Elschnig pearl formation along the posterior capsulotomy margin after neodymium:YAG capsulotomy

Recurrent Posterior Capsular Opacification in Adults: A Case Report and an Overview of Literature

Posterior capsular opacification (PCO), also known as "secondary cataract", is a common complication following cataract surgery that can significantly impair visual acuity. The incidence of PCO varies widely in the literature, influenced by intraocular lens (IOL) type and patient risk factors. Neodymium-doped yttrium-aluminum-garnet (YAG) laser posterior capsulotomy is the standard treatment for PCO-related visual impairment. Recurrence of PCO after initial treatment with YAG capsulotomy, though more common in children, is rare in adults. Its underlying pathophysiological mechanisms are similar to that of primary PCO, which includes proliferation, migration, and/or clustering of lens epithelial cells (LECs), with subsequent reclosure of the posterior aperture. Potential risk factors for PCO recurrence that have been speculated through a comprehensive search of the current literature include younger age, female sex, high myopia, diabetes, vitrectomized status, uveitis, low-diopter IOLs, and certain IOL types with higher water content. We present a case of recurrent PCO in a highly myopic 48-year-old male following cataract surgery and implantable collamer lens (ICL) explantation who received a hydrophobic acrylic lens with 4% water content. Surgical techniques that may reduce recurrent PCO occurrence and appropriate postoperative care are emphasized to assist surgeons in their approach to patients at high-risk for this complication.

Factors Associated with Reclosure of Posterior Capsule Aperture by Flat Opacifications with Pearls after Nd:YAG Laser Posterior Capsulotomy

In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors.

Long-term myofibroblast persistence in the capsular bag contributes to the late spontaneous in-the-bag intraocular lens dislocation

Late spontaneous in-the-bag intraocular lens (IOL) dislocation is a complication presenting 6 months or later after cataract surgery. We aimed to characterize the cells in the lens capsules (LCs) of 18 patients with spontaneous late in-the-bag IOL dislocation. Patients' average age was 82.6 ± 1.5 years (range 72-98), and most of them had pseudoexfoliation syndrome (PEX). Cells from the LCs were positive for myofibroblast (αSMA), proliferation (Ki-67, PCNA), early lens development/lens progenitor (SOX2, PAX6), chemokine receptor (CXCR4), and transmembrane (N-cadherin) markers, while negative for epithelial (E-cadherin) marker. Moreover, the cells produced abundant fibronectin, type I and type V collagen in the nearby extracellular matrix (ECM). During ex vivo cultivation of dislocated IOL-LCs in toto, the cells proliferated and likely migrated onto the IOL's anterior side. EdU proliferation assay confirmed the proliferation potential of the myofibroblasts (MFBs) in dislocated IOL-LCs. Primary cultured lens epithelial cells/MFBs isolated from the LC of dislocated IOLs could induce collagen matrix contraction and continuously proliferated, migrated, and induced ECM remodeling. Taken together, this indicates that long-lived MFBs of dislocated IOLs might contribute to the pathogenic mechanisms in late in-the-bag IOL dislocation.

Evaluation of Nd:YAG Laser Capsulotomy Rates in a Real-Life Population

Objective

The objective of this study was to assess the rate of posterior capsule opacification (PCO), under “real-life” conditions, as measured by rates of Nd:YAG laser intervention, rather than from a controlled study from which patients with conditions predisposing to PCO have been excluded.

Methods and Analysis

This was a retrospective, multicenter study in an unselected consecutive cohort of patients undergoing surgery for senile cataract. Patients aged 18 years and older, previously implanted with the CT LUCIA 611P IOL, were contacted at 12, 18 and 24 months to ascertain if they had received Nd:YAG laser treatment. There was an additional assessment at 36 months at the Austrian centre.

Results

A total of 200 patients were recruited at two centers. Laser capsulotomy rates were 4.5% at 1 year and 10% by year 2 and 12% by year 3. Three Nd:YAG capsulotomies, carried out at other external centers, were performed for reasons other than PCO, including astigmatism, epiretinal membrane and ARMD. If these patients are excluded, the true rate of Nd:YAG carried out for PCO at 1 year was 3.5% and at 2 years was 8.5%.

