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Evereklioglu C, Arda H, Sener H, Polat OA, Gumus K, Horozoglu F. Comparison of the Rate of Posterior Capsule Opacification Following Combined Treatment With Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone: A Two-Year, Randomized Clinical Investigation. Cureus 2023; 15:e37223. [PMID: 37159777 PMCID: PMC10163951 DOI: 10.7759/cureus.37223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background and aim The use of non-steroidal anti-inflammatory drugs in animals decreases the incidence of posterior capsular opacification (PCO) following cataract surgery. We evaluated the rate of PCO in patients with cataract surgery and foldable "in the bag" posterior chamber intraocular lens (PC-IOL) implantation treated with combined dexamethasone 0.1% plus ketorolac tromethamine 0.5% versus dexamethasone 0.1% alone. Materials and methods A total of 114 eyes of 101 patients underwent uneventful corneal small-incision phacoemulsification with primary implantation of a foldable acrylic PC-IOL (AcrySof®, Alcon, Fort Worth, USA). Postoperatively for four weeks, group 1 eyes were treated with dexamethasone 0.1% plus ketorolac tromethamine 0.5% ophthalmic solutions four times daily for each whereas group 2 eyes were treated with dexamethasone 0.1% alone. Other regiments were the same for each group. Patients were evaluated between one- and four-year following surgery. The frequency and timing of severe PCO following surgery that needed Nd:YAG laser posterior capsulotomy were recorded and evaluated. Results The mean (SEM) age of group 1 (n = 54) and group 2 (n = 60) at operation was similar (62.8 ± 2.2 vs. 60.6 ± 1.7 years, respectively). Eighty-eight patients had unilateral cataract and 13 cases had bilateral disease. Overall, the mean follow-up duration was 24.7 months postoperatively (range, 15-48). Clinically significant PCO that finally needed Nd:YAG laser application developed in two eyes (3.7%) in group 1 and in four eyes (6.6%) in group 2, and the difference was not statistically significant (p>0.05). The mean month at capsulotomy was 26.5 in group 1 and 24.3 months in group 2 eyes (p>0.05). Conclusions Topical instillation of ketorolac ophthalmic solution in the immediate period after phacoemulsification and PC-IOL implantation did not seem to influence the incidence of PCO formation two years after cataract surgery.
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Konopińska J, Młynarczyk M, Dmuchowska DA, Obuchowska I. Posterior Capsule Opacification: A Review of Experimental Studies. J Clin Med 2021; 10:jcm10132847. [PMID: 34199147 PMCID: PMC8269180 DOI: 10.3390/jcm10132847] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Posterior capsule opacification (PCO) is the most common complication of cataract surgery. It causes a gradual deterioration of visual acuity, which would otherwise improve after a successful procedure. Despite recent advances in ophthalmology, this complication has not been eradicated, and the incidence of PCO can be as high as 10%. This article reviews the literature concerning the pathomechanism of PCO and examines the biochemical pathways involved in its formation and methods to prevent this complication. We also review the reported tests performed in cell cultures under laboratory conditions and in experimental animal models and in ex vivo human lens capsules. Finally, we describe research involving human eyes in the clinical setting and pharmacological methods that may reduce the frequency of PCO. Due to the multifactorial etiology of PCO, in vitro studies make it possible to assess the factors contributing to its complications and search for new therapeutic targets. Not all pathways involved in cell proliferation, migration, and contraction of the lens capsule are reproducible in laboratory conditions; moreover, PCO in humans and laboratory animals may be additionally stimulated by various degrees of postoperative reactions depending on the course of surgery. Therefore, further studies are necessary.
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Walker JL, Menko AS. Immune cells in lens injury repair and fibrosis. Exp Eye Res 2021; 209:108664. [PMID: 34126081 DOI: 10.1016/j.exer.2021.108664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/18/2022]
Abstract
Immune cells, both tissue resident immune cells and those immune cells recruited in response to wounding or degenerative conditions, are essential to both the maintenance and restoration of homeostasis in most tissues. These cells are typically provided to tissues by their closely associated vasculatures. However, the lens, like many of the tissues in the eye, are considered immune privileged sites because they have no associated vasculature. Such absence of immune cells was thought to protect the lens from inflammatory responses that would bring with them the danger of causing vision impairing opacities. However, it has now been shown, as occurs in other immune privileged sites in the eye, that novel pathways exist by which immune cells come to associate with the lens to protect it, maintain its homeostasis, and function in its regenerative repair. Here we review the discoveries that have revealed there are both innate and adaptive immune system responses to lens, and that, like most other tissues, the lens harbors a population of resident immune cells, which are the sentinels of danger or injury to a tissue. While resident and recruited immune cells are essential elements of lens homeostasis and repair, they also become the agents of disease, particularly as progenitors of pro-fibrogenic myofibroblasts. There still remains much to learn about the function of lens-associated immune cells in protection, repair and disease, the knowledge of which will provide new tools for maintaining the core functions of the lens in the visual system.
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Affiliation(s)
- Janice L Walker
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - A Sue Menko
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
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Intraocular lenses as drug delivery devices. Int J Pharm 2021; 602:120613. [PMID: 33865952 DOI: 10.1016/j.ijpharm.2021.120613] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 12/14/2022]
Abstract
Cataract surgery is one of the most common and safe surgical procedures nowadays. However, it is not free of risks as endophthalmitis, ocular inflammation and posterior capsule opacification (PCO) can appear as post-surgery complications. The usual eye drop therapy used as prophylaxis for the former two complications has limited bioavailability. In turn, the prevention of PCO involves an adequate surgical technique and a careful choice of intraocular lens (IOL) design and material. Also, different drugs have been tested to reduce incidence of PCO, but no prophylaxis demonstrated to be completely effective. In the past few years, IOLs have been proposed as drug delivery devices to replace or/assist the usual eye drop therapy in the post-operatory period. The great advantage of drug loaded IOLs would be to ensure a continuous drug delivery, independent of patient's compliance without requiring any further action besides IOL implantation. The biggest challenge of drug loaded IOLs production is to achieve a controlled and extended release that meet therapeutic needs without inducing toxicity to the surrounding ocular tissues or affecting the physical properties of the lens. This review starts by addressing the possible complications after cataract surgery, as well as the most commonly adopted prophylaxis for each of them. The various types of IOLs are described and their main advantages/disadvantages are discussed. The different strategies pursued to incorporate drugs into the IOLs and control their release, which include soaking the IOL in the drugs solution, supercritical impregnation, surface modifications, and attachment of drug reservoirs to the IOL, among others, are reported. For each strategy, a summary of the publications is presented, which includes the target complication, the types and amounts of released drugs and the IOL materials. A brief description of each individual study is given afterwards. Optimization of drug loaded IOLs through mathematical modelling and possible issues raised by their sterilization are also tackled. At the end, the future commercialization of drug loaded IOLs is commented.
