated from the underlying IOL optic using MVR blade. Circumferential relaxing radial nicks were made on the capsular rim to create space for the passage of irrigation-aspiration (IA) probes behind the IOL. Bimanual IA of the flocculent cortical material was performed without damaging the posterior capsule. Air was injected at end of surgery to ensure graft apposition. All cases gained 1-3 lines of Snellen’s acuity and no case developed graft failure, rejection, or endothelial decompensation. An intact posterior capsule is associated with better outcomes post a repeat graft, if required. Our technique helps avoid complications related to a disturbed anterior hyaloid phase and minimizes postoperative inflammation.

Vision Restoration: Cataract Surgery and Surgical Correction of Myopia, Hyperopia, and Presbyopia

Cataract surgery is one of the most common surgical procedures performed in the United States. The decision to remove a cataract is determined by the patient's ability to perform activities of daily living, such as reading, driving, and watching television. Cataract surgery also offers the potential of spectacle independence with a wide array of premium intraocular lens options. In addition, with the continuing advances in ophthalmology, patients now also have the option of selecting between traditional approaches and femtosecond laser-assisted procedures. Cataract surgery continues to be an effective and ever-improving procedure for vision restoration.

Impact of intraocular lens characteristics on intraocular lens dislocation after cataract surgery

Background

To assess the influence of intraocular lens (IOL) characteristics on IOL dislocations after cataract surgery.

Methods

Patients who underwent cataract surgery at the Department of Ophthalmology Graz, Austria, between 1996 and 2017 were included and medical records were reviewed. Cox proportional-hazard regression models were used to assess the influence of IOL characteristics on IOL dislocation.

Results

From 68 199 eyes out of 46 632 patients (60.2% women, mean age: 73.71 SD±10.82 years), 111 (0.16%) had an in-the-bag (ITB) disloaction and 35 (0.05%) had an out-of-the-bag (OTB) dislocation. The HRs adjusted for predisposing factors significantly associated with a higher risk for an ITB dislocation were 2.35 (95% CI, 1.45 to 3.8) for hydrophilic IOLs, 2.01 for quadripode IOLs (95% CI, 1.04 to 3.86) and 1.61 (95% CI, 1.04 to 2.48) for haptic angulation. A lower risk was observed for three-piece IOLs (HR=0.58, 95% CI, 0.34 to 0.98) and larger overall IOL diameter (HR=0.79, 95% CI, 0.66 to 0.95). For an OTB dislocation, the HR associated with a higher risk was 18.81 (95% CI, 5.84 to 60.58) for silicone IOLs and 2.12 (95% CI, 0.62 to 7.29) for hydrophilic IOLs. Larger overall IOL diameter (HR 0.40, 95% CI; 0.25 to 0.63) showed a lower risk.

Conclusion

Hydrophilic IOLs, quadripode IOLs and haptic angulation were associated with a higher risk for an ITB dislocation, whereas three-piece IOLs and a larger overall diameter were associated with a lower risk. Risk factors for OTB dislocation were silicone IOLs, hydrophilic IOLs and a smaller overall IOL diameter.

Capsule milking: Modification of capsulorhexis technique for intumescent cataract

We describe a single-stage modification of the continuous curvilinear capsulorhexis that facilitates creation of a well-sized round and centered capsulorhexis in an intumescent cataract. This is done without special instrumentation. The modification is based on overcoming the problem of high intralenticular pressure. It involves physically flattening the central anterior capsule, specifically over the site of puncture, simultaneous puncture and aspiration for decompression, followed by flattening of the midperiphery of the lens where the capsulorhexis can be safely initiated. This minimizes the tendency of capsulorhexis runaway and allows 1-stage creation of a well-sized capsule opening for phacoemulsification.

Scanning Electron Microscopy Analysis of the Anterior Capsulotomy Edge: A Comparative Study between Femtosecond Laser-Assisted Capsulotomy and Manual Capsulorhexis

Purpose

To compare the capsule edges ultrastructure obtained by two femtosecond laser-assisted cataract surgery (FLACS) platforms and manual continuous curvilinear capsulorhexis (CCC) using scanning electron microscopy (SEM).

Setting

Eye Clinic, University of Trieste, Italy.

Design

Experimental comparative study.

Methods

150 anterior capsules were collected and divided into three groups as follows: Group 1 (50 capsules) obtained with manual CCC, Groups 2 and 3 (each with 50 capsules) obtained with the Catalys Laser and the LenSx Laser, respectively. All samples were imaged by means of SEM and regularity of the cut surface, and thickness of the capsule edge were evaluated and compared.

Results

All femtosecond laser (FSL) capsules were perfectly circular, whereas some alteration of the circular shape was observed in the manual ones. Group 1 showed a smooth and regular capsule edge without any surface irregularity, conversely Groups 2 and 3 showed postage-stamp perforations on the capsule edge. The cut surface irregularity value in Group 2 was 1.4 ± 0.63, while it was 0.7 ± 0.49 in Group 3 (p < 0.05). Group 1 had a significantly lower thickness of the capsule edge than the FSL groups (p < 0.05). No statistically significant difference in the capsule edge thickness between the FSL groups was found (p=0.244).

Conclusions

Despite the presence of slight cut surface irregularities, both FSL capsulotomies showed a better geometry and circularity than the manual ones. Capsulotomy specimens obtained using both FSL capsulotomies showed laser-induced alterations of the capsule edge when compared with smooth and regular edges obtained using manual CCC.