Conclusion

It is critical to ensure that Nd:YAG capsulotomies are being performed only for the correct clinical reason. Carrying out unnecessary procedures places the patient at risk of adverse events, is a cost to the healthcare system, and is likely to have no direct visual benefit for the patient. In PCO studies, it should be a requirement to document the fibrosis grade to confirm that Nd:YAG capsulotomy was correctly indicated.

German claims data analysis to assess impact of different intraocular lenses on posterior capsule opacification and related healthcare costs

Aim

Cataract extraction is one of the most frequent surgeries in Germany. In most cases, the clouded natural lens is replaced by a hydrophobic or hydrophilic acrylic intraocular lens (IOL) implant. The most common long-term complication after cataract surgery is the development of a posterior capsule opacification (PCO). Although no precise real world data are available, published evidence suggests a lower risk for PCO development for hydrophobic acrylic IOLs compared to hydrophilic acrylic IOLs. Therefore, in the present study we assessed real world data on the impact of different IOL material types on the incidence of post-operative PCO treatment.

Subject and methods

In this retrospective study, we included 3,025 patients who underwent cataract extraction and implantation of either an acrylic hydrophobic or hydrophilic IOL in 2010. We assessed clinical outcomes and direct costs in a 4-year follow-up period after cataract surgery from a statutory health insurance (SHI) perspective in Germany.

Results

PCO that required capsulotomies occurred significantly (p < 0.0001) less frequent in patients who had received a hydrophobic IOL (31.57% of 2,078 patients) compared to the group with hydrophilic IOL implants (56.6% of 947 patients) and costs per patient for postoperative treatment in a 4-year follow-up were 50.03 € vs. 87.81 € (i.e. 75% higher in the latter group, p < 0.0001).

Conclusion

Considering the high prevalence of cataract, the economic burden associated with adverse effects of cataract extraction is of great relevance for the German SHI. Hydrophobic lenses seem to be superior regarding both medical and economic results.

Comparison of clinical efficacy: Nd:YAG laser rates after implantation of AcrySof® SN60WF, Akreos® AO-MI60 and Hoya® YA-60BB

PURPOSE

To compare Nd:YAG laser rates following implantation of AcrySof(®) SN60WF (Alcon), Akreos(®) AO-MI60 (Baush & Lomb), and Hoya(®) YA-60BB (Hoya) intraocular lenses.

METHODS

This retrospective study was conducted at three French centers with each implanting at least two of the three implants. Included patients had undergone uncomplicated cataract surgery with at least 3 years of follow-up. Records of patients implanted with one of the three IOL's were drawn randomly from the surgical logs. Postoperative data were obtained from the medical records of either the surgeon or the referring physician. Time elapsing until Nd:YAG laser was analysed using Kaplan-Meier survival curves.

RESULTS

Three hundred eyes were implanted (AcrySof(®) 126, Akreos(®) 89, and Hoya(®) 85). AcrySof(®) recipients were the youngest (AcrySof(®) 72.1, Akreos(®) 76.4, and Hoya(®) 75.2 years of age: P=0.0007). The sex ratio was 4:6 male:female. Follow-up was longest for Hoya eyes (AcrySof(®) 29.4, Akreos(®) 24.6 and Hoya(®) 34.6 months; P=0.0002). Eyes implanted with AcrySof(®) had 1.74 times less chance of Nd:YAG laser treatment than Hoya eyes (P=0.0327) and 3.50 times less than Akreos(®) eyes (P<0.0001). The results remained unchanged when the analysis was restricted to events in the first 24 months (Risk Ratios: Hoya(®)=2.64: P=0.02; and Akreos(®)=4.22: P=0.0001). Adjustment on unbalanced confounding variables did not alter the results.

CONCLUSIONS

Eyes with AcrySof(®) implants required significantly fewer Nd:YAG laser capsulotomies than those with Hoya(®) and Akreos(®) implants and were therefore less subject to Nd:YAG laser treatment complications, thus ensuring better vision at the lowest cost.

Capsule membrane growth complicating glaucoma and corneal decompensation after neodymium:YAG capsulotomy

We report a case of progressive capsule membrane growth 4 months after neodymium:YAG capsulotomy for posterior capsule opacification. The clinical picture closely resembled epithelial ingrowth, but histology proved otherwise. Multiple operations were required to control glaucoma and capsule proliferation. However, the patient's visual potential was limited by corneal decompensation and glaucomatous damage.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Cost of cataract surgery after implantation of three intraocular lenses

Background:

Posterior capsule opacification is one of the most frequent adverse events following cataract surgery. This manuscript reports the lifetime cost of complications linked to posterior capsule opacification using three types of intraocular lens with square edges.