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Filipe HP, Bozukova D, Pimenta A, Vieira AP, Oliveira AS, Galante R, Topete A, Masson M, Alves P, Coimbra P, Gil MH, Guiomar AJ, Mata J, Colaço R, Saramago B, Werner L, Mamalis N, Serro AP. Moxifloxacin-loaded acrylic intraocular lenses: In vitro and in vivo performance. J Cataract Refract Surg 2021; 45:1808-1817. [PMID: 31856994 DOI: 10.1016/j.jcrs.2019.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the possibility of using acrylic intraocular lenses (IOLs) to ensure controlled and sustained release of moxifloxacin, an antibiotic commonly used for endophthalmitis prophylaxis after cataract surgery. SETTING Academic, industrial, and clinical partners from Portugal, Belgium, Iceland, and the United States. DESIGN Experimental study. METHODS The physical properties of IOLs loaded with moxifloxacin by soaking were characterized. In vitro drug-release studies were performed under hydrodynamic conditions similar to those of the eye, and the activity of the released drug was tested. In vitro cytotoxicity was evaluated, and the in vivo efficacy of the devices was assessed through rabbit experiments in which the effects of topical moxifloxacin drops (control) and moxifloxacin-loaded IOLs were compared. RESULTS The presence of moxifloxacin in the IOLs had little effect on the evaluated physical properties and did not induce cytotoxicity. In vitro drug release experiments showed that the IOLs provided controlled release of moxifloxacin for approximately 2 weeks. The drug remained active against the tested microorganisms during that period. Moxifloxacin-loaded IOLs and the control treatment induced similar in vivo behavior in terms of inflammatory reactions, capsular bag opacification scores, and uveal and capsule biocompatibility. The drug concentration in the aqueous humor after 1 week was similar in both groups; however, the concentration with the loaded IOLs was less variable. CONCLUSION The moxifloxacin-loaded IOLs released the drug in a controlled manner, providing therapeutic levels.
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Affiliation(s)
- Helena P Filipe
- Hospital das Forças Armadas, Polo de Lisboa-EMGFA, Lisboa, Portugal
| | | | - Andreia Pimenta
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal; Departamento de Engenharia Mecânica, Instituto Superior Técnico, Universidade de Lisboa, Portugal; IDMEC, Instituto de Engenharia Mecânica Instituto Superior Técnicon, Universidade de Lisboa, Portugal
| | - Ana Paula Vieira
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Portugal
| | - Andreia Sofia Oliveira
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal; Departamento de Engenharia Mecânica, Instituto Superior Técnico, Universidade de Lisboa, Portugal; IDMEC, Instituto de Engenharia Mecânica Instituto Superior Técnicon, Universidade de Lisboa, Portugal
| | - Raquel Galante
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal; CIIEM, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Caparica, Portugal
| | - Ana Topete
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal; CIIEM, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Caparica, Portugal
| | - Már Masson
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavík
| | - Patrícia Alves
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Portugal
| | - Patrícia Coimbra
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Portugal
| | - M Helena Gil
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Portugal
| | - A Jorge Guiomar
- CIEPQPF, Departamento de Ciências da Vida, Universidade de Coimbra, Portugal
| | - José Mata
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Rogério Colaço
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal; Departamento de Engenharia Mecânica, Instituto Superior Técnico, Universidade de Lisboa, Portugal; IDMEC, Instituto de Engenharia Mecânica Instituto Superior Técnicon, Universidade de Lisboa, Portugal
| | - Benilde Saramago
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Liliana Werner
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Nick Mamalis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Ana Paula Serro
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Portugal; CIIEM, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Caparica, Portugal.
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Mylona I, Tsinopoulos I. A Critical Appraisal of New Developments in Intraocular Lens Modifications and Drug Delivery Systems for the Prevention of Cataract Surgery Complications. Pharmaceuticals (Basel) 2020; 13:E448. [PMID: 33302370 PMCID: PMC7762578 DOI: 10.3390/ph13120448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/13/2022] Open
Abstract
Cataract surgery is the commonest ophthalmic surgery worldwide. The replacement of the diseased lens with a synthetic one (intraocular lens-IOL) remains the treatment of choice, despite its potential complications that include infection, inflammation and posterior capsule opacification. The potential for drug delivery via the IOL has been researched extensively over a period of twenty-five years, yet there is very limited progress in transferring the findings from research to everyday practice. The objective of this review is to assess the progress made in the field of IOL lens modifications and drug delivery systems over the past five years. Thirty-six studies that were conducted during the past five years were identified and deemed suitable for inclusion. They were grouped in three broad categories, studies that described new methods for loading a drug onto the IOL, assessment of the effects of drugs that were loaded to the IOL and studies that assessed the effects of non-pharmaceutical modifications of IOLs. While considerable progress is continually being made with regard to methods and materials, there is still little capitalization upon these research studies, with no commercially available IOL-based drug delivery system being available. Close cooperation between researchers in basic sciences (chemistry, physics, materials science and pharmacy), clinical researchers, IOL manufacturers and the pharmaceutical industry is an important prerequisite for further development.
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Affiliation(s)
- Ioanna Mylona
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, 564 29 Thessaloniki, Greece;
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Multi-region finite element modelling of drug release from hydrogel based ophthalmic lenses. Math Biosci 2020; 331:108497. [PMID: 33098846 DOI: 10.1016/j.mbs.2020.108497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022]
Abstract
Understanding the way in which drug is released from drug carrying hydrogel based ophthalmic lenses aids in the development of efficient ophthalmic drug delivery. Various solute-polymer interactions affect solute diffusion within hydrogels as well as hydrogel-bulk partitioning. Additionally, surface modifications or coatings may add to resistance of mass transfer across the hydrogel interface. It is necessary to consider both interfacial resistances as well as the appropriate driving force when characterizing interface flux. Such a driving force is induced by a difference in concentration which deviates from equilibrium conditions. We present a Galerkin finite element approach for solute transport in hydrogels which accounts for diffusion within the gel, storage effects due to polymer-solute interaction, as well as partitioning and mass transfer resistance effects at the interface. The approach is formulated using a rotational symmetric model to account for realistic geometry. We show that although the resulting global system is not symmetric in the case of partitioning, it is similar to a symmetric negative semidefinite system. Thus, it has non-positive real eigenvalues and is coercive, ensuring the validity of the finite element formulation as well as the numerical stability of the implicit backward Euler time integration method employed. Two models demonstrating this approach are presented and verified with release experimental data. The first is the release of moxifloxacin from intraocular lenses (IOLs) plasma grafted with different polyacrylates. The second accounts for both loading as well as the release of diclofenac from disc shaped IOL material loaded for varied time periods and temperature.