Long-term effectiveness and safety of a three-piece acrylic hydrophobic intraocular lens modified with hydroxyethyl-methacrylate: an open-label, 3-year follow-up study

Background

Clareon^® is a new hydrophobic acrylic optic biomaterial designed for enhanced clarity and greater resistance to glistening. The present study evaluated the effectiveness and safety of a three-piece hydrophobic, monofocal intraocular lens (IOL) Model MA60NM, made of this new optic material.

Methods

In this prospective, multicenter, open-label study, eligible patients aged ≥60 years, underwent a unilateral implantation with IOL Model MA60NM following phacoemulsification. Patients were followed-up for up to 3 years after implantation. Visual outcome and serious adverse events (SAEs, cumulative and persistent) were compared to ISO grid rates (BS EN ISO 11979-7:2006). The primary effectiveness variable was Best Spectacle-Corrected Visual Acuity (BSCVA) at 1-year postoperative follow-up. In addition, posterior capsular opacification (PCO) was assessed qualitatively and graded by slit lamp exam on a 5-point scale at all visits.

Results

Overall, 179 and 138 patients completed the 1-year and 3-year postoperative follow-up, respectively. The BSCVA outcomes were better with IOL Model MA60NM than the ISO grid rates with 95.5% of patients at 1 year and 94.2% of patients at 3 years having achieved a BSCVA of 20/40 or better vs 92.5% in ISO grid. The incidence of cumulative or persistent SAEs was lower after Model MA60NM implantation than the ISO grid reference. The incidence of clinically significant PCO was 1.1% at the 1-year and 2.2% at the 3-year visit. Posterior capsulotomy rate was 1.1% at 1 year and 1.4% at 3 years.

Conclusion

The three-piece hydrophobic, monofocal IOL Model MA60NM was effective for the visual correction of aphakia and successfully met all the safety parameters as defined by the ISO criteria. PCO and posterior capsulotomy rates were low over the 3-year follow-up period. This study provides evidence and supports the long-term safety and effectiveness of the new optic biomaterial Clareon^®.

ThinOptX vs AcrySof: Comparison of visual and Refractive Results, Contrast Sensitivity, and the Incidence of Posterior Capsule Opacification

PURPOSE

To evaluate the visual and refractive results, the changes in contrast sensitivity, and the incidence of posterior capsule opacification (PCO) after the implantation of UltraChoice 1.0 ThinOp-tX (ThinOptX Inc.) intraocular lens (IOL) and conventional acrylic foldable IOL (AcrySof MA30AC).

METHODS

Twenty-five patients were randomized into two groups prospectively. In Group 1, microincisional phacoemulsification and the ThinOptX IOL implantation were applied in one eye, and in Group 2, conventional phacoemulsification and the AcrySof IOL implantation were applied in the fellow eye. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), contrast sensitivity, and the incidence of PCO were observed in the two groups and comparisons were made.

RESULTS

Mean follow-up period was 12.8+/-1.5 months (range 11 to 14 months). In the last follow-up examination, UCVA and BCVA were significantly lower and the PCO scores were significantly higher in Group 1 (p<0.05). Although SIA was lower in Group 1, the difference was not statistically significant. Contrast sensitivity in higher spatial frequencies was significantly lower in Group 1 in the 6th month and 12th month visits. Capsular contraction was seen in 3 eyes (12%) in Group 1 whereas there was no capsular contraction or phimosis in Group 2.

CONCLUSIONS

Long-term evaluation of the ThinOptX IOL concludes with an increased rate of PCO, a diminished resistance to the capsular contraction vs the AcrySof IOL, and a decrease in visual performance. The poor after cataract performance of this rollable lens shows that microphacoemulsification and ThinOptX IOL implantation is not as effective as conventional hacoemulsification and AcrySof IOL implantation in the long term.

The effect of single-piece hydrophobic acrylic intraocular lenses on the development of posterior capsule opacification

PURPOSE

To evaluate the long-term effect of a single-piece hydrophobic acrylic intraocular lens (IOL), AcrySof SN60AT (Alcon Laboratories, Fort Worth, Texas, USA), on the development of posterior capsule opacification (PCO) 5 years postoperatively.

DESIGN

Prospective, observational, consecutive, case series.

METHODS

setting: Iladevi Cataract and IOL Research Center, Ahmedabad, India.

STUDY POPULATION

Three hundred and ninety eyes with uncomplicated age-related cataract were included. Patients with diabetes mellitus, glaucoma, high myopia, pseudoexfoliation, traumatic cataract, subluxated cataract, previous ocular surgeries, and allergy to dilating drops were excluded. intervention procedures: Digital retroillumination photographic documentation was performed and analyzed for PCO using Evaluation of Posterior Capsule Opacification software. The scores and areas were calculated.

MAIN OUTCOME MEASURES

PCO development and the influence of the anterior capsule cover (total on and part on) on the IOL optic was studied within the capsulorrhexis margin and the central 3.0 mm optic area.

RESULTS

There was a significant increase in PCO up to 3 years. No significant change in PCO was observed between 3 and 5 years within the capsulorrhexis margin and central 3.0 mm optic area. In the total on group, within the capsulorrhexis margin, significantly lower scores and areas were observed when compared with part-on scores and areas.

CONCLUSION

The increase in PCO up to 3 years was significant. Stabilization in PCO was observed between 3 and 5 years with no difference at 5 years. There was a low incidence of PCO in eyes with total anterior capsule cover over the IOL optic.

[Posterior capsule opacification]

Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology.

Comparison of posterior capsule opacification in rabbit eyes receiving different administrations of rapamycin

BACKGROUND

Posterior capsule opacification (PCO) is a common complication after cataract surgery. The purpose of this study was to determine the effects of three administering ways of rapamycin (RAPA) on the formation of PCO in rabbit eyes for 12 weeks.

