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An S, Raju I, Surenkhuu B, Kwon JE, Gulati S, Karaman M, Pradeep A, Sinha S, Mun C, Jain S. Neutrophil extracellular traps (NETs) contribute to pathological changes of ocular graft-vs.-host disease (oGVHD) dry eye: Implications for novel biomarkers and therapeutic strategies. Ocul Surf 2019; 17:589-614. [PMID: 30965123 PMCID: PMC6721977 DOI: 10.1016/j.jtos.2019.03.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the role of neutrophil extracellular traps (NETs) and NET-associated proteins in the pathogenesis of oGVHD and whether dismantling of NETs with heparin reduces those changes. METHODS Ocular surface washings from oGVHD patients and healthy subjects were analyzed. Isolated peripheral blood human neutrophils were stimulated to generate NETs and heparinized NETs. We performed in vitro experiments using cell lines (corneal epithelial, conjunctival fibroblast, meibomian gland (MG) epithelial and T cells), and in vivo experiments using murine models, and compared the effects of NETs, heparinized NETs, NET-associated proteins and neutralizing antibodies to NET-associated proteins. RESULTS Neutrophils, exfoliated epithelial cells, NETs and NET-associated proteins (extracellular DNA, Neutrophil Elastase, Myeloperoxidase, Oncostatin M (OSM), Neutrophil gelatinase-associated lipocalin (NGAL) and LIGHT/TNFSF14) are present in ocular surface washings (OSW) and mucocellular aggregates (MCA). Eyes with high number of neutrophils in OSW have more severe signs and symptoms of oGVHD. NETs (and OSM) cause epitheliopathy in murine corneas. NETs (and LIGHT/TNFSF14) increase proliferation of T cells. NETs (and NGAL) inhibit proliferation and differentiation of MG epithelial cells. NETs enhance proliferation and myofibroblast transformation of conjunctival fibroblasts. Sub-anticoagulant dose Heparin (100 IU/mL) dismantles NETs and reduces epithelial, fibroblast, T cell and MG cell changes induced by NETs. CONCLUSION NETs and NET-associated proteins contribute to the pathological changes of oGVHD (corneal epitheliopathy, conjunctival cicatrization, ocular surface inflammation and meibomian gland disease). Our data points to the potential of NET-associated proteins (OSM or LIGHT/TNFSF14) to serve as biomarkers and NET-dismantling biologics (heparin eye drops) as treatment for oGVHD.
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Affiliation(s)
- Seungwon An
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Ilangovan Raju
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Bayasgalan Surenkhuu
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Ji-Eun Kwon
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Shilpa Gulati
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Muge Karaman
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Anubhav Pradeep
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | | | - Christine Mun
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Sandeep Jain
- Cornea Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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Ng L, Monagle K, Monagle P, Newall F, Ignjatovic V. Topical use of antithrombotics: review of literature. Thromb Res 2015; 135:575-81. [PMID: 25704903 DOI: 10.1016/j.thromres.2015.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/26/2014] [Accepted: 01/02/2015] [Indexed: 12/17/2022]
Abstract
While antithrombotics are usually administered intravenously, subcutaneously or orally, there are a number of publications reporting topical application of anticoagulation therapy. This paper aims to review the available literature regarding clinical conditions, the details of the topical antithrombotic treatment, as well as positive or adverse effects in an attempt to ascertain the safety and efficacy of this form of treatment. Published literature was searched to identify publications reporting the use of antithrombotic treatments administered via topical application between 1st January 1990 and 1st January 2013. There were 43 studies reported in 10 different clinical conditions. Majority of the studies were randomized controlled trials (51.2%), prospective studies (18.6%) or case reports (11.6%). The clinical conditions in which topical antithrombotics were administered included: microangiopathy, acute haemorrhoids, periodontitis, dermatitis, burns, ocular conditions and surgery, blunt force impact, scars, as well as clinical conditions associated with superficial venous thrombosis (SVT). The most commonly used topical antithrombotic was heparin (79.1% of studies). The respective dosage of different antithrombotics varied depending on specific clinical conditions. While most studies reported mean improvements or resolution of symptoms/condition in patients, the patient outcomes were variable. This review demonstrates that topical antithrombotic treatment is used according to a wide variety of protocols, with a subsequent variability in patient outcomes. Specific guidelines for the use of topical antithrombotics should be developed to standardize this form of treatment and ensure the best possible outcomes for patients.