Methods:

Costs were estimated from a retrospective study of patients who underwent cataract surgery and data from the literature. The lenses studied were hydrophobic acrylic (SA60AT and AR40E) and hydrophilic acrylic (XL-Stabi) lenses with square edges. The frequency of Nd-Yag laser capsulotomies after 4 years’ survival was estimated by two methods: the first involved linear adjustment of the rate at 5 and 6 years follow-up and then application of a constant rate after 6 years; the second involved linear adjustment after 5 years follow-up. The economic perspective was that of the French Sickness Fund.

Results:

After 3 years’ follow-up the percentage of patients who had not undergone laser Nd-Yag capsulotomy was 86.9% with SA60AT, 76.6% with AR40E and 54.6% with XL-Stabi lenses (p < 0.001). The total cost of capsulotomy and management of complications per patient lifetime was estimated to be €90.5 for SA60AT, €189.5 for AR40E and €288.0 for XL-Stabi lenses by the first extrapolation method. With the second method of extrapolation the costs were €94.8, €200.0 and €300.2, respectively.

Interpretation:

Lower costs for cataract surgery and management of related complications were observed with the two hydrophobic acrylic lenses; the lowest costs were observed with SA60AT lenses as they were associated with fewer Nd-Yag laser capsulotomies.

Effect of topical prednisolone and diclofenac on the short-term change in morphology of posterior capsular opacification

PURPOSE

To observe and document the effect of steroidal and nonsteroidal antiinflammatory treatment on the formation of Elschnig pearls.

DESIGN

A prospective, randomized, double blinded, placebo controlled, two-way-cross-over study.

METHODS

Thirty-nine eyes of 32 patients with pronounced, regeneratory posterior capsule opacification (PCO) were included. The patients were treated topically with prednisolone and diclofenac (verum) or with lubricating eye drops (placebo) four times daily for one week. After a wash-out period of two weeks the patients received the contrary treatment also four times daily for one week. Digital retroillumination images were taken at day one, three, five, eight, and 15 of each medication period. The changes in the size of 4,675 Elschnig pearls were analyzed.

RESULTS

The mean cumulative area of all marked pearls/eye and follow-up was 1.2 mm(2) (range: 0.1 mm(2) to 3.2 mm(2)). The mean pearl size was 12,809 microm(2) (range: 60 microm(2) to 1.08 x 10(6) microm(2)). Between the follow-up examinations, 1,274 pearls disappeared (mean: 33 pearls/eye, range: five to 69 pearls; 27%) and 777 newly formed pearls appeared (mean: 20 pearls/eye, range: three to 53 pearls; 20%). There was no statistically significant difference in pearl size change and in number of disappeared and newly appeared pearls between the verum and the placebo treatments.

CONCLUSIONS

Topical prednisolone and diclofenac do not influence the short-term change of Elschnig pearls. Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly among eyes.

Long-term changes in the morphology of posterior capsule opacification

PURPOSE

To classify the morphologic appearance of posterior capsule opacification (PCO) and to observe and document the changes over longer periods of time.

SETTING

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

METHODS

Eighty-one pseudophakic eyes of 53 patients with PCO of varying degrees were included in this prospective study. Digital retroillumination images of the posterior capsule were taken in a standardized fashion 1, 2, and 3 years after cataract surgery. The PCO morphology was classified, and changes among the 3 follow-up images were analyzed.

RESULTS

At 1, 2, and 3 years, pearls occurred in 16 (20%), 41 (51%), and 57 (63%) eyes. Pearls increased in size and number. Cases with thin layers of PCO decreased from 53 to 33 to 16 eyes. Conversely, cases with thick layers increased from 18 to 45 and 64 eyes. "Cheese holes" appeared most frequently as the predominant structure (range 47% to 51%), followed by plates (range 28% to 31%), islands (range 15% to 20%), and traces of PCO (range 1% to 5%). Changes in expansion of the PCO area were observed in 61 eyes (75%) during period 1 (1 to 2 years) and period 2 (2 to 3 years). Regions of expansion and regression in the same eye occurred in periods 1 and 2 in 11 eyes (14%) and 9 eyes (11%), respectively. The phenomenon of thinning bridges, a regression of syncytial extensions of PCO, occurred in 22 eyes (27%) and 32 eyes (40%), respectively. An overlapping growth of 2 layers was observed in 18 eyes (22%).