METHODS

Eighty rabbits were divided into four groups, according to the different administrations of RAPA which they received. These were: (1) the control group, (2) the irrigation-treated group - 5 ng/ml intraoperative RAPA irrigation solution, (3) the eye-drop-treated group - 2 mg/ml RAPA eye drops, and (4) the IOL-treated group - RAPA-poly(lactic-co-glycolic) acid (PLGA) loaded on the surface of intraocular lens (IOLs) (RAPA-PLGA-IOLs). All right eyes were treated with lens extraction plus IOL implantation, receiving relative administrations of RAPA. RAPA concentrations in the aqueous humour were determined by high performance of liquid chromatography (HPLC). The anterior chamber (AC) response was observed through slit-lamp biomicroscopy. After 12 weeks, the degree of PCO was determined by clinical evaluation. The histological sections, immunohistochemistry expression of proliferating cell nuclear antigen (PCNA) in the lens capsule were conducted.

RESULTS

In the early period, AC response for both experimental and control eyes were similar. In the IOL-treated group, RAPA reached its peak at 25.68 ± 0.74 μg/ml on the 4th day, and it was detectable until 8 weeks afterwards. However, in the other groups, RAPA could not be detected all the time. Compared with other groups, in the IOL-treated group, PCO was greatly alleviated; only a few layers of the lens epithelial cells (LECs) and a little proliferative material around the posterior capsules, and a significantly weak expression of PCNA in the nuclei of LECs. By contrast, there was no significant statistical difference in eye-drop-treated or irrigation-treated eyes and control eyes respectively.

CONCLUSIONS

Intraocular RAPA-PLGA-IOL was a promising, effective, and safe administration to prevent PCO compared with other methods in the rabbit PCO model.

The impact of capsulorhexis diameter, localization and shape on posterior capsule opacification

BACKGROUND

The aim of this study was to evaluate the impact of capsulorhexis diameter, localization and shape on posterior capsule opacification (PCO) development after cataract extraction with phacoemulsification.

MATERIAL/METHODS

We retrospectively analyzed of 297 patients who underwent phacoemulsification and AcrySof SA60AT implantation. In a first group of 97 patients, 53 received small capsulorhexis (3.9 to 4.9 mm in diameter) and 44 patients received large capsulorhexis (5.0 to 5.9 mm in diameter). Another group of 99 patients was split into subgroups--66 patients whose capsulorhexis were centrally located and 33 patients whose capsulorhexis were paracentral. A third group of 101 patients was split into subgroups--a subgroup of 59 patients were classified as having a regularly rimmed capsulorhexis and a subgroup of 42 patients as having an irregularly rimmed capsulorhexis. At 6 months follow-up, PCO was classified as none, mild, moderate, or severe, depending on the number of quadrants involved.

RESULTS

86.79% of the patients with a small capsulorhexis had no or mild PCO (p<0.001), whereas, 68.18% of the patients with a large capsulorhexis experienced moderate or severe PCO; 89.4% of the patients with a central capsulorhexis had no or mild PCO (p<0.001), whereas, 75.75% of the patients with a paracentral capsulorhexis had moderate or severe PCO; 86.44% of the patients with a regularly rimmed anterior capsulorhexis had no or mild PCO (p<0.001); and 69.04% of the patients with an irregular capsulorhexis rim had moderate or severe PCO.

CONCLUSIONS

A small capsulorhexis diameter, its central localization and regular shape result in less PCO following phacoemulsification.

Reduction of Nd:YAG capsulotomy rates after implantation of a single-piece acrylic hydrophilic intraocular lens with 360° squared optic edge: 24-month results

BACKGROUND AND OBJECTIVE

Posterior capsule opacification remains a significant problem following cataract surgery. The aim of the study was to evaluate the incidence of symptomatic posterior capsule opacification requiring Nd:YAG capsulotomy in patients who underwent cataract extraction and implantation of the Rayner C-flex 570C intraocular lens (IOL) (Rayner Intraocular Lens, Ltd., Sussex, UK).

PATIENTS AND METHODS

A retrospective study of 3,461 eyes that underwent cataract extraction and insertion of the Rayner C-flex IOL from January 2004 to December 2005. The cases that received Nd: YAG capsulotomies were evaluated.

RESULTS

Over a 24-month period, 3,461 Rayner C-flex IOLs were implanted. Nd:YAG capsulotomy was performed in 58 of these cases. The rate of Nd:YAG capsulotomy was 0.6% at 12 months and 1.7% at 24 months. The mean time to Nd:YAG capsulotomy was 9.3 months (range: 1.3 to 22.7 months). The follow-up period was 5.3 to 29.0 months.

CONCLUSION

The incidence of symptomatic posterior capsule opacification with the Rayner C-flex IOL is low.

Comparison of Nd : YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, or acrylic intra-ocular lenses in four European countries

PURPOSE

The aim of this study was to compare the incidence of Nd : YAG laser capsulotomy after cataract surgery according to the type of intra-ocular lens material (PMMA, silicone, hydrophilic acrylic, hydrophobic acrylic) implanted in four European countries (France, Italy, Germany, Spain).

DESIGN

A retrospective record review.

PARTICIPANTS

A review of 1525 patients (first operated eye), aged 50 to 80 years, operated on for cataract in 1996 or 1997 in 16 surgical centers (4 per country).

METHODS

The study employed a retrospective cohort design. Charts were reviewed to collect information during at least a three-year period following cataract surgery to identify patients who underwent Nd : YAG laser capsulotomy postoperatively.