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8
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Xiang Y, Zou M, Zhang Y, Jin R, Nie Y. Drug-loaded and Blue-ray Filtered Hydrogel as a Potential Intraocular Lens for Cataract Treatment. Pharm Nanotechnol 2020; 8:302-312. [PMID: 32167435 DOI: 10.2174/2211738508666200313144112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/21/2020] [Accepted: 02/25/2020] [Indexed: 02/08/2023]
Abstract
Background:
Indomethacin (IND) is a class of non-steroidal, anti-inflammatory
drugs, which is used to treat various kinds of ocular inflammation, and has been reported to
prevent posterior capsule opacification (PCO) by inhibiting the mitosis and collagen synthesis
of human lens epithelial cells (LECs). In addition, the specific absorption spectrum of indomethacin
shows the effect of absorbing short-wavelength blue-violet light.
Objective:
We prepared an indomethacin-loaded hydrogel as a potential intraocular lens (IOLs)
material to prevent endophthalmitis, PCO and filter harmful blue light.
Methods:
Indomethacin prodrugs (HEMA-IND) (HI) were prepared by esterification of indomethacin
and 2-hydroxyethyl methacrylate (HEMA), and poly (HEMA-co-MAA-co-MMA-co-
HI) (HAMI) hydrogels were prepared by free-radical polymerization of 2-hydroxyethyl methacrylate
(HEMA), methyl methacrylate (MMA), methacrylic acid (MAA) and HI. The physical
and chemical properties of obtained hydrogel were detected, including optical, morphology,
thermomechanical and surface properties, equilibrium water content, drug release behaviors and
cytotoxicity.
Results:
HAMI hydrogels can filter harmful short-wavelength blue light and show other necessary
properties like visible light transparency, glass transition temperatures, mechanical
strength, and biocompatibility for making intraocular lenses. Meanwhile, MAA increases the
hydrophilicity of the hydrogels, resulting in a lower water contact angle and controllable drug
release from the hydrogels.
Conclusion:
In summary, HAMI hydrogels show a great potential as IOL biomaterials that can
maintain the sustained release of indomethacin and filter harmful blue light after cataract surgery.
Lay Summary:
People with cataract surgery can be at high risk of postoperative complications,
such as PCO and postoperative endophthalmitis. Moreover, early IOLs allowed all ultraviolet
(UV) and visible light to pass through retina without restriction, thus to damage the retina and
the retinal pigment epithelium, which may lead to retinopathy and age-related macular degeneration
(AMD). Herein, we sought to design and prepare a kind of IOLs loaded with indomethacin
to mitigate those postoperative complications and filter harmful blue light to improve the
treatment prognosis.
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Affiliation(s)
- Yang Xiang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Mengwei Zou
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Ying Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Rongrong Jin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Yu Nie
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
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Surface modification of an intraocular lens material by plasma-assisted grafting with 2-hydroxyethyl methacrylate (HEMA), for controlled release of moxifloxacin. Eur J Pharm Biopharm 2017; 120:52-62. [DOI: 10.1016/j.ejpb.2017.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/13/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
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Pimenta AFR, Vieira AP, Colaço R, Saramago B, Gil MH, Coimbra P, Alves P, Bozukova D, Correia TR, Correia IJ, Guiomar AJ, Serro AP. Controlled release of moxifloxacin from intraocular lenses modified by Ar plasma-assisted grafting with AMPS or SBMA: An in vitro study. Colloids Surf B Biointerfaces 2017; 156:95-103. [PMID: 28531880 DOI: 10.1016/j.colsurfb.2017.04.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/03/2017] [Accepted: 04/29/2017] [Indexed: 11/30/2022]
Abstract
Intraocular lenses (IOLs) present an alternative for extended, local drug delivery in the prevention of post-operative acute endophthalmitis. In the present work, we modified the surface of a hydrophilic acrylic material, used for manufacturing of IOLs, through plasma-assisted grafting copolymerization of 2-acrylamido-2-methylpropane sulfonic acid (AMPS) or [2-(methacryloyloxy)ethyl]dimethyl-(3-sulfopropyl)ammonium hydroxide (SBMA), with the aim of achieving a controlled and effective drug release. The material was loaded with moxifloxacin (MFX), a commonly used antibiotic for endophthalmitis prevention. The characterization of the modified material showed that relevant properties, like swelling capacity, wettability, refractive index and transmittance, were not affected by the surface modification. Concerning the drug release profiles, the most promising result was obtained when AMPS grafting was done in the presence of MFX. This modification led to a higher amount of drug being released for a longer period of time, which is a requirement for the prevention of endophthalmitis. The material was found to be non-cytotoxic for rabbit corneal endothelial cells. In a second step, prototype IOLs were modified with AMPS and loaded with MFX as previously and, after sterilization and storage (30days), they were tested under dynamic conditions, in a microfluidic cell with volume and renovation rate similar to the eye aqueous humour. MFX solutions collected in this assay were tested against Staphylococcus aureus and Staphylococcus epidermidis and the released antibiotic proved to be effective against both bacteria until the 12th day of release.
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Affiliation(s)
- A F R Pimenta
- CQE, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal; IDMEC, Departamento de Engenharia Mecânica, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - A P Vieira
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Coimbra, Portugal
| | - R Colaço
- IDMEC, Departamento de Engenharia Mecânica, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - B Saramago
- CQE, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - M H Gil
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Coimbra, Portugal
| | - P Coimbra
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Coimbra, Portugal
| | - P Alves
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Coimbra, Portugal
| | | | - T R Correia
- CICS, Departamento de Ciências Médicas, Universidade da Beira Interior, Covilhã, Portugal
| | - I J Correia
- CICS, Departamento de Ciências Médicas, Universidade da Beira Interior, Covilhã, Portugal
| | - A J Guiomar
- CIEPQPF, Departamento de Engenharia Química, Universidade de Coimbra, Coimbra, Portugal; Departamento de Ciências da Vida, Universidade de Coimbra, Coimbra, Portugal
| | - A P Serro
- CQE, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal; CIIEM, Instituto Superior de Ciências da Saúde Egas Moniz, Caparica, Portugal.
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11
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Prevention of posterior capsular opacification. Exp Eye Res 2015; 136:100-15. [PMID: 25783492 DOI: 10.1016/j.exer.2015.03.011] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/04/2015] [Accepted: 03/13/2015] [Indexed: 01/22/2023]
Abstract
Posterior capsular opacification (PCO) is a common complication of cataract surgery. The development of PCO is due to a combination of the processes of proliferation, migration, and transdifferentiation of residual lens epithelial cells (LECs) on the lens capsule. In the past decades, various forms of PCO prevention have been examined, including adjustments of techniques and intraocular lens materials, pharmacological treatments, and prevention by interfering with biological processes in LECs. The only method so far that seems effective is the implantation of an intraocular lens with sharp edged optics to mechanically prevent PCO formation. In this review, current knowledge of the prevention of PCO will be described. We illustrate the biological pathways underlying PCO formation and the various approaches to interfere with the biological processes to prevent PCO. In this type of prevention, the use of nanotechnological advances can play a role.
