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Zhang Y, Du Y, Wang A, Zhou X, Lu Y, Zhu X. Outcomes of Cataract Surgery in Eyes With Axial Length > 33 mm. Am J Ophthalmol 2024; 265:137-146. [PMID: 38701876 DOI: 10.1016/j.ajo.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE To evaluate the visual outcomes and perioperative complications for cataract surgery in eyes with axial length (AL) >33.0 mm. DESIGN Prospective clinical cohort study. METHODS One hundred twenty-two eyes with moderate high myopia (26.0 mm ≤ AL < 28.0 mm, control group), and 118 eyes with extreme high myopia (AL > 33.0 mm, EHM group) were followed up after cataract surgery (1 week and 1 year post-op). Myopic maculopathy grading according to ATN system, best-corrected visual acuity (BCVA), and complications were compared. RESULTS Postoperatively, BCVA in the EHM group improved significantly at both visits (both P < .001), despite being worse than that of the control group (both P < .05). The EHM group exhibited greater hyperopic refractive errors (P < .001), which were found to be associated with more severe T grade, longer AL, poorer second follow-up BCVA, and smaller anterior capsular opening (ACO) area. A higher incidence of retinal detachment and a more constricted ACO were observed in the EHM group (P = .030 and <.001, respectively), with the latter being significantly associated with longer AL and the absence of capsular tension ring (both P < .05). No difference in BCVA was found between the aphakic and pseudophakic eyes in the EHM group at both visits (both P > .05). CONCLUSION Cataract surgery improves vision of eyes with AL >33 mm, yet the increased risk of perioperative complications requires attention. Leaving these eyes aphakic might be effective and safe in the long term.
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Affiliation(s)
- Yinglei Zhang
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Yu Du
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Anjian Wang
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital (A.W.), Nagoya, Aichi, Japan
| | - Xingtao Zhou
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Yi Lu
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China
| | - Xiangjia Zhu
- Eye Institute, Eye and Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; NHC Key Laboratory of Myopia (Fudan University) (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China; Shanghai Key Laboratory of Visual Impairment and Restoration (Y.Z., Y.D., X.Z., Y.L., X.Z.), Shanghai, People's Republic of China.
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Comparing the outcomes of YAG laser anterior capsulotomies performed by an advanced nurse practitioner to ophthalmologists in the management of anterior capsular contraction syndrome. J Am Assoc Nurse Pract 2022; 34:1133-1138. [DOI: 10.1097/jxx.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
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Yang S, Jiang H, Nie K, Feng L, Fan W. Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules. BMC Ophthalmol 2021; 21:19. [PMID: 33413210 PMCID: PMC7792360 DOI: 10.1186/s12886-020-01772-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia. METHODS A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia. RESULTS Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. CONCLUSION CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-INR-17011217 , date of registration April 22, 2017, prospectively registered.
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Affiliation(s)
- Shangfei Yang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hui Jiang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Kailai Nie
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Liwen Feng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wei Fan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Vanags J, Erts R, Laganovska G. Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support. ACTA ACUST UNITED AC 2021; 57:medicina57010035. [PMID: 33401604 PMCID: PMC7823552 DOI: 10.3390/medicina57010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Abstract
Background and Objectives: To evaluate anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation after cataract surgery in patients with weak or partially absent zonular support and assess methods of reducing these complications. Materials and Methods: For this prospective study, we enlisted cataract surgery patients in our hospital with preoperative diagnoses of weak zonules. All patients received phacoemulsification surgery with implantation of a hydrophobic acrylic IOL and capsular tension ring (CTR). ACO reductions were measured for six months after enrolment. Data on late IOL dislocations were collected five years after enrolment of the last patient. Results: Fifty-three patients were enrolled from 2011 to 2015. Over the six-month active follow-up period, ACO area reduction was 23% in patients receiving CTRs of 11 mm diameter and 8% for patients with CTRs of 12 mm, with an overall mean of 15% reduction. Five years after the last patient was enrolled, seven patients (13%) had experienced late IOL-CTR-capsular bag dislocation. For these patients, the mean ACO reduction in the first six months of follow-up was 33%, including for those who had received neodymium-doped yttrium aluminum garnet (Nd: YAG) anterior capsulotomies. Conclusion: Use of hydrophobic acrylic lenses and CTR reduces ACO contraction, with rates comparable to those after cataract surgery without ocular comorbidity. Our patients experienced a relatively high rate of late IOL-CTR-capsular bag dislocation. However, dislocated complexes were easily repositioned and few patients required IOL exchange. Frequent visits are warranted to promptly detect late complications of cataract surgery in patients with weak zonular support.
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Affiliation(s)
- Juris Vanags
- Clinic of Ophthalmology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia;
- Department of Ophthalmology, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence: ; Tel.: +37-12-6068-123; Fax: +37-16-7069-549
| | - Renārs Erts
- Faculty of Medicine, University of Latvia, LV-1079 Riga, Latvia;
| | - Guna Laganovska
- Clinic of Ophthalmology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia;
- Department of Ophthalmology, Riga Stradins University, LV-1007 Riga, Latvia
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Zhang BN, Wu X, Dai Y, Qi B, Fan C, Huang Y. Proteomic analysis of aqueous humor from cataract patients with retinitis pigmentosa. J Cell Physiol 2020; 236:2659-2668. [PMID: 32869287 DOI: 10.1002/jcp.30031] [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: 06/08/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
A postcataract surgery complication in patients with retinitis pigmentosa (RP) is lens capsular contraction. To identify potential proteins contributing to this phenomenon, high-performance liquid chromatography/mass spectrometry-based proteomic analysis was conducted with aqueous humor samples collected from 11 patients who underwent cataract surgeries, with four patients diagnosed as RP and cataract (RP group) and the other seven with only senile cataract group. The upregulated proteins in the RP group were enriched in wound response, while downregulated proteins were enriched in cell adhesion and lens crystallins. Receptors of two dramatically upregulated proteins tenascin-C (TNC) and serotransferrin were found expressed in human lens epithelial cells (HLEs). TNC can promote primary HLEs proliferation and cell line HLE-B3 migration. This study indicates aqueous humor proteomic analysis serves as an effective way to unveil the pathogenesis of RP complications. TNC is a potential target of stimulating HLEs proliferation in RP concomitant cataract patients that worth further research.
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Affiliation(s)
- Bi Ning Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaoming Wu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Yunhai Dai
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Benxiang Qi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Caixia Fan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Yusen Huang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
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Effects of Residual Anterior Lens Epithelial Cell Removal on Axial Position of Intraocular Lens after Cataract Surgery. J Ophthalmol 2018; 2018:9704892. [PMID: 30210870 PMCID: PMC6120298 DOI: 10.1155/2018/9704892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/14/2018] [Accepted: 07/22/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to assess the effects of residual anterior lens epithelial cell (LEC) removal by anterior capsule polishing on the effective lens position (ELP) and axial position stability of the intraocular lens (IOL) after cataract surgery via postoperative measurement of the anterior chamber depth. Methods We enrolled 30 patients (60 eyes) requiring bilateral cataract surgery for age-related cataracts. Meticulous anterior capsule polishing and removal of residual LECs under the capsule were performed using a bimanual irrigation/aspiration system for one randomly selected eye in each patient. The eye without polishing served as a control. ELP was measured at five different time points after surgery, and axial shifting of IOL was determined at each visit by comparison with the position at the previous visit. Results The polishing and control groups showed significant differences with regard to the mean ELP at 1 (3.40 ± 0.29 versus 3.53 ± 0.32 mm, resp.; p=0.026) and 2 months (3.42 ± 0.32 versus 3.61 ± 0.35 mm, resp.; p=0.001) after surgery, the mean standard deviation for the five ELP values (0.087 ± 0.093 versus 0.159 ± 0.138 mm, p=0.001), and the root mean square of the change in ELP at each follow-up visit (0.124 ± 0.034 versus 0.246 ± 0.038 mm, p=0.047). The eyes in the control group exhibited a tendency for backward IOL movement with a concurrent hyperopic shift in refraction of approximately 0.2 diopter at 2 months after surgery. Conclusion Our findings suggest that residual anterior LEC polishing enhances the axial position stability of IOLs, without any complications, after cataract surgery.