CONCLUSIONS

The morphology of PCO is multifaceted. Apart from the Elschnig pearls, categories such as cheese holes, plates, islands, and traces of PCO were distinguished. Over the years, pearls increased in frequency, size, and number. Expansion and regression occurred simultaneously in some cases. Two or more layers grew on top of each other in some eyes.

Daily changes in the morphology of Elschnig pearls

PURPOSE

To observe and document the daily changes in the morphology of Elschnig pearls.

DESIGN

A prospective cohort study.

METHODS

Twenty-nine pseudophakic eyes with pronounced, regeneratory posterior capsule opacification (PCO) were included in this prospective study. Retroillumination images were taken at days 0, 1, 2, and 14. A square grid was laid over the images. Increase, decrease, appearance, and disappearance of pearls between the follow-up images were quantified.

RESULTS

A total of 1371 areas (mean: 53/eye) of 26 eyes were analyzed between days 0 and 1 and 1 and 2, and 896 areas (50/eye) of 18 eyes between days 0 and 14. Between days 0 and 1, days 1 and 2, and days 0 and 14, we observed "no change" in pearl size in 72%, 77%, and 32%, a "minor increase" in 16%, 14%, and 10%, a "major increase" in 4%, 3%, and 42%, a "minor decrease" in 14%, 11%, and 11%, and a "major decrease" in 4%, 3%, and 37%, respectively. Appearance of newly formed pearls was found in 1%, 1%, and 9% and disappearance of pearls in 1%, 1%, and 5%, respectively.

CONCLUSIONS

Significant changes in the morphology of Elschnig pearls were observed within time intervals of only 24 hours. Appearance and disappearance of pearls, as well as progression and regression of pearls within these short intervals illustrate the dynamic behavior of regeneratory PCO. These findings may contribute to a better understanding of PCO and have implications on pharmaceutical interventions for PCO.

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

PURPOSE

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

SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

YAG curios #1: repeat Nd:YAG laser posterior capsulotomy

A descriptive case series of five patients identified either opportunistically or from a retrospective review of the laser register is presented. All underwent cataract surgery between 1995 and 1999 and required initial Nd:YAG laser posterior capsulotomy 15-30 months after surgery. They subsequently developed reclosure of the capsulotomy, necessitating repeat laser capsulotomy 11-82 months later. One patient, who received a hydrogel intraocular lens, required a third capsulotomy after a further 12 months. The rate of repeat Nd:YAG laser capsulotomy in our unit was 0.31%.

YAG curios #2: Nd:YAG laser treatment following suction posterior capsulorhexis

Suction posterior capsulorhexis (SPC) is a relatively new technique for creating a posterior capsulorhexis. We present a case series of seven patients who required Nd:YAG laser treatment 27 months after SPC. No patient had pre-existing risk factors for increased postoperative inflammation and all received a one-piece polymethylmethacrylate intraocular lens placed in-the-bag. Although it reduces the need for Nd:YAG laser treatment, SPC, like the more usual forceps posterior capsulorhexis, does not completely eliminate it.

Adverse clinical consequences of neodymium:YAG laser treatment of posterior capsule opacification

PURPOSE

To evaluate the clinical consequences of complications from neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) over the lives of cataract patients.

SETTING

CHU de Caen, Caen, France.

METHODS

A model was constructed to estimate the lifetime clinical consequences of postoperative PCO treated by Nd:YAG laser capsulotomy. The probability of death was modeled from French mortality tables as a polynomial function of sex and age. The probability of becoming blind was modeled as a function of age from data in the literature. The incidence of Nd:YAG complications came from the literature. The rate of Nd:YAG capsulotomy over time was modeled as a survival curve using data from a cohort of 3335 patients.

RESULTS

Over 9 years in a 70-year-old population, switching from an IOL with a 20% Nd:YAG capsulotomy rate at 3 years to an IOL with a 5% rate would avoid 1 chronic intraocular pressure increase requiring medical follow-up in every 54 surgeries, 1 case of glaucoma in every 237 surgeries, 1 case of cystoid macular edema in every 265 surgeries, and 1 retinal detachment in every 265 surgeries. A 3-year clinical study would only capture one-third to one-half of long-term adverse events of Nd:YAG capsulotomy.