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Brookshire HL, English RV, Nadelstein B, Weigt AK, Gift BW, Gilger BC. Efficacy of COX-2 inhibitors in controlling inflammation and capsular opacification after phacoemulsification cataract removal. Vet Ophthalmol 2014; 18:175-85. [PMID: 24636042 DOI: 10.1111/vop.12159] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the efficacy of 0.9% bromfenac (Xibrom™) or a celecoxib-impregnated intraocular lens (celecoxib-IOL) compared with 1% prednisolone acetate (PA) in controlling postoperative inflammation and posterior capsule opacification (PCO). ANIMAL STUDIED Fifty-nine dogs undergoing cataract extraction by phacoemulsification. PROCEDURE Bilateral patients received bromfenac or celecoxib-IOL plus PA in one eye, and PA in the contralateral eye. Unilateral patients received bromfenac or PA. Complete ophthalmic examination including tonometry, slit-lamp grading of flare and PCO, and digital image acquisition for masked PCO evaluation was performed within 24 h and 1, 4, 12, 24, and 56 weeks following surgery. RESULTS Celecoxib-IOL/PA-treated eyes had significantly less flare than PA-treated eyes, which had significantly less flare than bromfenac-treated eyes 24 h postoperatively. There was no significant difference in intraocular pressure (IOP) postoperatively, or at 1, 24, or 56 weeks. Celecoxib-IOL/PA-treated eyes had significantly lower IOP measurements than bromfenac and PA-treated eyes at 4 and 12 weeks. There was no significant difference in PCO level between groups using slit-lamp biomicroscopy at any time point. Masked evaluation of digital images revealed significantly less PCO in celecoxib-IOL/PA- vs. bromfenac-treated eyes at 4 weeks, and in bromfenac- vs. PA-treated eyes at 56 weeks. CONCLUSIONS Eyes receiving celecoxib-IOL/PA had better initial control of inflammation. Bromfenac was equally effective compared with PA in controlling inflammation. There was no association between COX-2 inhibitor administration and ocular hypertension. Celecoxib-IOL/PA-treated eyes showed better initial control of PCO (up to 12 weeks), while eyes receiving bromfenac had better long-term control of PCO (56 weeks).
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Abstract
PURPOSE OF REVIEW To describe the development and use of intraocular lenses (IOLs) as drug delivery systems and to review the current literature on their application and efficacy. RECENT FINDINGS Many drugs have been loaded onto IOLs by coating or by attachment in a separate reservoir. With incorporation of polymeric materials either as a coating or by attachment as a separate reservoir, it is possible to achieve a sustained and controlled release of drugs. Experimental evidence in animal models has shown that IOL drug delivery systems are effective in the prevention and treatment of inflammation, infection and posterior capsule opacification after cataract surgery. SUMMARY The use of IOLs as drug delivery reservoirs appears to show great promise. Although excellent results with therapeutic potential have been reported in experimental animal studies, further studies are needed to reach clinical use.
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Davis JL, Yi NY, Salmon JH, Charlton AN, Colitz CMH, Gilger BC. Sustained-release celecoxib from incubated acrylic intraocular lenses suppresses lens epithelial cell growth in an ex vivo model of posterior capsule opacity. J Ocul Pharmacol Ther 2012; 28:359-68. [PMID: 22372691 DOI: 10.1089/jop.2011.0196] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To determine whether celecoxib (CXB) can be released from incubated intraocular lenses (IOLs) sufficiently to inhibit lens epithelial cell (LEC) growth in an ex vivo model of posterior capsule opacification (PCO). MATERIALS LEC growth was evaluated for 14 days in canine lens capsules (LCs) that had been exposed to media containing 20 μM CXB for 1-5 days. After the incubation of hydrophilic and hydrophobic IOLs in CXB solution, the determination of the in vitro release of CXB from the IOLs was performed for up to 28 days. The incubated and nonincubated IOLs were evaluated in the ex vivo model of PCO, and the rate of LEC growth was evaluated over 28 days. RESULTS The treatment of LCs with 20 μM CXB for 4 and 5 days completely inhibited LEC growth. LEC repopulation did not occur after the removal of CXB. IOLs incubated in CXB for 24 h resulted in a sustained release of CXB in vitro at levels theoretically sufficient to inhibit PCO. LCs in the ex vivo model of PCO treated with acrylic IOLs incubated in CXB had significantly suppressed LEC ingrowth compared with untreated and IOL-only LCs. CONCLUSIONS A 4-day treatment of LCs with a concentration of 20 μM CXB may effectively prevent PCO. IOLs incubated in CXB for 24 h resulted in a sustained release of CXB in vitro at levels sufficient to inhibit LEC growth in the ex vivo model of PCO. Further studies are needed to determine whether CXB-incubated IOLs can effectively prevent the development of PCO in vivo.
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Affiliation(s)
- Jennifer L Davis
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
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Evereklioglu C, İlhan Ö. Do Non-Steroidal Anti-Inflammatory Drugs Delay Posterior Capsule Opacification After Phacoemulsification in Children? A Randomized, Prospective Controlled Trial. Curr Eye Res 2011; 36:1139-47. [PMID: 21978235 DOI: 10.3109/02713683.2011.609304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Division of Cataract and Refractive Surgery, Erciyes University Medical Faculty,
Kayseri, Turkey
| | - Özgür İlhan
- Department of Ophthalmology, Division of Cataract and Refractive Surgery, Erciyes University Medical Faculty,
Kayseri, Turkey
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16
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Indications for Lens Surgery/Indications for Application of Different Lens Surgery Techniques. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Liu H, Wu L, Fu S, Hou Y, Liu P, Cui H, Liu J, Xing L, Zhang X. Polylactide-glycoli acid and rapamycin coating intraocular lens prevent posterior capsular opacification in rabbit eyes. Graefes Arch Clin Exp Ophthalmol 2008; 247:801-7. [PMID: 19066932 DOI: 10.1007/s00417-008-1007-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 10/16/2008] [Accepted: 11/05/2008] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Posterior capsular opacification (PCO) is caused by the proliferation and migration of residual lens epithelium cells (LECs) after extracapsular cataract extraction (ECCE). Rapamcin (RAPA) is known to be a potent immunosuppressive drug with anti-inflammatory and anti-proliferative effects. The aim of this study was to investigate the safety and efficacy of rapamycin sustained release from modified intraocular lens (IOLs) in the prevention of PCO in rabbits. METHODS Three types of IOLs were used, including the original IOL without modification, IOL with polylactide-glycoli acid (PLGA) coating (PLGA-IOL), and RAPA-loaded PLGA-IOL (RAPA-PLGA-IOL). Sixty New Zealand albino rabbits undergoing phacoemulsification in left eyes were randomly and equally divided into three groups. Group A was implanted with the original IOLs, group B was implanted with the PLGA-IOLs, and group C was implanted with the RAPA-PLGA-IOLs. All of the 60 treated left eyes were examined by a slit-lamp microscope. The concentrations of RAPA in the aqueous humor and blood were determined by high-performance liquid chromatography (HPLC), indicating an vivo release of drug from the polymer carrier. Anterior segment tissue was histologically examined, and wet posterior capsules were weighed. Six months after intervention the PCO was graded. RESULTS The mean concentrations of RAPA in the aqueous humor from group C at 2 h, 1 days, 3 days, and 7 days after operation were 12.81 +/- 1.27 microg/ml, 14.57 +/- 0.99 microg/ml, 6.39 +/- 0.95 microg/ml, and 1.10 +/- 0.32 microg /ml respectively. The concentrations of RAPA in blood were undetectable. During the early days after the operation, the reactions of the anterior chamber from groups A and B were more severe than from group C. Our findings showed that the initial appearance of PCO in group C was much later than in the other two groups. The wet posterior capsules were weighed to be 0.3735 +/- 0.0943 g (group A), 0.3754 +/- 0.1093 g (group B), and 0.0432 +/- 0.0089 g (group C). Histological observation showed a similar phenomenon, that there was remarkably less accumulation of lens materials on the posterior capsules in group C than in the other two groups. CONCLUSION Our findings suggest that the designed RAPA-PLGA-IOL effectively prevented formation and development of PCO for a relatively long duration.