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Choi M, Lazo MZ, Kang M, Lee J, Joo CK. Effect of number and position of intraocular lens haptics on anterior capsule contraction: a randomized, prospective trial. BMC Ophthalmol 2018; 18:78. [PMID: 29558909 PMCID: PMC5859398 DOI: 10.1186/s12886-018-0742-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to evaluate the degree of anterior capsule contraction (capsulorhexis contraction) with three different single-piece, hydrophilic acrylic intraocular lenses (IOLs). METHODS Patients were prospectively randomized to be implanted with one of three types of IOLs during cataract surgery: the Ophtec Precizon (IOL A), the Lucid Korea Microflex (IOL B), and the Carl Zeiss Asphina (IOL C). One week, 2 weeks, and 6 months after surgery, the area of the anterior capsule opening was measured using digital retro-illumination images after dilation of the pupil. The data were then evaluated using POCOman software. RESULTS The study included 236 eyes of 202 patients. The area of the anterior capsule opening reduced by 3.53 ± 3.31 mm (17.06% ± 15.99%) between 1 week and 2 months post-operatively in the IOL A group, by 0.62 ± 1.32 mm (2.87% ± 6.03%) in the IOL B group, and by 1.09 ± 1.53 mm (4.72% ± 6.10%) in the IOL C group. The IOL B group showed minimal anterior capsule contraction 2 months after surgery (p < 0.001). CONCLUSIONS IOLs with a four-plate haptic design (IOL B) showed more anterior capsular stability than those with a two-loop plate haptic (IOL A) or two-plate haptic (IOL C) design. The number and position of haptics in a capsular bag may affect anterior capsule contraction. We assume that supporting the zonules evenly may play a role in anterior capsular stability. TRIAL REGISTRATION Current Controlled Trials ISRCTN76566080 , Retrospectively registered (Date of registration: 14 Feb 2018).
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Affiliation(s)
- Mihyun Choi
- Department of Ophthalmology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Marjorie Z Lazo
- Catholic Institute for Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Minji Kang
- Department of Ophthalmology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jeehye Lee
- Department of Ophthalmology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Choun-Ki Joo
- Department of Ophthalmology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Biomaterial Influence on Intraocular Lens Performance: An Overview. J Ophthalmol 2018; 2018:2687385. [PMID: 29736282 PMCID: PMC5874989 DOI: 10.1155/2018/2687385] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/08/2017] [Accepted: 01/02/2018] [Indexed: 11/18/2022] Open
Abstract
There is strong evidence that the IOL material is the factor having the greatest impact on posterior capsule opacification (PCO), anterior capsule opacification (ACO) development, and glistening formation after cataract surgery, even though there are other IOL features—such as haptic material and design and edge and optic design—that also have some influence. We reviewed the published literature describing the adverse events that are mainly related to the intraocular lens (IOL) material, such as PCO, ACO, and the subsequent capsule contraction, as well as glistening formation. The adverse events presented in this overview are the most common ones in clinical practice, and therefore, they are generally included in the clinical protocols for IOL evaluation.
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Averkina EA, Gamidov AA, Bol'shunov AV, Gamidov GA. [Capsule contraction syndrome in pseudophakia]. Vestn Oftalmol 2017; 133:92-97. [PMID: 29165419 DOI: 10.17116/oftalma2017133592-97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is a review of the literature on capsule contraction syndrome (CCS) in pseudophakic patients that involves severe fibrosis along the margin of the anterior capsule's opening and progressive contraction of the capsular bag. Possible causes of CCS and principles of its prevention and treatment have been analyzed.
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Affiliation(s)
- E A Averkina
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Gamidov
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - A V Bol'shunov
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - G A Gamidov
- N.A. Semashko Railway Clinical Hospital, JSC Russian Railways, 23 korp. 1 Stavropol'skaya St., Moscow, Russian Federation, 109386
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Elevated Transforming Growth Factor-β2 in the Aqueous Humor: A Possible Explanation for High Rate of Capsular Contraction Syndrome in High Myopia. J Ophthalmol 2016; 2016:5438676. [PMID: 26942002 PMCID: PMC4749807 DOI: 10.1155/2016/5438676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/22/2015] [Accepted: 12/27/2015] [Indexed: 01/18/2023] Open
Abstract
Purpose. The purpose of the study was to elucidate the role of transforming growth factor-beta 2 (TGF-β2) in the development of high myopic capsular contraction syndrome. Methods. Nineteen cases of capsular contraction syndrome, including 14 with high myopia, were collected, and their clinical data were reviewed. Aqueous humor and anterior capsular membranes were obtained during capsulotomy. Hematoxylin-eosin and immunohistochemical staining with anti-TGF-β2 antibody were performed on capsular membranes. TGF-β2 levels in aqueous humor were assayed using ELISA and western blot. Results. High myopia was significantly associated with the incidence of capsular contraction syndrome (odds ratio: 14.74, P < 0.001, 95% CI: 5.29–41.05). Histopathological analysis revealed proliferation of fibroblast-like lens epithelial cells on the shrunken anterior capsule, labeled with TGF-β2 antibodies. ELISA and Western blot showed higher levels of TGF-β2 in aqueous humor of patients with capsular contraction syndrome and high myopia. Conclusions. High myopia is a risk factor for capsular contraction syndrome. Elevated TGF-β2 levels in high myopic cataract patients may play an important role in the pathogenesis of capsular contraction syndrome.
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Nd:YAG Capsulotomy after Phacoemulsification in Vitrectomized Eyes: Effects of Pars Plana Vitrectomy on Posterior Capsule Opacification. J Ophthalmol 2014; 2014:840958. [PMID: 24868457 PMCID: PMC4020170 DOI: 10.1155/2014/840958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 11/17/2022] Open
Abstract
To compare the progression of posterior capsule opacification (PCO) in patients who required Nd:YAG laser capsulotomy following either combined cataract surgery with pars plana vitrectomy (PPV; C-CV), sequential cataract surgery after PPV (S-CV), or cataract surgery alone (CA). The medical records of 321 patients (408 eyes) who underwent Nd:YAG capsulotomy were retrospectively evaluated. The CA group had a significantly longer time interval from cataract surgery to capsulotomy than that of both the CV group (P = 0.006) and the S-CV (P = 0.013) and C-CV (P = 0.042) subgroups when age-matched comparisons were used. CV patients who implanted a hydrophobic acrylic IOL had shorter time intervals than those of CA patients (P = 0.028). CV patients had larger hazard of earlier capsulotomy than CA patients (hazard ratio (HR) = 1.337; 95% confidence interval (CI) 1.100–1.625; P = 0.004). C-CV and S-CV patients both had larger hazard than CA patients in earlier capsulotomy (HR = 1.304; 95% CI = 1.007–1.688; P = 0.044, HR = 1.361; 95% CI = 1.084–1.709; P = 0.008, resp.). PCO progresses more rapidly in patients undergoing combined or sequential cataract surgery and PPV than in patients undergoing CA.
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Lee JC, Kim YC. The Influence of Vitrectomy of Nd:YAG Laser Posterior Capsulotomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.12.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin Cheol Lee
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Maedel S, Hirnschall N, Chen YA, Findl O. Effect of heparin coating of a foldable intraocular lens on inflammation and capsular bag performance after cataract surgery. J Cataract Refract Surg 2013; 39:1810-7. [PMID: 24140372 DOI: 10.1016/j.jcrs.2013.05.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effect of a heparin-coated foldable intraocular lens (IOL) on postoperative flare in high-risk patients. SETTING Vienna Institute for Research in Ocular Surgery, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. DESIGN Randomized clinical trial. METHODS This study included patients with diabetes mellitus (DM), pseudoexfoliation syndrome (PXF), or both scheduled for cataract surgery in both eyes. One eye received a coated IOL (Polylens EC-1YH PAL) and the other eye, an uncoated control IOL (Polylens EC-1Y PAL). Aqueous flare measurements were taken using a laser flare meter (FM-600, Kowa) preoperatively and 1 hour, 1 day, 3 weeks, and 3 months postoperatively. Visual acuity and anterior (ACO) and posterior (PCO) capsule opacification were assessed, and IOL centration and tilt were measured with a Purkinje meter. RESULTS Eighty eyes of 40 patients were included in the study; 64 eyes of 32 patients completed the study. The mean flare values (photons/ms) preoperatively and 1 hour, 1 day, 3 weeks, and 3 months postoperatively were 6.98 ± 3.71 (SD), 19.14 ± 18.90, 16.62 ± 25.33, 10.33 ± 9.70, 8.74 ± 4.64, respectively, with the coated IOL and 8.65 ± 5.73, 22.08 ± 16.23, 13.44 ± 13.71, 7.50 ± 4.11, and 7.03 ± 3.70, respectively, with the control IOL. No significant differences were found in flare, visual acuity, ACO, PCO, tilt, or centration between the coated IOL and the control IOL at any timepoint. CONCLUSION No significant differences in flare or capsule performance were found between the coated IOL and control IOL.