MAIN OUTCOME MEASURES

Data on the type of intra-ocular lens implanted was extracted from the patient notes, as was the date and outcome of the Nd : YAG laser intervention. Kaplan-Meier survival curve analysis with the time to Nd : YAG laser was performed on the data. RESULTS A total of 1525 patients (first operated eye) were available for the study (n = 294 for hydrophilic acrylic, n = 384 for PMMA, n = 421 for hydrophobic acrylic, n = 426 for silicone). There was a highly statistically significant difference between the IOL groups for the incidence of posterior capsule opacification (p < 0.001) and for Nd : YAG laser treatment (p < 0.001). The mean delay of Nd : YAG laser treatment from the date of cataract operation was 2.48 years (+/-1.70, ranging from 0 to 5.88 years). The rate of Nd : YAG laser capsulotomy over the follow-up period was lowest in the hydrophobic acrylic group (7.1%), followed by silicone (16.2%), PMMA (19.3%) and hydrophilic acrylic (31.1%), respectively.

CONCLUSIONS

A low incidence of posterior capsular opacification (PCO) and Nd : YAG laser treatment was detected in hydrophobic acrylic IOLs in comparison to three other types of IOLs implanted in a large cohort of persons with age-related cataract. Choice of IOL type may reduce the need for Nd : YAG laser treatment, although further research on the reasons for this is needed.

Influence on posterior capsule opacification and visual function of intraocular lens optic material

PURPOSE

To examine the influence of optic material on posterior capsule opacification (PCO) by comparing PCO and visual functions between eyes with an acrylic intraocular lens (IOLs) and those with a silicone IOL of the same optic design and with the same haptics.

DESIGN

Randomized clinical trial.

METHODS

One hundred patients scheduled for phacoemulsification surgery underwent implantation of an acrylic IOL (AMO Sensar; AR40e) in one eye and implantation of a silicone IOL (ClariFlex) of the same optic design and loops in the fellow eye. Eighty-nine patients (89%) remained for analysis. The PCO value was measured using the Scheimpflug videophotography system at one, three, six, 12, 18, 24, 30, and 36 months postoperatively. The incidence of eyes that required a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy was examined; visual acuity and contrast sensitivity with and without a glare source were also evaluated.

RESULTS

The mean PCO value did not increase significantly during follow-up in either the acrylic or silicone IOL group. When comparing the groups, no statistically significant difference was found in the PCO or in the incidence of Nd:YAG capsulotomy, although both tended to be slightly better in the silicone group than in the acrylic group. There was also no significant difference between the groups in visual acuity or in photopic and mesopic contrast sensitivity with or without glare.

CONCLUSIONS

When acrylic and silicone IOLs are of the same optic design and with the same haptics, the optic material does not influence the development of PCO enough to impair visual function.

Anterior capsule cover and axial movement of intraocular lens

PURPOSE

To measure optic shift (OS) of a single piece monofocal intraocular lens (IOL) with varying relationships between anterior capsule cover and IOL optic.

METHODS

This is a prospective randomized masked study of 150 eyes undergoing phacoemulsification. Eyes received either option: 360 degrees total capsule cover (group I); partial cover (group II); or no cover (group III). OS was calculated as difference in anterior chamber depth after administration of cyclopentolate 1% and pilocarpine 2% on IOLMaster at separate visits at 6 months follow-up. Subsequently, using retro-illumination photographs, percentage area of capsule cover was calculated. OS within and between groups I and II was analyzed. The impact of one quartile change in area of capsule cover on percentage change in OS was measured for both groups. Unpaired t-test, correlation, and regression were applied.

RESULTS

In groups I, II, and III, mean age of patients was 56.68+/-6.38, 57.09+/-7.34, 59.15+/-6.35 years, respectively; mean OS (mm) was 1.25+/-0.28, 1.20+/-0.24; 0.95+/-0.26 (P=0.013), respectively; and percentage area of capsule cover (%) was 47.35+/-10.48, 33.83+/-10.11, 0.16+/-0.13 (P=0.001), respectively. Mean percentage area of capsule cover in group I vsgroup II was significant (P=0.001). OS was 1.22+/-0.26 mm in groups I and II (combined) vs0.95+/-0.26 mm in group III (P=0.004, (0.06, 0.33)). OS in group I vsgroup II was not significant (P=0.46). Correlation coefficient was r=0.38 (P<0.001). With every increment on quartile (a quartile is any of the three values which divide the sorted data set into four equal parts, so that each part represents one-fourth of the sample or population) class of area of capsule cover the OS increased by 0.12 mm.

CONCLUSION

The OS differed significantly between total and partial cover groups combined vsno cover group.

Modification of the surface properties of a lens material to influence posterior capsular opacification

PURPOSE

To study the effect of surface properties of materials on cellular behaviour and the formation of posterior capsular opacification (PCO).

METHODS

Polymethylmethacrylate, silicone and a hydrophobic acrylic were plasma treated and used in tissue culture. The changes in surface properties were quantified by dynamic contact angle measurements. Bovine lens epithelial cells (BLECs) were seeded onto these materials and cultured for 1 month. Serial photographs were taken. The cells were then fixed and stained to facilitate counting.

RESULTS

Plasma treatment significantly increased the hydrophilicity of surfaces. BLECs grew on all surfaces but significantly more cells adhered to the treated than the untreated surfaces. On the untreated surfaces the BLECs had a fibroblastic morphology whereas on the treated surfaces the cells maintained their epithelial morphology.