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Affiliation(s)
- Leanne Ng
- Haematology Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Kate Monagle
- Haematology Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Clinical Haematology, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia
| | - Fiona Newall
- Haematology Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Clinical Haematology, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Nursing Research, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Nursing, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, VIC 3052, Australia.
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Matsushima H, Iwamoto H, Mukai K, Katsuki Y, Nagata M, Senoo T. Preventing secondary cataract and anterior capsule contraction by modification of intraocular lenses. Expert Rev Med Devices 2014; 5:197-207. [DOI: 10.1586/17434440.5.2.197] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Malleter M, Jacquot C, Rousseau B, Tomasoni C, Ducourneau D, Tourette P, Pineau A, Roussakis C. Study of antiproliferative effects of synthetic substances against lens epithelial cell line (SRA 01/04). J Ocul Pharmacol Ther 2012; 28:299-306. [PMID: 22235844 DOI: 10.1089/jop.2011.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A cataract is a clouded area of the eye, which impairs vision. Cataracts can be caused by a natural hardening of the lens in the elderly, or may be the result of eye injury. However there is a treatment by extracapsular surgery, almost 50% of operations are followed by another posterior capsule opacification. This secondary cataract is due to abnormal cellular proliferation. Pharmacologic inhibition of this cellular proliferation would be a very promising treatment. The objective of our study is to test some antiproliferative drugs, less toxic than those currently used such as 5-FU or mytomycin C. We have investigated the in vitro effects of several molecules (V0 and its derivatives) on a proliferative human lens epithelial cell line (SRA 01/04). During a first step, we have measured the IC50 of each molecule. After this first screening, we have studied the kinetic of the cell growth with or without the molecules at different concentration. Then, flow cytometry was used to determine the phase of the cell cycle at which the proliferation stopped. This study has shown that 3 molecules V19, V1, and A190 have an interesting profile in vitro and were selected to analyze their mechanism of action.
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Affiliation(s)
- Marine Malleter
- Université de Nantes, Nantes Atlantique Université, IICIMED/ERT-A0902, Cancer du Poumon et Cibles Moléculaires (CPCM), UFR des Sciences Pharmaceutiques, Nantes, France
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Abstract
BACKGROUND Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO. OBJECTIVES To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions. SEARCH STRATEGY We searched CENTRAL, MEDLINE, EMBASE, LILACS in March 2009 and reference lists of identified trial reports. SELECTION CRITERIA We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices and pharmacological therapy compared to each other, placebo or standard treatment. DATA COLLECTION AND ANALYSIS We extracted data and entered it into RevMan. We compared visual acuity data, PCO scores and YAG capsulotomy rates and performed a meta-analysis when possible. MAIN RESULTS Sixty six studies were included in the review. The review was divided into three parts. 1. Influence of IOL optic material on the development of PCO. There was no significant difference in PCO development between the different IOL materials (PMMA, hydrogel, hydrophobic acrylic, silicone) although hydrogel IOLs tend to have higher PCO scores and silicone IOLs lower PCO scores than the other materials. 2. Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however not between 1-piece and 3-piece IOLs. 3. Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intraoperative/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) which led to a significantly lower PCO rate. AUTHORS' CONCLUSIONS Due to the highly significant difference between round and sharp edged IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.