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Affiliation(s)
- Sophie Maedel
- From the Vienna Institute for Research in Ocular Surgery (Maedel, Hirnschall, Chen, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria; Moorfields Eye Hospital NHS Foundation Trust (Hirnschall, Findl), London, United Kingdom
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Takamura Y, Tomomatsu T, Arimura S, Tomomatsu Y, Matsumura T, Takihara Y, Inatani M. Anterior capsule contraction and flare intensity in the early stages after cataract surgery in eyes with diabetic retinopathy. J Cataract Refract Surg 2013; 39:716-21. [DOI: 10.1016/j.jcrs.2012.12.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/13/2012] [Accepted: 12/15/2012] [Indexed: 11/16/2022]
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15
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Kim SY, Yang JW, Lee YC, Kim SY. Effect of haptic material and number of intraocular lens on anterior capsule contraction after cataract surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:7-11. [PMID: 23372373 PMCID: PMC3550319 DOI: 10.3341/kjo.2013.27.1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 07/19/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate changes over time of the anterior capsule opening size after phacoemulsification, based on haptic number and composition of three acrylic intraocular lenses (IOLs). Methods Fifty-five patients (70 eyes) were included. All underwent phacoemulsification followed by implantation of either an acrylic IOL with two-haptic (one-piece, 26 eyes; three-piece, 22 eyes), or four-haptic (one-piece, 22 eyes). The area of the anterior capsule opening size was measured one week postoperatively (baseline) and at three months. Results There was a significant reduction in the area of the anterior capsule opening from one week as compared to three months postoperatively in all groups (p < 0.001). However, there was no significant difference in the reduction in the anterior capsule opening between the IOLs (p = 0.36). Conclusions The number and material of the haptic of the three acrylic IOLs did not influence the degree of anterior capsule opening shrinkage.
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Affiliation(s)
- Sun Young Kim
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
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16
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Kim SA, Lee YE, Hwang KY, Joo CK. Usefulness of Open Ring Guider for Continuous Curvilinear Capsulorrhexis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.10.1494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Su Ah Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Eun Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu Yeon Hwang
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Choun-Ki Joo
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Abell RG, Kerr NM, Vote BJ. Femtosecond laser-assisted cataract surgery compared with conventional cataract surgery. Clin Exp Ophthalmol 2012; 41:455-62. [DOI: 10.1111/ceo.12025] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/16/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Robin G Abell
- Tasmanian Eye Institute; Launceston; Tasmania; Australia
| | - Nathan M Kerr
- Launceston Eye Institute; Launceston; Tasmania; Australia
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Hayashi K, Yoshida M, Hirata A, Hayashi H. Anterior capsule relaxing incisions with neodymium:YAG laser for patients at high-risk for anterior capsule contraction. J Cataract Refract Surg 2010; 37:97-103. [PMID: 21067893 DOI: 10.1016/j.jcrs.2010.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the effect of anterior capsule relaxing incisions created with a neodymium:YAG (Nd:YAG) laser on prevention of anterior capsule contraction after cataract surgery in high-risk patients. SETTING Hayashi Eye Hospital, Fukuoka, Japan. DESIGN Randomized masked clinical trials. METHODS Patients at high risk for anterior capsule contraction had anterior capsule relaxing incisions in either eye 3 days postoperatively. The anterior capsule opening was measured using a Scheimpflug videophotography system (EAS-1000) immediately and 1, 3, and 6 months after capsulotomy, and the percentage reduction in area was calculated. The degree of intraocular lens (IOL) decentration and tilt, posterior capsule opacification (PCO), and other complications were also assessed. RESULTS Of the 84 patients included, 30 had primary angle closure, 28 had pseudoexfoliation, and 26 had diabetic retinopathy. There was no significant difference in the mean opening area between fellow eyes at baseline. In patients with primary angle closure, the area was significantly greater and the percentage reduction in area was significantly less in the capsulotomy group than in the no-capsulotomy group (P≤.0428). In patients with pseudoexfoliation or diabetic retinopathy, the percentage reduction was significantly less in the capsulotomy group than in the no-capsulotomy group (P≤.0493), although there was no significant difference in area. No significant difference was found in IOL decentration or tilt, PCO, or incidence of other complications. CONCLUSION Neodymium:YAG laser anterior capsule relaxing incisions in the early period after cataract surgery were effective in preventing anterior capsule contraction in high-risk patients and had no adverse effects. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Ken Hayashi
- Hayashi Eye Hospital, Department of Ophthalmology, School of Medicine, Fukuoka University, Japan.
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19
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Nikpoor N, Stone DU. Rapid capsular phimosis in retinitis pigmentosa. ACTA ACUST UNITED AC 2010; 41 Online. [PMID: 20726501 DOI: 10.3928/15428877-20100726-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 04/23/2010] [Indexed: 11/20/2022]
Abstract
This case report retrospectively reviews the outcome of a 43-year-old man with retinitis pigmentosa who suffered rapid anterior capsular phimosis in each eye within 3 weeks following uncomplicated phacoemulsification with continuous curvilinear capsulorrhexis and single-piece acrylic intraocular lens (IOL) implantation. Anterior YAG capsulotomy was successfully performed in both eyes. It has been previously documented in the literature that capsular phimosis is more common in patients with retinitis pigmentosa. However, in the cases that were reviewed, capsular contracture progressed much less rapidly than in this patient. It is proposed that zonular dehiscence or increased lens epithelial cell fibrosis accompanying retinitis pigmentosa may be responsible for phimosis following phacoemulsification; in this case, the single-piece IOL may have offered less resistance to capsular contraction. Using a three-piece IOL, capsular tension ring, or making radial relaxing incisions in the anterior lens capsule may be useful approaches to minimize the aforementioned complications in patients with retinitis pigmentosa and cataracts.
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Affiliation(s)
- Neda Nikpoor
- Department of Ophthalmology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma 73104, USA
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20
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Alintaş AGK, Dal D. Capsule contraction syndrome in Behcet's disease. Int J Ophthalmol 2010; 3:358-60. [PMID: 22553593 DOI: 10.3980/j.issn.2222-3959.2010.04.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 11/28/2010] [Indexed: 11/02/2022] Open
Abstract
We reported the case of a 39-year-old patient with inactive Behcet's syndrome developed capsule contraction syndrome after uneventful phacoemulsification and a foldable intraocular lens implantation. Two weeks after the operation, the patient was accepted to hospital with severe decrease of visual acuity (VA) on the operated eye. Capsule opening area had been reduced considerably by fibrotic tissue, which evaluated with full dilated pupil. Since capsule contraction syndrome (CCS) had been diagnosed in very early stage and which structure was not severely thick, the fibrotic band was treated successfully, 360 degree circular shape, by neodymium YAG (Nd:YAG) laser. Capsule opening area was remained stable during follow up period of one month. But a significant reocclusion was developed that need surgical reopening 3 months after initial operation. Continuous curvilinier capsulorhexis (CCC) may be recurred again after a successful treatment in patient with uveitis like Behcet's disease.
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21
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Rosa N, Lanza M, De Bernardo M, Borrelli M, Politano L. Anterior capsule phimosis and capsular block syndrome in a patient with Steinert myotonic dystrophy: a case report. CASES JOURNAL 2009; 2:9298. [PMID: 20062622 PMCID: PMC2803962 DOI: 10.1186/1757-1626-2-9298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 12/10/2009] [Indexed: 11/20/2022]
Abstract
A 55-year-old man with myotonic dystrophy underwent phacoemulsification with IOL implantation in the right eye. 3 months after surgery, the patient showed a decreased visual acuity and an intraocular pressure (IOP) of 30 mmHg. Slit lamp examination showed a dense fibrosis of the anterior capsule with capsulorexis' shrinkage. Gonioscopy showed a closed angle. After a YAG laser iridotomy no decrease in the IOP was detected; following surgical peeling of the anterior capsule, the slit lamp showed a distended capsular bag. A YAG laser posterior capsulotomy was performed, without decrease in the IOP. Myotonic patients need to be closely followed up after cataract surgery, because in case of CBS development a prompt posterior capsulotomy could avoid more severe complications.