CONCLUSION

Reducing PCO and the associated use Nd:YAG laser capsulotomy may contribute to preserving visual acuity in patients over their lifetimes.

Use of Nd:YAG laser capsulotomy

Surgery for cataract removal has become successively refined such that posterior capsular opacification is the most common problem presenting after modern cataract extraction. Various techniques and treatments exist to manage patients with posterior capsular opacification using Nd:YAG capsulotomy. There are many possible variations in initial assessment, pre-laser treatments, laser techniques, and follow-up routines. The literature on the use of Nd:YAG laser for capsulotomy was reviewed and interpreted. This article presents the currently available knowledge in a format that allows the practitioner to tailor an evidence-based protocol for treating patients with symptomatic posterior capsule opacification.

Influence of intraocular lens material on regeneratory posterior capsule opacification after neodymium:YAG laser capsulotomy

PURPOSE

To evaluate the influence of a neodymium:YAG (Nd:YAG) laser capsulotomy on the morphology and development of regeneratory opacification of the remaining surrounding posterior capsule.

SETTING

Department of Ophthalmology, Medical School, University of Vienna, Vienna, Austria.

METHODS

Standardized digital retroillumination photographs were taken immediately before and after Nd:YAG laser capsulotomy and at 1 week, 6 months, and 1 to 3 years in 38 eyes of consecutive patients. Changes in regeneratory posterior capsule opacification (PCO) and opacification around the capsulotomy opening were evaluated. The influence of the type of intraocular lens (IOL) material and design (acrylic, n = 8; hydrogel, n = 8; silicone open loop, n = 11; silicone plate haptic, n = 6; poly(methyl methacrylate) [PMMA], n = 5) was assessed. The state of the anterior vitreous surface was examined at the slitlamp in all eyes.

RESULTS

In 8 of 17 eyes with a silicone IOL, reduced regeneratory PCO was observed. Massive pearl formation on the margin of the Nd:YAG capsulotomy was typical with silicone IOLs (8 eyes) but also occurred with PMMA IOLs. Eyes with acrylic IOLs had no change in regeneratory PCO after the capsulotomy. Three of 8 eyes with hydrogel IOLs had complete closure of the posterior capsulotomy opening.

CONCLUSIONS

Neodymium:YAG laser capsulotomy induced changes in the development and morphology of regeneratory PCO. Silicone and PMMA IOLs led to significant pearl formation on the capsulotomy margin, often combined with a reduction of peripheral regeneratory PCO (silicone). Hydrogel IOLs led to a higher incidence of reclosure of the Nd:YAG capsulotomy opening.

Elschnig pearl formation along the neodymium:YAG laser posterior capsulotomy margin. Long-term follow-up

PURPOSE

To examine the long-term occurrence and course of Elschnig pearl (string of pearls) formation along neodymium:YAG (Nd:YAG) laser posterior capsulotomy margins.

SETTING

Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

METHODS

The clinical records of eyes having an Nd:YAG posterior capsulotomy to treat posterior capsule opacification after cataract surgery were retrospectively reviewed. Kaplan-Meier and Cox proportional hazards analysis were performed.

RESULTS

Among 201 eyes, string of pearls developed in 139 (69.2%). The mean follow-up after the Nd:YAG posterior capsulotomy was 32.1 months +/- 25.3 (SD). At 2 years, the cumulative probability of developing string of pearls was 77.0% (95% confidence interval [CI], 70.6%-83.4%), after which it reached a plateau. Among the 139 eyes, 100 had sufficient data to be reviewed to assess the long-term outcome (mean follow-up from Nd:YAG posterior capsulotomy, 43.7 +/- 26.0 months). A second Nd:YAG posterior capsulotomy was performed in 18 eyes (18.0%) to treat progression of string of pearls, typically within 2 years after the initial Nd:YAG capsulotomy. The string of pearls disappeared spontaneously in 31 eyes (31.0%). The probability of disappearance was 80.4% (95% CI, 63.4%-97.4%) 8 years after the Nd:YAG posterior capsulotomy. Cox proportional hazards analysis identified no factor significantly favoring the disappearance of the string of pearls.

CONCLUSIONS

String of pearls was a common complication after Nd:YAG laser posterior capsulotomy. About 20% of cases were progressive and required a second capsulotomy; however, most regressed over several years.