CONCLUSIONS

Posterior capsular opacification is a form of wound healing and the behaviour of lens epithelial cells is central to its progression. Emphasis has been on the elimination of residual lens epithelial cells to combat PCO. This study demonstrated that the phenotype of BLECs was influenced by the surface properties of the intraocular lens materials. Gas plasma treatment of the materials increased their hydrophilicity and allowed the adhered BLECs to maintain their normal epithelial morphology. We believe that controlled growth of lens epithelial cells may reduce the incidence of PCO.

Comparison of posterior capsule opacification between fellow eyes with two types of acrylic intraocular lens

PURPOSE

To compare the degree of posterior capsule opacification (PCO) and visual function between fellow eyes that received two different types of hydrophobic acrylic intraocular lenses (IOLs).

METHODS

Forty-five patients underwent bilateral phacoemulsification and implantation of an Alcon AcrySof IOL (MA60AC) in one eye and an AMO Sensar IOL (AR40e) in the fellow eye. The PCO density value was measured using the Scheimpflug videophotography system at 1, 6, 12, and 24 months after surgery. The incidence of eyes that required a neodymium:YAG (Nd:YAG) laser capsulotomy, visual acuity, and contrast sensitivity with and without a glare source were also examined.

RESULTS

The mean PCO value did not show a significant increase in either the AcrySof MA60AC or Sensar AR40e IOL groups, and was similar between the two groups throughout the 24-month follow-up period. The incidence of Nd:YAG laser capsulotomy was also the same between the groups. No significant difference was found in mean visual acuity between the two IOL groups during the follow-up, and there was no significant difference in photopic or mesopic contrast visual acuity with and without a glare source at 1 and 24 months after surgery.

CONCLUSION

The degree of PCO in eyes with an AcrySof IOL are almost the same as that in eyes with a Sensar IOL, with the results that visual acuity and contrast sensitivity with and without glare are similar.

Posterior capsule opacification

PURPOSE OF REVIEW

This paper assesses the factors that contribute to the formation of an effective capsular bend as a deterrent to posterior capsule opacification. Its goal is to assist the practicing ophthalmologist in separating current understanding of this process from various working models previously proposed.

RECENT FINDINGS

While a square-edge design appreciably improves resistance to posterior capsule opacification, significant factors remain under the control of the surgeon. These factors combine to form the physical and psychological barrier of a capsular bend. Innovative digital imaging has shown lens epithelial cell migration, allowing for a more rapid assessment of posterior capsule opacification resistance. A three-piece intraocular lens allows for full 360 degree capsular bend formation surrounding the optic edge; some single-piece designs may inhibit capsular bend formation. Decreasing, but not eliminating, the surviving lens epithelial cell population may diminish capsular bend strength, which may decrease resistance to posterior capsule opacification in the face of a regenerating cortex. All demographic features of clear/refractive lens exchange suggest higher rates of posterior capsule opacification than with standard cataract surgery.

SUMMARY

The quality of capsular bend formation will determine how resistant an intraocular lens will be to posterior capsule opacification as a consequence of regenerating cortex. As refractive lens exchange and new accommodating intraocular lens designs become more popular, the problems of regenerating cortex will increase in magnitude.

Clinical results of the blue-light filtering AcrySof Natural foldable acrylic intraocular lens

PURPOSE

To verify the safety and effectiveness of the new AcrySof Natural (Alcon Laboratories, Inc.) blue-light filtering intraocular lens (IOL), which was designed to achieve a light-transmission spectrum similar to that of the natural human crystalline lens.

SETTING

Multicenter U.S. clinical trial.

METHODS

In a prospective randomized patient-masked multicenter study, 150 patients received the AcrySof Natural IOL and 147 patients received the AcrySof single-piece IOL as a control. Patients with bilateral age-related cataracts who were willing and able to wait at least 30 days between cataract procedures and had verified normal preoperative color vision were eligible for the study. Standardized surgery included a 4.0 to 5.0 mm capsulorhexis and phacoemulsification. All lenses were inserted in the capsular bag, with verification of in-the-bag placement of both haptics. In all bilateral implantation cases, the same model IOL was used in each eye. Postoperatively, contrast sensitivity and color perception were measured up to 180 days and up to 1 year (for visual acuity) after implantation.

RESULTS

No statistically significant differences were discovered between the 2 patient groups in visual acuity, contrast sensitivity evaluated under mesopic and photopic conditions, or the number of patients who passed the Farnsworth D-15 color perception test. There were no lens-related adverse events in either group.

CONCLUSIONS

The blue-light filtering AcrySof Natural IOL was equivalent to the conventional AcrySof lens in terms of postoperative visual performance. Additional long-term clinical studies should show whether the IOL actually provides the theoretical benefits to retinal health.

Cost-effectiveness analysis of PMMA, silicone, or acrylic intra-ocular lenses in cataract surgery in four European countries

PURPOSE

To compare the cost-effectiveness of different intra-ocular lens (IOL) materials (Hydrophobic acrylic, Polymethylmethacrylate (PMMA), Hydrophilic acrylic and Silicone) implanted after cataract surgery with reference to Nd:YAG laser capsulotomy and Nd:YAG-related complications in four European countries (France, Italy, Germany and Spain).

SETTING

A retrospective review of 1,525 patients (eyes), aged 50 to 80 years, operated with phacoemulsification for cataract in 1996 or 1997 in 16 surgical centres (4 per country).