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Affiliation(s)
- Nicola Rosa
- Centro Grandi Apparecchiature, 2nd University of Naples, Naples, Italy
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22
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Georgalas I, Petrou P, Kalantzis G, Papaconstantinou D, Koutsandrea C, Ladas I. Nd: YAG capsulotomy for posterior capsule opacification after combined clear corneal phacoemulsification and vitrectomy. Ther Clin Risk Manag 2009; 5:133-7. [PMID: 19436607 PMCID: PMC2697513 DOI: 10.2147/tcrm.s4754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of Neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) following combined phacoemulsification and vitrectomy for the treatment of cataract in association with macular hole (MH) or epiretinal membrane (ERM). METHODS Retrospective clinical study of 34 eyes of 34 patients who underwent combined cataract surgery and vitrectomy, developed PCO, and subsequently underwent Nd:YAG laser capsulotomy. Follow-up examinations included visual acuity measurement, evaluation of intraocular lens (IOL) centration, intraocular pressure (IOP) measurement, and dilated fundus examination. RESULTS Nd:YAG laser capsulotomy was performed in all 34 eyes. The mean age of the patients was 65.08 years (range 45-87) and the mean follow up period was 11.05 months (range 4-23). The mean time elapsed between the last intraocular operation and the development of PCO was 10.00 months for patients with previous ERM and 15.33 for those with MH (P = 0.001, t-test for equality of means). None of our patients developed recurrence of MH, retinal detachment, IOL dislocation, or permanent IOP elevation. CONCLUSION In our study, the most remarkable observation is that no complication occurred after the YAG capsulotomy, possibly because the eyes were vitrectomized and vitreous seems to play an important role in the occurrence of post-Nd:YAG complications. In addition we noted that PCO seems to occur earlier in the eyes undergoing combined surgery for cataract and ERM when compared with those where combined phacoemulsification and vitrectomy are performed for cataract and MH.
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Affiliation(s)
- Ilias Georgalas
- Department of Ophthalmology, "G. Gennimatas" Hospital of Athens, NHS, Athens, Greece
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23
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Hayashi K, Yoshida M, Nakao F, Hayashi H. Prevention of anterior capsule contraction by anterior capsule relaxing incisions with neodymium:yttrium-aluminum-garnet laser. Am J Ophthalmol 2008; 146:23-30. [PMID: 18405874 DOI: 10.1016/j.ajo.2008.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 02/13/2008] [Accepted: 02/14/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine the effect of two or three neodymium:yttrium-aluminum-garnet (Nd:YAG) laser relaxing incisions made in the anterior capsular rim on prevention of anterior capsule contraction after cataract surgery. DESIGN Randomized clinical trials. METHODS One hundred patients scheduled for bilateral cataract surgery were randomized to one of two groups: two or three relaxing incisions in the left eye and no incisions in the right eye, and relaxing incisions in the right eye and no incisions in the left eye. The anterior capsule opening area was measured using Scheimpflug photography immediately after capsulotomy and at one, three, and six months after capsulotomy, and the percentage reduction was calculated. The degree of intraocular lens (IOL) decentration and tilt and of posterior capsule opacification (PCO) also were examined. RESULTS There was no significant difference in the anterior capsule opening area between fellow eyes at baseline (P > or = .1770). In patients who underwent two incisions, no significant difference was found between fellow eyes in the opening area (P > or = .4098) or in the percentage of reduction (P > or = .8730) throughout follow-up. In patients who underwent three incisions, the opening area in eyes with capsulotomy was significantly greater than that in eyes without capsulotomy (P < or = .0154), and the percentage reduction was significantly smaller in eyes with capsulotomy than in eyes without capsulotomy (P < or = .0016). No significant differences were found in the IOL decentration and tilt, or in PCO. CONCLUSIONS Three relaxing incisions made in the anterior capsule decrease the anterior capsule contraction, whereas two incisions do not.
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Affiliation(s)
- Ken Hayashi
- Hayashi Eye Hospital, 4-23-35 Hakataeki-mae, Hakata-Ku, Fukuoka, Japan.
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24
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Hayashi K, Hayashi H. Effect of anterior capsule contraction on visual function after cataract surgery. J Cataract Refract Surg 2007; 33:1936-40. [DOI: 10.1016/j.jcrs.2007.06.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 06/26/2007] [Indexed: 11/25/2022]
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25
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Moodie JJ, Vernon SA. A novel manoeuvre using a Kelly punch in the management of severe capsule contraction syndrome. Eye (Lond) 2007; 21:894-6. [PMID: 17347675 DOI: 10.1038/sj.eye.6702785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Toda J, Kato S, Oshika T, Sugita G. Posterior capsule opacification after combined cataract surgery and vitrectomy. J Cataract Refract Surg 2007; 33:104-7. [PMID: 17189803 DOI: 10.1016/j.jcrs.2006.09.018] [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] [Received: 07/11/2006] [Accepted: 09/06/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the degree of posterior capsule opacification (PCO) after combined cataract surgery and vitrectomy and after cataract surgery alone in age-matched control patients and in patients with and without diabetes mellitus (DM). SETTING Sugita Eye Hospital, Nagoya, Japan. METHOD In a prospective study, patients were divided into 2 groups: those having cataract surgery alone (cataract group) and those having combined cataract and vitrectomy surgery (combined group). The 2 groups were further divided into patients without DM (non-DM subgroup) and patients with DM (DM subgroup). The PCO rates were determined 3, 6, and 12 months after surgery using the POCO system. RESULTS In the cataract group, the non-DM subgroup and the DM subgroup each comprised 42 eyes of 42 patients. In the combined group, the non-DM subgroup comprised 26 eyes of 26 patients and the DM subgroup, 23 eyes of 23 patients. In the cataract group, the PCO rate in the DM subgroup was significantly higher than in the non-DM subgroup at every postoperative examination (P<.05). In the non-DM subgroup, the PCO rate was significantly higher at every postoperative examination in patients having combined surgery than in patients having cataract surgery alone (P<.05). In the combined group, the PCO rate did not differ significantly between the non-DM subgroup and the DM subgroup. CONCLUSION Even patients without DM must be carefully monitored for PCO development after combined surgery.
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Affiliation(s)
- Junko Toda
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
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27
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Miyata K, Kato S, Nejima R, Miyai T, Honbo M, Ohtani S. Influences of optic edge design on posterior capsule opacification and anterior capsule contraction. ACTA ACUST UNITED AC 2006; 85:99-102. [PMID: 17244219 DOI: 10.1111/j.1600-0420.2006.00758.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the influence of optic edge design on posterior capsule opacification (PCO) and anterior capsule contraction (ACC). METHODS A total of 43 eyes of 43 patients scheduled to undergo cataract surgery were included in this study. Patients received either a Sensor AR40 intraocular lens (IOL) or a Sensor AR40e IOL. The area of the anterior capsule opening (ACO) was determined by diaphanoscopy using the anterior eye segment analysis system EAS-1000 at 1 day, 1 week and 1, 3, 6 and 12 months postoperatively. Posterior capsule opacification was evaluated objectively in two ways, using either the EAS-1000 or POCOman. RESULTS There was no significant difference between the two groups in either ACO area or percentage reduction of ACO area at any time-point after surgery. The difference in the degree of PCO 1 year after surgery was not significant when measured by either the EAS-1000 or POCOman. CONCLUSIONS A sharp IOL edge is required to prevent PCO. Sharp-edged IOLs do not appear to be a risk factor for ACC.