Evaluation of 3 modern single-piece foldable intraocular lenses: clinicopathological study of posterior capsule opacification in a rabbit model

PURPOSE

To assess the development of posterior capsule opacification (PCO) with 3 modern single-piece foldable intraocular lenses (IOLs) in a histopathological study and to compare the potential preventive effects of the IOL design and biomaterial in retarding PCO.

SETTING

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

METHODS

Thirty-one rabbit eyes were randomly operated on with phacoemulsification and implantation of 3 single-piece foldable lenses: a hydrophilic acrylic design, the Rayner Centerflex 570H (n = 11); a hydrophobic acrylic design, the Alcon AcrySof SA30AL (n = 10); and a silicone large-hole plate design, the Staar AA-4203VF (n = 10). Central PCO (CPCO), peripheral PCO (PPCO), and Soemmering's ring formation were evaluated 3 weeks after surgery using the Miyake-Apple posterior photographic technique. Histological sections of each globe were prepared to document capsular bag status and performance of IOL geometry.

RESULTS

The acrylic IOLs (Centerflex and AcrySof) had lower CPCO and PPCO scores than the silicone plate IOL (P <.05). There was no significant difference in Soemmering's ring formation among the 3 models. Pathological evaluations revealed effective blockage of migrating lens epithelial cells (LECs) at the site of the truncated optic edge of the Centerflex and AcrySof IOLs, even in the presence of large amounts of retained/regenerative cortical material.

CONCLUSIONS

The AcrySof IOL has a hydrophobic surface and the Centerflex a hydrophilic surface, but no correlation to these characteristics could be identified. The single-piece AcrySof optic geometry created a clear-cut barrier effect equal to that of its 3-piece predecessor. The anatomic profile of the Centerflex IOL shows the same characteristics. The optics of both acrylic lenses have square truncated edges that functionally block ingrowth of migrating LECs toward the central visual axis, leaving clear posterior capsules. The square optic edge was an appropriate geometric configuration to create a barrier effect. There was no effect of the biomaterial on PCO prevention.

Secondary closure of neodymium:YAG laser posterior capsulotomy

A 67-year-old man reported reduced vision after cataract surgery and neodymium:YAG (Nd:YAG) laser posterior capsulotomy. The diagnosis was complicated due to severe glistenings within the optic of an acrylic foldable intraocular lens (IOL), proliferation of lens epithelial remnants over the capsulotomy opening, and presumed vitreous opacity. Although IOL exchange surgery was considered, a second Nd:YAG laser intervention successfully removed the proliferated lens materials and restored the visual acuity. The glistenings were not the cause of the reduced vision.

Surgical prevention of posterior capsule opacification. Part 1: Progress in eliminating this complication of cataract surgery

PURPOSE

To evaluate over almost 2 decades the success of a component of cataract surgery that represents a critical step in reducing the incidence of posterior capsule opacification (PCO); namely, the efficacy of cortical cleanup.

SETTING

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

METHODS

Accessioned from the early 1980s to 1997, 3320 eyes obtained postmortem with posterior chamber intraocular lenses were analyzed with respect to formation of a postoperative Soemmering's ring. This anatomic lesion, the precursor of clinical PCO, represents an important and measurable indication of the quality of cortical cleanup. Its formation was documented using Miyake-Apple posterior photographic analysis.

RESULTS

The quality and thoroughness of cortical cleanup and overall effectiveness in eliminating retained and/or regenerating cortical cells, as measured by scoring of Soemmering's rings, showed virtually no net change since the early 1980s. The intensity of Soemmering's ring was higher in the most recent specimens than in those in the early 1980s.

CONCLUSION

The results indicate that renewed attention to cortical cleanup in cataract surgery is warranted for significant reduction in incidence or the elimination of PCO. More attention to the hydrodissection (cortical cleaving hydrodissection) step of the procedure is likely a practical, immediately implementable, and inexpensive remedy.

Capsular opacification after cataract surgery

Posterior-capsule opacification, by far the most common complication of primary cataract surgery, continues to stimulate important work toward understanding its causes, preventing it, and effectively treating it. Of special note here are a report by Koch and Kohnen that a combination of vitrectomy and posterior capsulorhexis is required to inhibit posterior-capsule opacification in pediatric patients; work by Nishi et al. toward the dream of replacing the cataractous lens with a flexible artificial lens, supported by the natural capsular bag; and methods by Tetz et al. and Pande et al. for precise quantification of posterior-capsule opacification.