METHODS

The study was conducted using a cost-effectiveness approach. Medical charts were reviewed to collect retrospective information during the 3-year period following cataract surgery in order to identify patients who underwent Nd:YAG laser capsulotomy post-operatively. Clinical data were combined with unit costs assessed by experts for Nd:YAG laser capsulotomy and their complications. A cost-effectiveness ratio (cost per patient without Nd:YAG laser capsulotomy intervention) was estimated in relation to each IOL material used in each of the four European countries.

RESULTS

Hydrophobic acrylic, specifically Acrysof, was the most cost-effective IOL material in all the countries except Germany where it was second. PMMA had the best ratio in Germany, was second in Spain and only third in Italy and France. Silicone was second in France and ranked third in the other countries, while hydrophilic acrylic had the worst ratio overall in all countries.

CONCLUSIONS

Cost-effectiveness ratios of hydrophobic acrylic (Acrysof) were better than those of other types of IOL materials used in most of the countries. Sensitivity analyses were performed to vary the base case analysis to demonstrate the economic importance of the assumptions. In all cases, hydrophobic acrylic IOL material was shown to be a highly cost-effective option.

Posterior Capsule Opacification in the Presence of an Intraocular Lens with a Sharp versus Rounded Optic Edge

PURPOSE

To compare the degree of posterior capsule opacification (PCO) and visual function in eyes implanted with an acrylic intraocular lens (IOL) with a sharp posterior optic edge with that in eyes implanted with an IOL with a rounded optic edge.

DESIGN

Randomized clinical trial.

PARTICIPANTS

Seventy-five consecutive patients scheduled for bilateral phacoemulsification were assigned randomly to 1 of 2 groups. One group received an acrylic IOL with a sharp edge (Sensar AR40e, AMO, Santa Ana, CA) in the left eye and an acrylic IOL of the same optic material and loops but with a rounded-edge optic (Sensar AR40) in the right eye. The other group received the sharp-edged IOL in the right eye and the rounded-edge IOL in the left eye. Sixty-nine patients (92%) completed follow-up.

INTERVENTION

All patients underwent implantation of a sharp-edged IOL in 1 eye and a rounded-edge IOL in the fellow eye.

MAIN OUTCOME MEASURES

The PCO value of these patients was measured using the Scheimpflug videophotography system at 1, 3, 6, 12, 18, and 24 months after surgery. The incidence of eyes that required a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy was examined. Visual acuity and contrast sensitivity with and without a glare source also were evaluated.

RESULTS

The mean PCO value in the sharp-edge IOL group was significantly less than that in the rounded-edge IOL group throughout the follow-up period. The incidence of Nd:YAG capsulotomy also was significantly less in the sharp-edge group than in the rounded-edge group (P = 0.0095). No significant difference was found in mean visual acuity during the 24 months of follow-up. However, contrast visual acuity with and without glare was significantly better in the sharp-edge group than in the rounded-edge group at 24 months after surgery.

CONCLUSIONS

The degree of posterior capsule opacification in eyes with an acrylic IOL with a sharp posterior optic edge is significantly less than that in eyes with a rounded-edge IOL, and the sharp-edge optic led to better contrast sensitivity with and without glare.

Factors that influence the development of posterior capsule opacification with a polyacrylic intraocular lens

PURPOSE

To identify factors that contribute to posterior capsule opacification (PCO) after implantation of a 5.5 mm polyacrylic (IOL).

DESIGN

A retrospective analysis of a cohort of sequential images taken from the PCO database at St. Thomas' Hospital, London, to include all patients with an AcrySof MA30 lens and a 1-year retroillumination image.

METHODS

Records of age, gender, axial length, and PCO measurements using the POCO software system were available. Images were divided into those with greater or less than 10% PCO. The degree of rhexis-IOL contact was recorded in clock hours.

RESULTS

Images of 60 eyes were analyzed. Twenty-one eyes had more than 10% PCO. No correlation was found between PCO and age, gender, or axial length. Forty-eight eyes (80%) had some loss of rhexis-IOL contact. These eyes had increased PCO (P < .001) compared with eyes with complete IOL-rhexis contact. More PCO developed when the rhexis was partly on and partly off the IOL.

CONCLUSIONS

PCO is reduced when the rhexis is in complete contact with the anterior IOL surface. The failure to achieve this accounts for the majority of increased PCO seen in patients implanted with this IOL model. PCO formation is related to surgical technique as well as IOL design, and comparisons cannot be made between IOLs without taking this into consideration. These results support the trend to the use of larger optic IOLs to prevent PCO and also support the "capsule compression" theory of PCO prevention.

Three-year follow-up of posterior capsule opacification with two different silicone intraocular lenses

PURPOSE

To compare posterior capsule opacification (PCO) after cataract surgery with implantation of two silicone intraocular lenses (IOLs) with different designs.

METHODS

We carried out a prospective, clinical study of 116 patients randomized to standardized phacoemulsification with implantation of CeeOn Edge (n = 57) or SI40NB (n = 59) IOLs. The follow-up period was 3 years. To evaluate PCO morphologically, digital images were obtained and analysed using evaluation of posterior capsule opacification computer software (epco). The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded.

RESULTS

At 2 and 3 years, the eyes with SI40NB IOLs had significantly more PCO than those with the CeeOn Edge IOLs (p = 0.00014 and p = 0.002). Nine Nd:YAG capsulotomies were performed in the SI40NB group and none in the CeeOn Edge group. This difference was statistically significant (p = 0.003). In some patients a regression of PCO was noticed and confirmed using epco. Statistically less PCO was noted when the capsulorhexis rim was placed so that it covered all 360 degrees of the optic of the IOL.