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28
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Ebihara Y, Kato S, Oshika T, Yoshizaki M, Sugita G. Posterior capsule opacification after cataract surgery in patients with diabetes mellitus. J Cataract Refract Surg 2006; 32:1184-7. [PMID: 16857507 DOI: 10.1016/j.jcrs.2006.01.100] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 01/17/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE To prospectively compare the degree of posterior capsule opacification (PCO) after cataract surgery in patients with and without diabetes mellitus. SETTING Sugita Eye Hospital, Nagoya, Japan. METHODS Forty-two eyes of 42 consecutive diabetes mellitus patients (DM group) and 42 eyes of 42 non-DM patients (control group) scheduled to have cataract surgery were enrolled. The PCO value was determined using the posterior capsule opacification (POCO) system 3, 6, and 12 months after surgery. RESULTS Posterior capsule opacification values 3 months after surgery did not differ significantly between the 2 groups (P>.05). At 6 and 12 months, the PCO values of the DM group were significantly higher than those of the control group (P = .002 and P = .03, respectively). CONCLUSION Diabetic patients had significantly more severe PCO after cataract surgery than nondiabetic patients.
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Affiliation(s)
- Yoko Ebihara
- Department of Ophthalmology, Shiga Medical College, Ohtsu, Japan
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29
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Tadros A, Bhatt UK, Abdul Karim MN, Zaheer A, Thomas PW. Removal of lens epithelial cells and the effect on capsulorhexis size. J Cataract Refract Surg 2005; 31:1569-74. [PMID: 16129293 DOI: 10.1016/j.jcrs.2005.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2005] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the long-term effects of lens epithelial cell (LEC) removal on capsulorhexis opening size. SETTING Dorset County Hospital, Dorchester, United Kingdom. METHODS This prospective randomized control study included 39 eyes of 38 patients. Twenty eyes were selected randomly for removal of LECs from the anterior capsule as part of routine cataract operation comprising phacoemulsification with intraocular lens (IOL) implantation. The other 19 eyes were used as controls in which the LECs were not removed. All surgeries were performed by 1 surgeon (A.T.). All patients had silicone IOL (Allergan SI-40) implantation. The capsulorhexis opening size was determined immediately after surgery and 2 weeks and 6 months after surgery. Data on treatment outcome of the cataract surgery were analyzed statistically. RESULTS Six months postoperatively, the size of the capsulorhexis had statistically significant increased in the study group that had LECs removed (mean increase 1.07 +/- 1.70 mm(2); paired Student t test P=.01), whereas the capsulorhexis size had statistically significant decreased in the control group (mean decrease -3.38 +/- 2.37 mm(2); paired Student t test, P<.0001). The difference in changes in the capsulorhexis areas between the 2 groups was also highly statistically significant (independent-sample Student t test, P<.0001). CONCLUSION Removal of anterior subcapsular LECs by aspiration helped maintain the size of the capsulorhexis opening and thus can help prevent capsule contraction syndrome.
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Affiliation(s)
- Athanassius Tadros
- Royal Eye Infirmary, Dorset County Hospital, Dorchester, United Kingdom.
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30
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Kawai K. Secondary anterior capsulotomy in pseudophakic eyes. J Cataract Refract Surg 2005; 31:1101-3. [PMID: 16039482 DOI: 10.1016/j.jcrs.2004.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2004] [Indexed: 11/17/2022]
Abstract
This report describes a 1-handed technique and a 2-handed technique anterior capsulotomy in pseudophakic eyes. Each technique was used in a case of proliferative vitreoretinopathy accompanying anterior capsule contraction that occurred following cataract and intraocular lens (IOL) implantation. A capsulorhexis forceps and a stab knife were inserted into the anterior chamber, and the capsule contraction alleviated without extracting the IOL in both cases. Secondary anterior capsulotomy contributed to both the surgeon's visibility during intraocular surgery, including the subsequent vitreous surgery, and the patient's postoperative visual acuity. The transparency of the pupil region was restored. While the 1-handed technique involves the risk of adversely affecting Zinn's zonule, the 2-handed technique does not place a burden on Zinn's zonule and is thought to considerably improve the surgeon's visibility in subsequent vitreoretinal surgery.
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Affiliation(s)
- Kenji Kawai
- Department of Ophthalmology, Tokai University School of Medicine, Isehara-shi, Kanagawa 259-1193, Japan.
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31
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Hayashi K, Hayashi H. Intraocular lens factors that may affect anterior capsule contraction. Ophthalmology 2005; 112:286-92. [PMID: 15691565 DOI: 10.1016/j.ophtha.2004.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Accepted: 11/05/2004] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To examine the various factors comprising intraocular lenses (IOLs) that may affect the degree of anterior capsule contraction after cataract surgery. DESIGN Randomized controlled clinical trials. PARTICIPANTS Three hundred thirty-one patients scheduled for bilateral cataract surgery were studied to compare the degree of anterior capsule contraction in fellow eyes that received different IOLs with regard to the following factors: (1) optic material-acrylic optic versus silicone optic; (2) optic design-round-edge optic versus sharp-edge optic; (3) haptic material-polymethyl methacrylate (PMMA) loop versus polyvinylidene fluoride loop; and (4) haptic material and design-single-piece acrylic haptic versus 3-piece PMMA haptic. The 2 IOLs implanted in the fellow eyes of each patient had almost the same material and design, except for the specific factor being compared. METHODS All patients underwent phacoemulsification surgery with implantation of different IOLs in fellow eyes. MAIN OUTCOME MEASURES The area of the anterior capsule opening was measured using the Scheimpflug videophotography system at 3 days or 1 week (baseline) and at 1, 3, and 6 months after surgery. The percent reduction in the anterior capsule opening area from baseline was determined at 1, 3, and 6 months after surgery. RESULTS The mean percent reduction of the anterior capsule opening area was significantly greater in eyes with a silicone optic IOL than in eyes with an acrylic optic IOL. However, no significant difference was observed in the percent reduction between round-edge and sharp-edge optic IOLs, between PMMA and polyvinylidene fluoride loop IOLs, and between single-piece acrylic and 3-piece PMMA haptic IOLs. Strong associations were found in the percentage between round-edge and sharp-edge optic IOLs, between PMMA and polyvinylidene fluoride loop IOLs, and between single-piece acrylic and 3-piece PMMA haptic IOLs, whereas there was a relatively weak association between silicone and acrylic optic IOLs. CONCLUSIONS Among the IOL factors examined, optic material affects most significantly the degree of anterior capsule contraction, whereas optic design and haptic material and design are not strongly related to anterior capsule contraction.
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Sacu S, Menapace R, Wirtitsch M, Buehl W, Rainer G, Findl O. Effect of anterior capsule polishing on fibrotic capsule opacification: three-year results. J Cataract Refract Surg 2005; 30:2322-7. [PMID: 15519082 DOI: 10.1016/j.jcrs.2004.02.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the long-term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO). SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS This randomized double-blind study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients received round-edged intraocular lenses (IOLs); 26 received an SI-40 IOL (Advanced Medical Optics Inc.) in both eyes, and 26 received a Silens6 IOL (Domilens) in both eyes. Both IOLs consist of different silicone material and have different haptic angulation. The SI-40 IOL has 13.0 mm open-loop poly(methyl methacrylate) (PMMA) haptics angulated by 10 degrees. The Silens6 IOL has 12.5 mm open-loop PMMA haptics with no angulation. In 1 eye, the anterior capsule was extensively polished. The anterior capsule was left unpolished in the contralateral eye, which acted as a control. Digital slitlamp photographs of the ACO and fibrotic PCO were taken with a standardized technique for 3 years postoperatively. The intensity of ACO was measured objectively (score 0% to 100%) using Adobe Photoshop software. Fibrotic PCO was graded subjectively (score 0 to 4). RESULTS The mean ACO was 17% in the polished eyes and 26% in the control eyes (P = .0001). The mean fibrotic PCO score was 0.5 and 1.0, respectively (P = .0007). The mean ACO was 15% in the polished SI-40 eyes and 26% in the control SI-40 eyes (P = .01). It was 19% in the polished Silens6 eyes and 26% in the control Silens6 eyes (P = .003). The mean fibrotic PCO score was 0.4 in the polished SI-40 eyes and 1.1 in the control SI-40 eyes (P = .0006). It was 0.6 in the polished Silens6 eyes and 0.9 in the control Silens6 eyes (P = .08). CONCLUSIONS Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round-edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.