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Affiliation(s)
- Hongling Liu
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, Heilongjiang Province, People's Republic of China
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18
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Burger J, Kreutzer T, Alge CS, Strauss RW, Eibl K, Haritoglou C, Neubauer AS, Kampik A, Priglinger SG. Capsular tension ring–based in vitro capsule opacification model. J Cataract Refract Surg 2008; 34:1167-72. [DOI: 10.1016/j.jcrs.2008.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 03/29/2008] [Indexed: 10/21/2022]
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Rabsilber TM, Limberger IJ, Reuland AJ, Holzer MP, Auffarth GU. Long-term results of sealed capsule irrigation using distilled water to prevent posterior capsule opacification: a prospective clinical randomised trial. Br J Ophthalmol 2007; 91:912-5. [PMID: 17202203 PMCID: PMC1955631 DOI: 10.1136/bjo.2006.106468] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated long-term safety and efficacy of sealed capsule irrigation (SCI) during cataract surgery to prevent posterior capsule opacification (PCO). METHODS One eye of each of 17 patients (mean age: 70.1+/-9.7 years) who presented with bilateral cataracts was randomly chosen for SCI treatment. After phacoemulsification, the capsular bag was vacuum sealed with the PerfectCapsule device (Milvella) followed by SCI using distilled water for two minutes. No vacuum loss occurred during irrigation. Each patient's fellow eye served as a control. One hydrophilic acrylic intraocular lens model was implanted in all eyes. Five patients had to be excluded due to deep anterior chamber, small pupil or unilateral surgery. Follow-up examinations took place one day and one, three, six, 12 and 24 months after surgery. We evaluated safety parameters, anterior capsule (AC) overlapping and PCO. RESULTS Postoperatively, mean best corrected visual acuity, pachymetry, endothelial cell count, intraocular pressure, AC overlapping and PCO showed no statistically significant difference between SCI and the control group (p>0.05, Wilcoxon test). CONCLUSION SCI is a safe procedure and enables the specific pharmacological targeting of lens epithelial cells inside the capsular bag. Using distilled water, however, it is not possible to reduce PCO development significantly. Thus, alternative substances should be evaluated.
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Affiliation(s)
- Tanja M Rabsilber
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Germany
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20
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Inan UU, Bozkurt E, Oztürk F, Ermis S, Yaman S. Effect of diclofenac on prevention of posterior capsule opacification in human eyes. Can J Ophthalmol 2006; 41:624-9. [PMID: 17016538 DOI: 10.1016/s0008-4182(06)80036-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Diclofenac sodium has been demonstrated to be effective in preventing proliferation of lens epithelial cells both in vitro and in animal studies. The effects of diclofenac sodium given during the hydrodissection stage of phacoemulsification surgery on posterior capsule opacification (PCO) were investigated. METHODS Eleven patients undergoing phacoemulsification in both eyes were included. Patients with pseudoexfoliation, uveitis, and diabetes were excluded. Hydrodissection was done with only balanced salt solution in the first eyes. In the fellow eyes, 0.25 mg/mL diclofenac was given with hydrodissection. The same type of intraocular lens was implanted in both eyes of each patient. Follow-up was 21.8 (SD 3.5) months in the diclofenac group and 22.9 (3.7) months in the control group. PCO was evaluated clinically by dividing the posterior capsule into 24 zones. Mann-Whitney U test was used for statistical analysis. RESULTS There were no statistically significant differences of age, diameter of capsulorhexis, pupillary width, visual acuity, intraocular pressure, or length of follow-up between groups. PCO score was 0.49 (SD 0.21) in eyes receiving diclofenac and 0.73 (0.23) in the contralateral fellow eyes. The difference was not statistically significant (p=0.053). INTERPRETATION Diclofenac sodium given by hydrodissection in phacoemulsification decreased, but did not significantly prevent, the development of PCO.
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Affiliation(s)
- Umit Ubeyt Inan
- Department of Ophthalmology, Kocatepe University School of Medicine, Afyonkarahisar, and the Beyoğlu Research and Teaching Eye Hospital, Istanbul, Turkey
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21
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Symonds JG, Lovicu FJ, Chamberlain CG. Differing effects of dexamethasone and diclofenac on posterior capsule opacification-like changes in a rat lens explant model. Exp Eye Res 2006; 83:771-82. [PMID: 16713596 DOI: 10.1016/j.exer.2006.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 02/21/2006] [Accepted: 03/27/2006] [Indexed: 10/24/2022]
Abstract
Posterior capsular opacification (PCO) arises from lens cells that remain associated with the lens capsule after cataract surgery and subsequently become abnormal, proliferate and migrate into the visual pathway. In this study, a rat lens explant model was used to assess the effects of the prototype steroidal and non-steroidal anti-inflammatory drugs, dexamethasone (DEX) and diclofenac (DIC), on epithelial cells undergoing PCO-like changes. Such drugs are widely used at the time of cataract surgery. TGFbeta2 and FGF-2 were added sequentially and explants were cultured for up to 30 days, with or without addition of DEX or DIC at a clinically relevant concentration. Without DEX or DIC, explants became multilayered and cells tended to retract into PCO-like plaques. Inclusion of DEX, but not DIC, resulted in transient formation of needle-like cells, enhanced cell coverage, and the retention a monolayer of migratory cells surrounding PCO-like plaques. With or without drug addition, most cells became aberrant, as indicated by loss of Pax6 expression and the presence of PCO markers alpha-smooth muscle actin and type I collagen; however, DEX and DIC both strongly enhanced type I collagen accumulation. Furthermore, DEX enhanced cell coverage in explants treated with TGFbeta alone. Thus the behaviour of lens cells was significantly and differentially affected by the presence of DEX and DIC, highlighting the possibility that drugs used to control inflammation after cataract surgery, and the clinician's choice of drugs, may influence PCO development.