CONCLUSIONS

A clinically and statistically significant difference in PCO development between CeeOn Edge and SI40NB IOLs at 2 and 3 years postoperatively was found. These findings support earlier studies indicating that a sharp edge of the optic is a more important factor in IOL design than IOL material in the prevention of PCO.

Comparison of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses

PURPOSE

To determine the amount of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses (IOLs) in patients having cataract surgery.

SETTING

Department of Ophthalmology, Gulhane Military Medical Academy and Medical School, Ankara, Turkey.

METHODS

Eighty-eight patients having phacoemulsification with IOL implantation were divided into 2 groups. One group received a 3-piece hydrophobic acrylic IOL with 12.5 mm poly(methyl methacrylate) haptics and the other, a 1-piece hydrophobic acrylic IOL with 12.5 mm haptics. The amount of IOL decentration and tilt was quantitated using Purkinje reflections and photographic documentation at the last postoperative control. The results of the 2 groups were compared.

RESULTS

Bag fixation of the IOL and an intact continuous curvilinear capsulorhexis (CCC) were confirmed in all cases at the last postoperative control, which was at a mean of 27.1 months +/- 5.4 (SD) and 26.7 +/- 4.4 months in the 3-piece group and 1-piece group, respectively (P = 0.659). There was no significant difference between groups in the percentage of patients with measurable tilt and decentration and of patients without measurable tilt and decentration (P = .956). The mean IOL tilt was 2.72 +/- 0.55 degrees in the 3-piece group and 2.70 +/- 0.84 degrees in the 1-piece group and the mean IOL decentration, 0.39 +/- 0.13 mm and 0.34 +/- 0.08 mm, respectively. There were no significant between-group differences in tilt or decentration (P = .897 and P = .103, respectively).

CONCLUSION

There were no significant differences in tilt and decentration between 1-piece and 3-piece hydrophobic acrylic IOLs in eyes with capsular bag IOL implantation and an intact CCC.

Performance of the 1CU accommodating intraocular lens in relation to capsulorhexis size

PURPOSE

To assess the correlation between continuous curvilinear capsulorhexis (CCC) size and visual outcomes in patients with an accommodating intraocular lens (IOL).

SETTING

Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.

METHODS

Nineteen eyes had phacoemulsification and implantation of a 1CU accommodating IOL (HumanOptics AG). Three months after surgery, the uncorrected and best corrected distance and near visual acuities and the distance corrected near visual acuity were measured. Retroillumination photographs were taken to assess CCC size and centration and the amount of overlap between the CCC and IOL optic. The photographs were analyzed using Evaluation of Posterior Capsule Opacification system software.

RESULTS

The mean age of the patients was 53.5 years (range 30 to 73 years). The mean uncorrected distance acuity improved from 0.05 preoperatively to 0.70 at 3 months and the best corrected near acuity, from 0.30 to 0.94. The mean postoperative distance corrected near acuity was 0.5 (range 0.1 to 1.0), which improved to 0.9 with near correction. The mean CCC size (4.3 mm) and amount of CCC decentration (0.35 mm) did not correlate with visual outcomes. However, there was a correlation between the amount of CCC-optic overlap (mean 35%; range 16% to 55%) and distance corrected near acuity (r = 0.641, P = .003). Distance corrected near acuity was better with less overlapping; that is, with a larger CCC.

CONCLUSIONS

A larger capsulorhexis with less CCC-optic overlapping gave better near visual outcomes. Results indicate that an overlap between 25% and 35%, which correlates with a CCC between 4.5 mm and 5.0 mm, provides the best capsule strength without compromising accommodation with the single-piece 1CU IOL.

Acute angle-closure glaucoma caused by vitreous prolapse after neodymium:YAG posterior capsulotomy

We report the second known case of acute angle-closure glaucoma from vitreous prolapse after neodymium:YAG (Nd:YAG) laser posterior capsulotomy in a patient with a posterior chamber intraocular lens (IOL). This is the first reported case to result in corneal decompensation that required penetrating keratoplasty. The rare complication of vitreous prolapse was unusual in this patient because of the presence of a posterior chamber IOL, a small 4.0 mm capsulotomy opening, and low (26 mJ) Nd:YAG laser energy.

The effect of lens edge design versus anterior capsule overlap on posterior capsule opacification

PURPOSE

To determine whether lens edge design or anterior capsule overlap on the intraocular lens (IOL) has greater effect on posterior capsule opacification (PCO).

DESIGN

Retrospective cohort clinical study.

METHODS

Retrospective.

SETTING

Academic clinical practice.

PATIENT POPULATION

The patient population consisted of 259 uncomplicated surgical patients (259 eyes) with no confounding comorbidity and at least 1 year of follow-up after surgical placement of a silicone or hydrophobic acrylic lens.

OBSERVATION PROCEDURES

Digital retroilluminated photographs were taken to ascertain PCO, anterior capsular opacification (ACO), previous neodymium:YAG capsulotomy and degree of anterior capsule overlap on the IOL optic.

MAIN OUTCOME MEASURES

PCO, ACO, YAG capsulotomy rate, and anterior capsule overlap on the IOL optic.

RESULTS

One hundred forty-eight digital images (74 silicone and 74 acrylic) were measurable for both anterior capsule overlap and PCO. Complete 360 degrees of anterior capsule overlap on the IOL was associated with decreased PCO (P = <.001). A significant negative correlation was found between the degree of anterior capsule overlap and PCO (P = <.001). Evaluation of PCO, and YAG capsulotomy rates were similar between acrylic and silicone lenses. Minimal anterior capsule overlap may also be associated with PCO prevention.