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Affiliation(s)
- Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna, Medical School, Vienna, Austria
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Sacu S, Menapace R, Buehl W, Rainer G, Findl O. Effect of intraocular lens optic edge design and material on fibrotic capsule opacification and capsulorhexis contraction. J Cataract Refract Surg 2004; 30:1875-82. [PMID: 15342049 DOI: 10.1016/j.jcrs.2004.01.042] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS This randomized controlled patient- and examiner-masked study comprised 210 eyes of 105 patients with bilateral age-related cataract. In Group 1 (n = 53), the Sensar OptiEdge AR40e hydrophobic acrylic IOL with a sharp posterior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex OptiEdge silicone IOL with a sharp posterior optic edge was compared with the PhacoFlex SI-40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digital slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillumination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm(2)) was determined objectively. RESULTS One year after surgery, the mean ACO score was 32% in eyes with the sharp-edged acrylic IOL and 29% in eyes with the round-edged acrylic IOL (P<.05). In the silicone group, the mean was 31% and 26%, respectively (P<.05). The mean fibrotic PCO score was lower in eyes with a sharp-edged acrylic IOL than in eyes with a round-edged acrylic IOL (0.26 and 0.93, respectively; P<.05) and in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (0.24 and 0.82, respectively; P<.001). At 1 year, the mean capsulorhexis area was statistically significantly smaller in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (P<.05). CONCLUSIONS Acrylic and silicone IOLs with the sharp OptiEdge design led to significantly less fibrotic PCO but more ACO than round-edged acrylic and silicone IOLs. The sharp-edged silicone IOL caused significantly more capsulorhexis contraction than the round-edged silicone IOL and both acrylic IOLs.
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Affiliation(s)
- Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna, A-1090 Vienna, Austria.
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Hayashi Y, Kato S, Fukushima H, Numaga J, Kaiya T, Tamaki Y, Oshika T. Relationship between anterior capsule contraction and posterior capsule opacification after cataract surgery in patients with diabetes mellitus. J Cataract Refract Surg 2004; 30:1517-20. [PMID: 15210231 DOI: 10.1016/j.jcrs.2003.11.045] [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: 11/25/2003] [Indexed: 01/10/2023]
Abstract
PURPOSE To prospectively assess the relationship between contraction of the anterior capsule opening and posterior capsule opacification (PCO) after cataract surgery in patients with diabetes mellitus. SETTING Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Kaiya Eye Clinic, Hamamatsu, and Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaragi, Japan. METHODS This study comprised 45 patients (45 eyes) with diabetes mellitus who had cataract surgery. In all eyes, the anterior capsule opening area and degree of PCO were determined by diaphanoscopy using an anterior eye segment analysis system (EAS-100, Nidek, Inc.) 1 day and 1 year postoperatively. RESULTS There was no correlation between the size of the anterior capsule opening area 1 day after surgery and the degree of PCO 1 year after surgery (Pearson correlation coefficient [r] = 0.041; P =.79). The percentage reduction in the anterior capsule opening area from 1 day to 1 year after surgery did not correlate with the degree of PCO 1 year after surgery (r = -0.08; P =.60). CONCLUSION Contraction of the anterior capsule opening and PCO after cataract surgery cannot be explained by a common mechanism.
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Affiliation(s)
- Yoshie Hayashi
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Lee HJ, Min SH, Kim TY. Bilateral spontaneous dislocation of intraocular lenses within the capsular bag in a retinitis pigmentosa patient. KOREAN JOURNAL OF OPHTHALMOLOGY 2004; 18:52-7. [PMID: 15255238 DOI: 10.3341/kjo.2004.18.1.52] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 45-year-old man with retinitis pigmentosa (RP), who had undergone uneventful extracapsular cataract extraction (ECCE) in his right eye eight years previously, and phacoemulsification in his left eye six years previously, had spontaneously dislocated intraocular lenses (IOL) within the capsular bag in both eyes one month apart. We removed the dislocated IOLs, and performed anterior vitrectomy and scleral fixation of the new IOLs. Mild contraction of the capsular bags and uneven distribution of the zonular remnants' clumps along the equator of the capsules were found by scanning electron microscopic (SEM) examination. In this study, we propose the correlation between RP and zonular weakness. To our knowledge, this is the first case report of bilateral spontaneous dislocation of IOLs within the capsular bag of an RP patient.
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Affiliation(s)
- Hye Jin Lee
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
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Tanaka SI, Saika S, Tamura M, Ohnishi Y. Histological observation of complete closure of anterior capsulotomy in 2 cases. J Cataract Refract Surg 2004; 30:1374-7. [PMID: 15177621 DOI: 10.1016/j.jcrs.2003.09.066] [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] [Accepted: 09/23/2003] [Indexed: 11/27/2022]
Abstract
We report the histological finding of complete closure of the anterior capsulotomy window in 2 cases. The cases were successfully treated with surgery after neodymium:YAG laser anterior capsulotomy failed. Histology and immunohistochemistry were performed to determine the pathogenesis. Histology revealed the presence of elongated, fibroblast-like lens epithelial cells in association with extracellular matrix accumulation, which were positive for collagen types, fibronectin, and osteopontin. The cells were labeled with anti-alpha-smooth muscle actin antibody. The finding indicates that phenotypic modulation in lens epithelial cell to contractile cell type and accumulation of matrix are involved in closure of the anterior capsulotomy window.
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Affiliation(s)
- Sai-Ichi Tanaka
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan.
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Sira M, Ho T. Acute angle closure glaucoma secondary to a luxated lens associated with retinitis pigmentosa. Eye (Lond) 2004; 19:472-3. [PMID: 15184934 DOI: 10.1038/sj.eye.6701527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Tognetto D, Toto L, Sanguinetti G, Cecchini P, Vattovani O, Filacorda S, Ravalico G. Lens epithelial cell reaction after implantation of different intraocular lens materials. Ophthalmology 2003; 110:1935-41. [PMID: 14522768 DOI: 10.1016/s0161-6420(03)00736-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine the influence of intraocular lens (IOL) material on anterior capsular opacification and membrane growth over the anterior IOL surface in patients who have undergone standardized small-incision cataract surgery and foldable IOL implantation in the capsular bag. DESIGN Randomized controlled trial. PARTICIPANTS Eighty-eight cataract patients (88 eyes). METHODS Patients were randomly assigned to receive one of four different foldable IOLs after phacoemulsification: Storz Hydroview H60M, Corneal ACR6D, AMO SI40NB, and Alcon AcrySof MA60BM. Examinations on days 7, 30, 90, 180, 360, and 720 after surgery included ophthalmologic examination, slit-lamp biomicroscopy, and photography using red reflex and focal illumination of the anterior IOL surface. MAIN OUTCOME MEASURES Best-corrected visual acuity was measured at each examination. In addition, the anterior capsule opacification and the membrane growth on the anterior IOL surface were graded according to a subjective method by the same researcher. RESULTS The fibrosis of the anterior capsule was more frequently observed in the group using Corneal ACR6D and AMO SI40NB. The Hydroview and ACR6D groups showed a higher percentage of cases with membrane growth from the rhexis edge on the anterior IOL surface. AcrySof showed the lowest presence of fibrosis of the anterior capsule, and no membrane growth was noted. CONCLUSIONS Anterior capsule opacification is an index of IOL biocompatibility. The natural location of lens epithelial cells (LECs) precludes the possibility of the IOL's design influencing the anterior capsule behavior. The local response of LECs varies according to the IOL studied. This may be related to the chemical and physical properties of the materials used in the different IOLs.
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Affiliation(s)
- Daniele Tognetto
- Eye Clinic, University of Trieste, Ospedale Maggiore, Piazza Ospedale, 1-34129 Trieste, Italy.