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Affiliation(s)
- Joel G Symonds
- Discipline of Anatomy and Histology and Institute for Biomedical Research, F13, University of Sydney, Sydney, NSW 2006, Australia
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22
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Fan DSP, Yip WWK, Yu CBO, Rao SK, Lam DSC. Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n8p564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
With the advent of modern surgical techniques, paediatric cataract has become much more manageable. Intraocular lens (IOL) implantation is the standard of care for patients over the age of 2 years. The use of IOL in young infants is still controversial. In addition, there are still unresolved issues, such as the minimum age at which IOL can be safely implanted, IOL power selection and IOL power calculation. The current trends in the management of the above challenges are discussed. Although numerous reports on the prevention and management of posterior capsule opacification have been published, there are ongoing intensive debates and research. Long-term postoperative complications like glaucoma and rhegmatogenous retinal detachment are problems that cannot be overemphasised and these issues are also reviewed.
Key words: Congenital cataract, Intraocular lens, Posterior capsule opacification
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Affiliation(s)
| | - Wilson WK Yip
- The Chinese University of Hong Kong, Kowloon, Hong Kong
| | | | | | - Dennis SC Lam
- The Chinese University of Hong Kong, Kowloon, Hong Kong
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Kim HC, Härtner S, Behe M, Behr TM, Hampp NA. Two-photon absorption-controlled multidose drug release: a novel approach for secondary cataract treatment. JOURNAL OF BIOMEDICAL OPTICS 2006; 11:34024. [PMID: 16822073 DOI: 10.1117/1.2209564] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Tens of millions of cataract surgeries are done every year and the number is increasing heavily. Posterior capsule opacification is the major postoperative complication with an incidence of 10 to 50% within 5 years, depending on the age of the patient. We present a novel approach for secondary cataract treatment in a noninvasive manner. Photochemically triggered drug release from a polymer enables repeated drug applications for cataract treatment years after implantation of the intraocular lens, just when needed. However, light in the visible spectral range must pass through the lens but must not induce drug release. We demonstrate that two-photon absorption photochemistry is a powerful tool to overcome this problem. With wavelengths in the visible regime, a photochemical reaction that requires energies in the UV is triggered. The high intensities needed for this process never occur in any lighting condition in daily lives, but may be easily obtained with focused laser beams routinely used in ophthalmology. The properties of the therapeutic system are specified and the function is demonstrated by in-vitro cell tests. Noninvasive multidose photochemically triggered drug release from implanted intraocular lenses carrying a drug depot may be a therapeutic as well as an economic choice to established treatments of secondary cataracts.
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Affiliation(s)
- Hee-Cheol Kim
- University of Marburg, Faculty of Chemistry, Germany
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24
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Abstract
AIM The aim of this study was to review the postoperative findings in the anterior segment after primary vitrectomy performed in combination with cataract surgery. PATIENTS AND METHOD In a retrospective analysis covering the period from August 2000 to March 2002, we identified 513 consecutive operations on the retina and vitreous body performed primarily to correct various retinal diseases in the ophthalmology department of the Ludwig Maximilian University in Munich. Concomitant cataracts present in all cases were also treated in the one session. Measurement parameters of postoperative irritation of the anterior chamber included anterior chamber cells, Tyndall effect, fibrin, intraocular pressure, and synechiae formation. Various influencing factors were compared to the measurement parameters in univariate analysis. RESULTS Correlations between some influencing factors and various measurement parameters were statistically significant in univariate analysis. This was not, however, the case for any of the factors in multivariate analysis. CONCLUSION Performance of the combined operation according to our protocol does not entail any single parameter that indicates a risk for increased postoperative irritation of the anterior chamber.
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Affiliation(s)
- A J Mueller
- Augenklinik, Ludwig-Maximilians-Universität, München
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25
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Zaczek A, Laurell CG, Zetterström C. Posterior capsule opacification after phacoemulsification in patients with postoperative steroidal and nonsteroidal treatment. J Cataract Refract Surg 2004; 30:316-20. [PMID: 15030818 DOI: 10.1016/j.jcrs.2003.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2002] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effect of dexamethasone, diclofenac, and a placebo given for 3 weeks after phacoemulsification and intraocular lens (IOL) implantation on the formation of posterior capsule opacification (PCO). SETTING St. Erik's Eye Hospital, Stockholm, Sweden. METHODS In a 2-year prospective randomized double-blind study, a laser flare meter was used to measure aqueous flare intensity preoperatively and 3 days, 2 weeks, and 2 years after phacoemulsification and IOL implantation. Posterior capsule opacification was evaluated 2 years postoperatively using retroillumination images taken with a Scheimpflug camera. The Evaluation of Posterior Capsule Opacification system was used to score the areas of PCO density. RESULTS The median rate of PCO 2 years after phacoemulsification was 0.72 (range 0.32 to 1.57) in the dexamethasone group, 0.78 (range 0.19 to 2.14) in the diclofenac group, and 0.70 (range 0.35 to 1.70) in the placebo group. The differences were not statistically significant (P>.05; Kruskal-Wallis analysis of variance, multiple comparisons). The rate of neodymium:YAG laser posterior capsulotomy during the 2 years after surgery was not statistically different between groups (P>.05, chi-square test). There was no correlation (Spearman rank coefficient) between laser flare measurements and PCO formation in any group during the study (P>.05). CONCLUSION Topical instillation of diclofenac, dexamethasone, or a placebo in the immediate period after phacoemulsification and IOL implantation did not seem to influence the formation of PCO 2 years after cataract surgery.
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Bhermi GS, Spalton DJ, El-Osta AAR, Marshall J. Failure of a discontinuous bend to prevent lens epithelial cell migration in vitro. J Cataract Refract Surg 2002; 28:1256-61. [PMID: 12106737 DOI: 10.1016/s0886-3350(02)01209-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the effect of substrate geometry (discontinuous bend) on lens epithelial cell (LEC) growth in vitro. SETTING Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS Culture wells with central depths of 0.4 mm, 1.0 mm, or 3.0 mm and a sharp square-edged profile (discontinuous bend) or a round-edged profile (continuous bend) were produced from a block of poly(methyl methacrylate). Freshly harvested bovine LECs were attached to the center of each well and cultured using standard techniques. Observations were made of whether LECs grew out of the wells and of the time required to do so. RESULTS Lens epithelial cells migrated out of all the wells. There was no significant difference in the rate at which they migrated out of round-edged and square-edged wells. CONCLUSIONS In vitro, a sharp discontinuous bend did not appear to induce contact inhibition of migrating LECs nor did it significantly hinder the rate at which LECs migrated. Therefore, a discontinuous bend in the lens capsule in isolation is unlikely to be responsible for the observed reduction in posterior capsule opacification associated with the use of square-edged IOLs.