CONCLUSIONS

Implanting a lens with complete anterior capsule overlap on the IOL was found to significantly reduce PCO, which advantage appeared to be greater than PCO prevention by a truncated, sharp edge IOL design.

The Auckland Cataract Study: 2 year postoperative assessment of aspects of clinical, visual, corneal topographic and satisfaction outcomes

AIM

To assess clinical, visual, computerised corneal topographic, and subjective satisfaction with visual acuity, in a cohort of subjects 2 years after phacoemulsification surgery in a public hospital in New Zealand.

METHODS

Prospective study of a representative sample of 97 subjects (20%) randomly selected from 480 subjects in the original Auckland Cataract Study (ACS) cohort. The clinical assessment protocol was identical to the ACS and included an extensive questionnaire to enable direct comparisons to be made between the two groups.

RESULTS

The study population was predominantly female (66%) with a mean age of 76.3 (SD 9.9) years. New systemic and ocular disease affected 18.4% and 10.3% of subjects respectively, and 10.3% required referral to either a general practitioner (2.1%) or ophthalmologist (8.2%). Mean best spectacle corrected visual acuity (BSCVA) was 0.2 (0.2) logMAR units (6/9 Snellen equivalent), with mean spherical equivalent -0.37 (1.01) dioptres (D) and astigmatism -1.07 (0.70) D 2 years postoperatively, compared to mean BSCVA 0.1 (0.2) logMAR units (6/7.5 Snellen equivalent), spherical equivalent -0.59 (1.07) D, and astigmatism -1.14 (0.77) D 4 weeks after surgery. 94.9% of subjects retained a BSCVA of 6/12 or better, irrespective of pre-existing ocular disease. The overall posterior capsule opacification (PCO) rate was 20.4% and this was visually insignificant in all but 3.1% of eyes that had already undergone Nd:YAG posterior capsulotomy. Orbscan II elevation technology demonstrated corneal stability 2 years after uncomplicated phacoemulsification. Although corneal astigmatism was eliminated in approximately half of the subjects 1 month postoperatively, astigmatism showed a tendency to regress towards the preoperative level with local corneal thickening at the site of incision 2 years after cataract surgery. Of fellow eyes, 61.2% had undergone cataract surgery. Overall, 75.3% of subjects were moderately to very satisfied with their current level of visual acuity.

CONCLUSION

Two years after cataract surgery subjects are generally satisfied with their current level of vision and distance BSCVA is 6/12 or better in the majority of eyes. Although only a minority of eyes develop sufficient PCO to require capsulotomy 10.3% of eyes develop new vision threatening ocular pathology.

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.

Posterior capsule opacification: silicone plate-haptic versus AcrySof intraocular lenses

PURPOSE

To evaluate posterior capsule opacification (PCO) in fellow eyes, 1 receiving a silicone intraocular lens (IOL) and the other, an acrylate IOL.

SETTING

Department of Ophthalmology, Isala Clinics, Zwolle, The Netherlands.

METHODS

This retrospective study comprised 107 patients (214 eyes). In each patient, 1 eye was randomly selected to have implantation of an acrylate IOL (AcrySof MA30BA or MA60BM, Alcon) and the other eye, a plate-haptic silicone IOL (AA4203VF, Staar). Outcome measures were the total PCO index, percentage of neodymium:YAG (Nd:YAG) capsulotomies performed, and logMAR best corrected visual acuity (BCVA). The follow-up was 3 years.

RESULTS

The total PCO index was significantly lower in the AcrySof group than in the plate-haptic silicone group (P<.0001). There was no significant difference in logMAR BCVA between groups (P>.05). The percentage of Nd:YAG laser treatments was significantly lower in the AcrySof group (2.8%) than in the plate-haptic silicone group (23.1%) (P<.05).

CONCLUSIONS

There was significantly less PCO and a lower Nd:YAG laser capsulotomy rate after AcrySof IOL implantation than after plate-haptic silicone IOL implantation. These results did not seem to affect the logMAR BCVA as there were no significant differences between groups in this parameter.

Pharmacologic prevention of posterior capsule opacification: in vitro effects of preservative-free lidocaine 1% on lens epithelial cells

PURPOSE

To assess the in vitro effectiveness of preservative-free lidocaine 1% in removing lens epithelial cells (LECs) from the anterior capsule and to evaluate the effect of lidocaine on the LECs.

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

METHODS

Eight rabbits (16 eyes) were used in the study. After the rabbits were killed, the eyes were enucleated and divided into 2 groups. In Group 1 (n = 8 eyes), LECs were exposed to preservative-free lidocaine 1% or balanced salt solution (BSS) for 1, 2, or 5 minutes. The anterior capsules were then stained with trypan blue and alizarin red. Photomicrographs of each capsule were taken and analyzed for LEC damage. In Group 2 (n = 8 eyes), hydrodissection was performed with 1 of the agents, followed by phacoemulsification and cortical cleanup. The LEC attachment to the anterior capsule was evaluated by histopathology.

RESULTS

Anterior capsule fragments irrigated with BSS showed no LEC nuclear staining; ie, no direct toxic effect. In those irrigated with preservative-free lidocaine 1%, the LECs showed mild toxicity; some cells showed blue nuclear staining. After hydrodissection with lidocaine, the capsules were almost free of LECs; after hydrodissection with BSS, the capsules showed a normal layer of LECs attached to the anterior capsule.

CONCLUSIONS

Preservative-free lidocaine 1% may help diminish the amount of live LECs by facilitating cortical cleanup, by loosening the desmosomal area of cell-cell adhesion with decreased cellular adherence, or by a direct toxic effect. The use of this agent may help prevent posterior capsule opacification.