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Hesse Y, Kampmeier J, Lang GK, Baldysiak-Figiel A, Lang GE. Adherence and viability of porcine lens epithelial cells on three different IOL materials in vitro. Graefes Arch Clin Exp Ophthalmol 2003; 241:823-6. [PMID: 12937993 DOI: 10.1007/s00417-003-0718-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2003] [Revised: 05/19/2003] [Accepted: 05/20/2003] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate porcine lens epithelial cell (LEC) adhesion and viability on three different intraocular lens (IOL) materials. METHODS The IOL materials tested were poly(methylmethacrylate) (PMMA), silicone and hydrophobic acrylate. Primary porcine LECs were cultured on four discs of each material over a period of 10 days and, additionally, on six discs of the hydrophobic acrylate over a period of 20 days. Cells grown on untreated wells of a 96-well microtiter plate served as a control. Cell adhesion was photodocumentated on days 1, 2, 3, 4, 6, 8, 10, 14,17 and 20. A cell viability test using the LIVE/DEAD kit (Molecular Probes) was carried out at the end of the investigation. Experiments were run in triplicate. Statistical analysis was performed using the Student's t-test. RESULTS Confluent cell growth was reached on the hydrophobic acrylate discs and the control wells within 1 day and remained stable during the experiment. Only a few round cells were adherent on PMMA and silicone discs, and their number decreased during the experiment. After 10 days of culturing, the viability test (mean +/- SD) revealed 81.79 +/- 51.74% live cells on acrylate discs, which was not different from the control (105.83 +/- 21.78%, P=0.1589). Significantly lower relative numbers of live cells (P>0.0001) were found on PMMA (-0.62 +/- 2.24%) and silicone (21.47 +/- 8.42%) discs. The percentage of dead cells was significantly higher (P<0.0001) on hydrophobic acrylate discs (29.69 +/- 12.61%) compared to the control (-1.49 +/- 4.13%). After a culture period of 20 days, the percentage of live cells on hydrophobic acrylate discs (49.45 +/- 27.98%) was lower compared to day 10, but was not significantly different from control wells (58.77 +/- 10.71%) (P=0.2299). CONCLUSIONS Significantly fewer cells grew on PMMA and silicone discs compared to the control. Confluent cell growth and numbers of viable cells comparable to the control were observed on hydrophobic acrylate discs after a culture period of 20 days with a significantly higher percentage of dead cells.
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Affiliation(s)
- Yvonne Hesse
- Department of Ophthalmology, University of Ulm, Prittwitzstr 43, 89075 Ulm, Germany.
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40
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Mathew MRK, McLean SM, Murray SB, Bennett HGB, Webb LA, Esakowitz L. Expression of CD18, CD49b, CD49c and CD49e on lens anterior capsules in human cataracts. Eye (Lond) 2003; 17:473-7. [PMID: 12802345 DOI: 10.1038/sj.eye.6700380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To examine the lens epithelial cells obtained from the anterior lens capsules removed during cataract surgery and detect various subclasses of the cell surface adhesion molecules known as integrins. METHODS The circular sections of anterior capsules with attached lens epithelial cells (LECs) were obtained during cataract surgery from 28 patients. The lens capsules were immunohistochemically stained. RESULTS CD49b CD49c, CD49e, and CD18 were detected in varying degrees in specimens obtained from human cataractous lenses. The positive percentages were 33, 75, 33, and 20%, respectively. The most striking feature was the increasing staining profiles towards the edges of the capsules (away from the central part of the lens capsules) for CD49c, suggesting that the LECs showed higher immunoreactivity for this antibody. The immunoreactivity for CD49b and CD49e was weaker. This was absent for CD18 in the central part of the lens capsules. CONCLUSION The positive expression of antibodies suggests that specific integrin subunits were expressed in LECs of human cataracts. These results suggest that lens epithelial cells expressing CD49b, CD49c, CD49e, and CD18 might be precursors in the process of anterior lens epithelial cell (A cell) adhesion, and hence play a role in anterior capsule opacification or in subsequent migration and a possible role in posterior capsule opacification.
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Affiliation(s)
- M R K Mathew
- Department of Ophthalmology, Argyll and Clyde Acute Hospitals NHS Trust, Paisley, Renfrewshire, PA2 9PN, UK.
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Koizumi K, Watanabe A, Koizumi N, Kinoshita S. Peeling the fibrous membrane from the anterior capsule for capsulorhexis contraction after phacoemulsification in aphakic patients. J Cataract Refract Surg 2002; 28:1728-32. [PMID: 12388019 DOI: 10.1016/s0886-3350(02)01280-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a method for peeling the fibrous membrane from the anterior capsule without damaging the posterior capsule in patients with capsule contraction syndrome after cataract surgery. We also report 2 cases in which the technique was successfully used.
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Affiliation(s)
- Kan Koizumi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Shigeeda T, Nagahara M, Kato S, Kunimatsu S, Kaji Y, Tanaka S, Amano S, Oshika T. Spontaneous posterior dislocation of intraocular lenses fixated in the capsular bag. J Cataract Refract Surg 2002; 28:1689-93. [PMID: 12231332 DOI: 10.1016/s0886-3350(01)01178-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report 4 cases of complete posterior dislocation of an intraocular lens (IOL) in the capsular bag occurring a mean of 5.5 years after uneventful cataract surgery. In all 4 cases, posterior chamber IOLs were fixated within the capsulorhexis. The patients experienced sudden loss of vision without an episode of trauma or ocular disease. Using a 3-port pars plana vitrectomy, the IOLs were explanted through a limbal incision and a new IOL was sutured to the ciliary sulcus. Histological examination indicated that zonular fibers were severed at the site of insertion in the capsule.
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Affiliation(s)
- Takashi Shigeeda
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
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Park TK, Chung SK, Baek NH. Changes in the area of the anterior capsule opening after intraocular lens implantation. J Cataract Refract Surg 2002; 28:1613-7. [PMID: 12231321 DOI: 10.1016/s0886-3350(02)01378-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the reduction rate of the area of the anterior capsule opening after continuous curvilinear capsulorhexis (CCC) with 3 types of intraocular lenses (IOLs). SETTING St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. METHODS Sixty-five eyes of 51 patients having phacoemulsification and IOL implantation were assigned to 1 of 3 groups based on type of IOL: 1-piece acrylic (n = 16), 3-piece acrylic (n = 26), or silicone (n = 23). The area of the anterior capsule opening was measured 1 day and 1, 2, 3, 6, and 12 months postoperatively. RESULTS There was significant reduction in the area of the anterior capsule opening 1 day to 3 months postoperatively in all 3 groups (P <.001). There was no further reduction after 3 months in any group. The reduction in the area of the anterior capsule opening was significantly less in both acrylic IOL groups than in the silicone IOL group at 3 months (P =.040) and 12 months (P =.023); however, there was no significant difference between the 2 types of acrylic IOLs (P =.933). CONCLUSIONS Although there was a reduction in the area of the anterior capsule opening in all patients, the amount was significantly less in the 2 acrylic IOL groups than in the silicone IOL group. This should be considered when selecting an IOL, especially for eyes at risk for capsule contraction.
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Affiliation(s)
- Tae Kyung Park
- Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Tu KL, Carley F, Brown R. Total encapsulation and asymmetric deformation of an intraocular lens. J Cataract Refract Surg 2002; 28:903-6. [PMID: 11978478 DOI: 10.1016/s0886-3350(00)00764-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of marked anterior capsule contraction after uneventful cataract surgery in an 82-year-old women. The patient had implantation of a single-piece foldable acrylic intraocular lens (IOL) after phacoemulsification through a 3.0 mm superior corneal incision. Between 1 month and 5.5 months after surgery, significant anterior capsule contraction ensued with total encapsulation of the lens. The resultant fibrotic reaction, which had a localized tangential component, caused an asymmetric deformation and mild IOL displacement. The patient was treated on separate occasions with a neodymium:YAG laser anterior capsulotomy and surgical capsulotomy to release tension on the lens and clear the visual axis.
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Affiliation(s)
- Kyaw Lin Tu
- Department of Ophthalmology, Stepping Hill Hospital, England, Stockport, UK.
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45
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Kato S, Suzuki T, Hayashi Y, Numaga J, Hattori T, Yuguchi T, Kaiya T, Oshika T. Risk factors for contraction of the anterior capsule opening after cataract surgery. J Cataract Refract Surg 2002; 28:109-12. [PMID: 11777718 DOI: 10.1016/s0886-3350(01)00901-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the factors contributing to contraction of the anterior capsule opening (ACO) after cataract surgery in normal eyes. SETTING Department of Ophthalmology, University of Tokyo, School of Medicine, Tokyo, and Kaiya Eye Clinic, Hamamatsu, Japan. METHODS This study included 141 eyes of 141 patients scheduled to have cataract surgery. The area of the ACO was determined by diaphanoscopy using the EAS-1000 anterior eye segment analysis system 1 day and 9 months postoperatively, after which the percentage reduction in the ACO area was calculated. Aqueous flare intensity was measured with a laser flare-cell meter 1 week and 9 months after surgery. Multiple regression analysis was performed to determine which factors were correlated with the percentage reduction in the ACO area. Variables tested included patient age, axial length, the ACO area on the first postoperative day, and flare values 1 week and 9 months after surgery. RESULTS Patient age (r = 0.193, P =.029) and flare intensity 9 months after surgery (r = 0.255, P =.007) were significantly correlated with the percentage reduction in the ACO area (R(2) = 0.133). The axial length, ACO area 1 day postoperatively, and flare value at 1 week were not correlated with ACO contraction. CONCLUSION Contraction of the ACO after cataract surgery is related to instability of the blood-aqueous barrier.