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Affiliation(s)
- Gurpreet S Bhermi
- Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom
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27
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Barequet IS, Wygnanski-Jaffe T, Sachs D. Effect on Posterior capsule opacification of topical diclofenac sodium vs dexamethasone phosphate after cataract surgery. ACTA ACUST UNITED AC 2002. [DOI: 10.1007/s12009-002-0044-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Oztürk F, Kaynak S, Kurt E, Emiroğlu L, Ozer E, Ilker SS, Güler C. Prevention of posterior capsule opacification by intraoperative single-dose pharmacologic agents. J Cataract Refract Surg 2001; 27:1079-87. [PMID: 11489580 DOI: 10.1016/s0886-3350(00)00886-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine whether an intraoperative single dose of dexamethasone, diclofenac, ethylenediaminetetraacetic acid (EDTA), a combination of EDTA and RGD peptide (arginine-glycin-aspartic acid sequence), or mitomycin-C (MMC) is a pharmacological means of preventing or reducing the development of posterior capsule opacification (PCO). SETTING Department of Ophthalmology, Celal Bayar University, School of Medicine, Manisa, and Department of Pathology, Dokur Eylül University, School of Medicine, Izmir, Turkey. METHODS Fifty-four rabbits were randomly divided into 6 groups. Dexamethasone (4 mg/cc), diclofenac (2.5 mg/cc), EDTA (8 mg/cc), a combination of EDTA and RGD peptide (2.5 mg/cc), or MMC (0.04 mg/cc) was given, 0.1 cc by hydrodissection and 0.9 cc into the capsular bag after phacoemulsification. The sixth group served as a control group. After 3 months, the PCO was graded clinically and the proliferation of lens epithelial cells (LECs) was evaluated histologically. RESULTS The drugs were significantly effective in preventing PCO compared with the control (P <.005). Dexamethasone had a weaker effect than the other drugs. In histological analysis, although monolayer LECs in the dexamethasone and diclofenac groups were observed, there was no proliferative activity on the posterior capsules in the EDTA, EDTA+RGD, and MMC groups in contrast to the multilayer cells in the control. CONCLUSIONS Intraoperative single-dose application of EDTA, EDTA+RGD peptide combination, and MMC significantly prevented the development of PCO in rabbit eyes. Diclofenac was less effective but also reduced PCO. Although dexamethasone did not prevent the proliferation of LECs, it decreased PCO clinically.
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Abstract
Posterior capsule opacification (PCO) is still the most frequent complication of cataract surgery. A variety of studies has led to a better understanding of the pathogenesis of PCO, and strategies of molecular biology have produced new therapeutic options, such as immunological techniques or gene therapeutic approaches. Surgical strategies and intra-ocular lens-dependent factors also are capable to reduce the rate of PCO. In-the-bag implantation of intra-ocular lenses with a sharp optic edge seems to be effective in inhibiting equatorial lens epithelial cell migration to the center of the posterior capsule. Several PCO documentation systems have been developed that will lead to more exact and better comparable recording of PCO rates. In the year 2000, PCO or secondary cataract is still the most frequent complication after extracapsular cataract surgery. In a 1998 meta-analysis, PCO rates of 11.8% 1 year after extracapsular cataract surgery with intraocular lens implantation, 20.7% after 3 years, and 28.4 % after 5 years have been reported. For the United States, it has been estimated that the overall expenses for treatment of PCO are only exceeded by the costs for cataract treatment itself. In the past decade, a lot of experimental and clinical studies have been performed on this topic. They have led to 1) to a better understanding of the pathogenesis of the development of anterior and posterior capsule opacification; 2) more objective and better comparable systems of documentation and analysis of PCO; and a number of 3) surgical and 4) pharmaceutical strategies to prevent PCO.
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Affiliation(s)
- E Bertelmann
- Eye Department, Charité Campus Virchow Hospital, Humboldt University Berlin, Berlin, Germany.
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30
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31
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Wallentin N, Lundgren B, Lundberg C. Lack of correlation between intraocular inflammation and after-cataract formation in the rabbit eye. J Cataract Refract Surg 2000; 26:1389-97. [PMID: 11020625 DOI: 10.1016/s0886-3350(00)00307-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine whether an increased or reduced inflammatory response following cataract surgery influences the development of after-cataract. SETTING Department of Preclinical Ophthalmology, Pharmacia, Uppsala, Sweden. METHODS Rabbits that had had cataract surgery were given endotoxin, ovalbumin, dexamethasone, or diclofenac. Aqueous humor, leukocytes, and prostaglandin E(2) (PGE(2)) were analyzed, and the wet weight of the after-cataract was determined. RESULTS The wet weight of the after-cataract was unaffected by endotoxin and 67% lower in the eyes treated with ovalbumin than in the control eyes on day 56. Aqueous humor concentrations of leukocytes and PGE(2) were 94% and 87% lower in the group treated with dexamethasone than in the control group on day 7, and the concentration of PGE(2) was 98% lower in the diclofenac group; however, the wet weight of the after-cataract was unaffected by both treatments. CONCLUSION This study suggests that an increased inflammatory response does not increase the development of after-cataract and a reduction in the inflammatory response does not reduce the development of after-cataract.
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Affiliation(s)
- N Wallentin
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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32
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Abstract
The techniques and results of cataract surgery have changed dramatically during the past three decades. In the USA, we have moved from intracapsular cataract extraction as the preferred technique to almost exclusively extracapsular techniques. Smaller incisions have become the standard, with phacoemulsification now being the method of choice for most surgeons. Along with these advances have come improved intraocular lens materials and designs, especially well suited for use with smaller incisions. Phacoemulsification as a method to remove the cataractous lens was first proposed more than 20 years ago. Advances in techniques and equipment have led to a dramatic increase in the popularity of phacoemulsification with increased safety and efficiency. Viscoelastic agents have been developed synchronously with modern phacoemulsification techniques, playing an integral role in the success of this new technology. Improved surgical techniques for removing the anterior lens capsule have decreased the incidence of both intraoperative and postoperative capsular complications. Nucleus removal, formerly performed primarily in the anterior chamber, is now performed in the posterior chamber, decreasing damage to the corneal endothelium. Improved wound construction allows many wounds to be left unsutured, and smaller wounds allow shorter recovery time and greater intraoperative control and safety. Intraocular lenses can have smaller optic sizes and still maintain accurate centration. Foldable intraocular lenses can take advantage of the smaller incision, even further shortening the time to visual recovery. Continual evolution of this technology promises to further improve patient outcomes after cataract surgery.