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Affiliation(s)
- Satoshi Kato
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Macky TA, Pandey SK, Werner L, Trivedi RH, Izak AM, Apple DJ. Anterior capsule opacification. Int Ophthalmol Clin 2001; 41:17-31. [PMID: 11481537 DOI: 10.1097/00004397-200107000-00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T A Macky
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, SC 29425, USA
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Sudhir RR, Rao SK. Capsulorhexis phimosis in retinitis pigmentosa despite capsular tension ring implantation. J Cataract Refract Surg 2001; 27:1691-4. [PMID: 11687372 DOI: 10.1016/s0886-3350(01)00869-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 56-year-old man with retinitis pigmentosa presented with dense nuclear sclerosis and scattered zonular loss with laxity confirmed by ultrasound biomicroscopy. He had extracapsular cataract extraction with a 6.0 mm continuous curvilinear capsulorhexis and implantation of a capsular tension ring (CTR) and a single-piece poly(methyl methacrylate) (PMMA) intraocular lens (IOL) in the capsular bag in his left eye. Severe anterior capsule fibrosis and contracture of the capsulorhexis opening with nasal decentration of the IOL were noted 4 months after surgery. A neodymium:YAG (Nd:YAG) laser anterior capsulotomy was performed to prevent further zonular stress and IOL decentration. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR and PMMA IOL in patients with retinitis pigmentosa. Such patients must be carefully monitored postoperatively. An Nd:YAG laser anterior capsulotomy is a safe and effective option to manage anterior capsule fibrosis.
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Affiliation(s)
- R R Sudhir
- Sankara Nethralaya, Chennai, Tamil Nadu, India
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Werner L, Pandey SK, Apple DJ, Escobar-Gomez M, McLendon L, Macky TA. Anterior capsule opacification: correlation of pathologic findings with clinical sequelae. Ophthalmology 2001; 108:1675-81. [PMID: 11535472 DOI: 10.1016/s0161-6420(01)00674-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the degree of anterior capsule opacification (ACO) in human eyes obtained postmortem containing various rigid and foldable posterior chamber intraocular lens (PC-IOL) designs and compare the findings with clinical sequelae of capsular shrinkage. DESIGN Comparative autopsy tissue study with clinicopathologic correlations. MATERIALS Three hundred formalin-fixed human eyes containing the following PC-IOL styles were analyzed: (1) one-piece polymethyl methacrylate (PMMA) optic-PMMA haptic (n = 50), one-piece silicone-plate IOL, with large (2) or small (3) fixation holes (n = 35), (4) three-piece PMMA optic-Prolene haptic (n = 50), (5) three-piece acrylic optic-PMMA haptic (n = 55), three-piece silicone optic with PMMA (6) or polyimide (7) haptics (n = 30), and (8) three-piece silicone optic-Prolene haptic (n = 80) lenses. TESTING The eyes were sectioned in the equatorial plane for gross examination of the capsular bag from a posterior view. The cornea and iris were then excised for evaluation from an anterior view. MAIN OUTCOME MEASURES ACO was scored in each eye from 0 to IV, according to the degree/area of capsule opacification. Capsulorrhexis size and IOL decentration were measured with calipers. RESULTS The overall differences among the IOL groups regarding the three parameters were significant (ACO score: P < 0.001; capsulorrhexis diameter: P = 0.036; IOL decentration: P = 0.012). Mean ACO scores were highest with the large- and small-hole one-piece silicone-plate lenses (2.543 +/- 0.950) and lowest with the three-piece acrylic optic-PMMA haptic lenses (0.600 +/- 0.710). Of 10 cases of capsulorrhexis phimosis observed in the study, 7 cases were associated with three-piece silicone optic-Prolene haptic lenses, which also presented the highest mean decentration (0.375 +/- 0.601 mm). CONCLUSIONS Our results confirm previous histopathologic observations that the rate of ACO is the lowest with acrylic lenses and higher with plate-haptic silicone IOLs. Nevertheless, clinical sequelae of capsular shrinkage are also very important with three-piece silicone optic-Prolene haptic designs. Thus, IOL material and design are significant factors in the development of ACO, but they ultimately also influence the clinical presentation of capsular shrinkage.
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Affiliation(s)
- L Werner
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA
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49
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Jackson H, Garway-Heath D, Rosen P, Bird AC, Tuft SJ. Outcome of cataract surgery in patients with retinitis pigmentosa. Br J Ophthalmol 2001; 85:936-8. [PMID: 11466249 PMCID: PMC1724090 DOI: 10.1136/bjo.85.8.936] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM To determine the visual benefit of cataract extraction in patients with retinitis pigmentosa and to identify risk factors for poor outcome. METHODS A retrospective analysis was undertaken of a continuous series of 142 eyes of 89 patients with retinitis pigmentosa undergoing cataract surgery between 1985 and 1997. RESULTS Mean age at surgery was 47.5 years (range 24-81 years). In 100 eyes there was posterior subcapsular lens opacity alone, 37 eyes also had moderate nuclear sclerosis, and five had only nuclear sclerosis. All patients had central visual fields of <10 degrees. Overall, mean visual acuity improved from 1.05 (SD 0.38) preoperatively to 0.63 (SD 0.49) postoperatively on the logMAR scale. Significant postoperative capsular opacification occurred in 88/139 eyes (63%) and 45.1% required capsulotomy. Anterior capsulotomy was undertaken in 5/52 (9.6%) eyes undergoing phacoemulsification. Postoperative macular oedema was noted in 20 (14%) eyes. Visual acuity improved in 109 eyes (77%), was unchanged in 29 eyes (20.5%), and worsened after surgery in four eyes (2.5%). 86/89 patients reported major improvement of visual function. CONCLUSIONS Cataract surgery for relatively minor lens opacities is beneficial in patients with retinitis pigmentosa, and most report subjective improvement of visual symptoms. The incidence of capsular opacification is high and anterior capsular contraction may occur. The number of eyes with poor vision due to macular oedema was unexpectedly low.
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Affiliation(s)
- H Jackson
- Department of Clinical Ophthalmology, Institute of Ophthalmology, Cayton Street, London EC1V 9EL, UK
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Schauersberger J, Amon M, Kruger A, Abela C, Schild G, Kolodjaschna J. Lens epithelial cell outgrowth on 3 types of intraocular lenses. J Cataract Refract Surg 2001; 27:850-4. [PMID: 11408130 DOI: 10.1016/s0886-3350(00)00861-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the outgrowth of lens epithelial cells (LECs) on 3 types of intraocular lenses (IOLs) to determine the influence of lens material and lens design (optic edge) on this phenomenon. SETTING Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. METHOD Ninety eyes scheduled for cataract surgery were included in a prospective comparative study. A standardized surgical procedure was performed by 1 experienced surgeon. Patients received 1 of 3 types of posterior chamber IOLs of similar design with a 6.0 mm optic and poly(methyl methacrylate) haptic: AcrySof (Alcon), HydroView (Bausch & Lomb), or Sensar (Allergan). Each IOL type was implanted in 30 eyes. Postoperative biomicroscopic examinations were performed 1, 3, 7, 30, 90, and 180 days and 1 year after surgery. Lens epithelial cells in each quadrant of the anterior lens surface were subjectively graded. The product with the highest density and the number of quadrants with this density were used to measure LEC outgrowth. RESULTS Statistically significant differences (P <.05) were seen between the hydrophilic IOL and the 2 hydrophobic lenses from day 30 until the final examination. The HydroView lens had a higher number of LECs on its anterior surface than the AcrySof or Sensar IOL. There were no statistically significant differences between the 2 acrylic IOLs at any measurement. CONCLUSION The findings suggest that lens surface properties have a greater influence on LEC outgrowth than lens design (ie, sharp optic edge).
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Affiliation(s)
- J Schauersberger
- Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria.
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