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Abstract
This is a review of the current status of clinical research on the prevention of posterior capsular opacification (PCO), which is now the commonest complication of cataract surgery occurring in up to 50% of patients by 2 to 3 years after the operation. PCO is caused by lens epithelial cells retained in the capsular bag following surgery which then proliferate, migrate and transform to myofibroblasts. Interest in the prevention of PCO has centred around surgical technique, pharmacological methods to remove or destroy lens epithelial cells and changes in intraocular lens material and design. Changes in surgical technique have little effect in prevention of PCO although a capsulorhexis size which lies on the optic diameter appears to be beneficial. Many different cytotoxic drugs and pharmacological agents have been used experimentally to prevent PCO but the problem has limited damage only to lens epithelial cells. So far, no method has been shown to be safe for clinical use. Current interest is centred once again on the intraocular lens itself, particularly the material that it is made from and changes in its edge profile.
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Affiliation(s)
- D J Spalton
- Eye Department, St. Thomas' Hospital, London, UK
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34
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Abstract
Posterior capsule opacification (PCO) is the most frequent complication associated with decreased vision after cataract surgery. Previous methods of preventing PCO have not proven to be practical, effective, and safe for routine clinical procedure, but some novel concepts and methods have recently been developed. This 2-part review looks at clinical and experimental investigations of PCO, focusing on developments since 1992. Clinical aspects will be presented in a later issue. This paper addresses (1) in vitro models for PCO research; (2) pathophysiology and molecular biology of lens epithelial cells (LECs); (3) prevention of PCO. Of special interest are methods of culturing human LECs obtained by capsulotomy during cataract surgery, including those obtained with an intact capsular bag, to provide an in vitro model for investigating the pathophysiology of LECs; the effect of a sharp bend in the lens capsule that induces contact inhibition of migrating LECs; more specific inhibition of migrating LECs using an immunotoxin, b-FGF-saporin, or EDTA and RGD-peptides.
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Affiliation(s)
- O Nishi
- Nishi Eye Hospital, Osaka, Japan
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35
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Nishi O, Nishi K, Mano C, Ichihara M, Honda T. Lens refilling with injectable silicone in rabbit eyes. J Cataract Refract Surg 1998; 24:975-82. [PMID: 9682121 DOI: 10.1016/s0886-3350(98)80054-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the technique of refilling the lens capsule with injectable silicone and assess the postoperative findings. SETTING Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS The lens capsules in the eyes of 16 rabbits weighing 1.5 to 2.0 kg were refilled with 0.2 mL of silicone polymer (about 66% bag volume) after endocapsular phacoemulsification through an upper minicircular capsulorhexis 1.5 to 1.8 mm in diameter. The capsule opening was sealed with a silicone plug to prevent leakage of the injected silicone. Main outcome measures were surgical success rate, inflammation, endothelial cell loss, refractive change after pilocarpine 4% instillation, and capsule opacification. RESULTS The lens capsule could be refilled in 10 eyes. The failures were caused by capsule rupture during phacoemulsification (n = 3) and profuse leakage of the injected silicone. Silicone that leaked minimally during surgery was easily washed away. Silicone that leaked and polymerized in the anterior chamber postoperatively (n = 3) was easily removed by surgery the following day. Mean endothelial cell loss was 10.2% 1 month after surgery. Aqueous flare intensity was significantly lower on days 2 and 4 than after conventional intraocular lens implantation in a control group. The respective mean preoperative and postoperative refractions were 0.7 diopters (D) +/- 1.0 (SD) and 19.1 +/- 1.0 D and the mean change (difference between the refractions before and after topical application of pilocarpine 4%), -0.4 +/- 0.6 and 1.1 +/- 0.4 D (P < .01). Posterior capsule opacification (PCO) was noted after 3 weeks in all eyes. CONCLUSIONS Lens capsule refilling and capsular plug use to prevent silicone leakage was shown to be feasible and avoided complications caused by leakage. Refractive changes suggest that the procedure could yield accommodation in primates> Although neodymium: YAG laser capsulotomy did not cause herniation of the injected silicone, PCO prevention is an essential issue in lens refilling because the capsulotomy may annul the attained accommodation.
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Affiliation(s)
- O Nishi
- Nishi Eye Hospital, Osaka, Japan
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Nishi O, Nishi K, Morita T, Tada Y, Shirasawa E, Sakanishi K. Effect of intraocular sustained release of indomethacin on postoperative inflammation and posterior capsule opacification. J Cataract Refract Surg 1996; 22 Suppl 1:806-10. [PMID: 9279676 DOI: 10.1016/s0886-3350(96)80166-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess whether the sustained release of indomethacin significantly reduces postoperative inflammation and posterior capsule opacification (PCO). SETTING Nishi Eye Hospital, Jinshikai Medical Foundation, Osaka, Japan. METHODS A 7 mm diameter, 1 mm thick polylactic-polyglycolic acid disk containing 7 mg of indomethacin was implanted in five rabbit eyes after continuous curvilinear capsulorhexis and phacoemulsification. The disk and an IOL placed above it were implanted in the capsular bag. The contralateral eyes, which served as controls, received a disk without indomethacin and the same type IOL in the same manner. RESULTS The indomethacin was fully released within 3 weeks in vitro, a release rate of about 14 micrograms/h. Postoperatively, aqueous flare intensity was significantly lower at days 2, 3, and 4 and at weeks 1, 2, and 3. Prostaglandin E2 was not detectable in the aqueous humor of the indomethacin-treated eyes on day 3 and at week 4. In the control eyes, mean concentration was 491 pg/ml +/- 54 (SD) and 990 +/- 243 pg/ml, respectively. Histopathological examination showed no significant decrease in PCO. CONCLUSION Although sustained release of indomethacin significantly decreased inflammation, it did not reduce PCO.
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Affiliation(s)
- O Nishi
- Nishi Eye Hospital, Osaka, Japan
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Nishi O, Nishi K, Saitoh I, Sakanishi K. Inhibition of migrating lens epithelial cells by sustained release of ethylenediaminetetraacetic acid. J Cataract Refract Surg 1996; 22 Suppl 1:863-8. [PMID: 9279686 DOI: 10.1016/s0886-3350(96)80176-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the effect of the sustained-release of ethylenediaminetetraacetic acid (EDTA) chelating Ca++ on lens epithelial cell (LEC) migration. SETTING Nishi Eye Hospital, Jinshikai Medical Foundation, Osaka, Japan. METHODS Polylactic-glycolic acid disks containing 10% EDTA were placed in saline solution for about 2 weeks in vitro. About 60% (7 micrograms/hour) of the EDTA was released during that time. The disks with a posterior chamber intraocular lens placed above were implanted in the capsular bag in five rabbit eyes after continuous curvilinear capsulorhexis and phacoemulsification. A disk without EDTA and the same lens type were placed in the bag in the contralateral eyes, which served as controls. RESULTS After 2 to 3 months, opacification in the central posterior capsule was significantly reduced in all eyes that received the disk with EDTA. CONCLUSION The deprivation of Ca++ disrupted interaction between the posterior capsule and migrating LECs by inactivating the adhesion molecule integrin synthesized by LECs, significantly reducing LEC migration onto the posterior capsule.
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Affiliation(s)
- O Nishi
- Nishi Eye Hospital, Osaka, Japan
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