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Affiliation(s)
- Oliver Findl
- Hanusch HospitalDepartment of OphthalmologyHeinrich‐Collin‐Strasse 30ViennaAustriaA‐1140
| | - Wolf Buehl
- Medical University of ViennaDepartment of OphthalmologyWähringer Gürtel 18‐20ViennaAustria1090
| | - Peter Bauer
- Medical University of ViennaInstitute of Medical StatisticsSpitalgasse23ViennaAustriaA‐1090
| | - Thomas Sycha
- Medical University of ViennaDepartment of NeurologyWähringer Gürtel 18‐20ViennaAustriaA‐1090
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Walker TD. Pharmacological attempts to reduce posterior capsule opacification after cataract surgery - a review. Clin Exp Ophthalmol 2008; 36:883-90. [DOI: 10.1111/j.1442-9071.2009.01921.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however, this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO. OBJECTIVES To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions. SEARCH STRATEGY We searched CENTRAL, MEDLINE, EMBASE, LILACS in January 2007 and reference lists of identified trial reports. SELECTION CRITERIA We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices, and pharmacological therapy, compared to each other, placebo or standard treatment. DATA COLLECTION AND ANALYSIS Data were extracted and entered into Review Manager. Visual acuity data, PCO score and YAG capsulotomy rates were compared and a meta-analysis was performed when possible. MAIN RESULTS Fifty three studies were included in the review. The review was divided into three parts. (1) Influence of IOL optic material on the development of PCO. Compared to other materials, the meta-analysis of the included studies showed a significantly higher PCO score (overall effect: 12.39 (95% confidence interval: 9.82 to 14.95), scale 0 to 100) and YAG rate (odds ratio: 8.37 (3.74 to 20.36)) only in hydrogel IOLs. (2) Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however, not between 1-piece and 3-piece IOLs. (3) Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intra-/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) leading to a significantly lower PCO rate. AUTHORS' CONCLUSIONS Due to the highly significant difference between round and sharp edge IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials, except for hydrogel IOLs, that showed more PCO than the other materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.
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Affiliation(s)
- O Findl
- Medical University of Vienna, Department of Ophthalmology, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, Vienna, Austria, A-1090.
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Tetz M, Wildeck A. Evaluating and defining the sharpness of intraocular lenses. J Cataract Refract Surg 2005; 31:2172-9. [PMID: 16412935 DOI: 10.1016/j.jcrs.2005.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop a new method for the evaluation of the optic edge design of intraocular lenses (IOLs). SETTING Charité Humboldt University and Berlin Eye Research Institute (Beri), Berlin, Germany. METHODS Poly(methyl methacrylate) IOLs with 11 edge designs were manufactured. Each lens design was evaluated using EPCO 2000. Also, edge's ability to stop cell growth was observed by placing each IOL into cell culture and observing cell growth over 18 days on average. RESULTS Only 3 groups, those with the sharpest edge design, prevented the growth of lens epithelial cells onto the visual axis of the lens. The edge design that effectively stopped cell growth was characterized by an area above the edge of 13.5 microm2 at the most. CONCLUSION Results shows that the edge design of IOLs plays an important role in the prevention of posterior capsule opacification. A specific optic edge design was most effective in this prevention.
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Affiliation(s)
- Manfred Tetz
- Berlin Eye Research Institute (Beri), Berlin, Germany.
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9
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Matsushima H, Mukai K, Gotoo N, Yoshida S, Yoshida T, Sawano M, Senoo T, Obara Y, Clark JI. The Effects of Drug Delivery Via Hydrophilic Acrylic (Hydrogel) Intraocular Lens Systems on the Epithelial Cells in Culture. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050901-07] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Barequet IS, Wygnanski-Jaffe T, Sachs D. Effect on Posterior capsule opacification of topical diclofenac sodium vs dexamethasone phosphate after cataract surgery. ACTA ACUST UNITED AC 2002. [DOI: 10.1007/s12009-002-0044-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Belkacémi Y, Touboul E, Méric JB, Rat P, Warnet JM. [Radiation-induced cataract: physiopathologic, radiobiologic and clinical aspects]. Cancer Radiother 2001; 5:397-412. [PMID: 11525197 DOI: 10.1016/s1278-3218(01)00111-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cataractogenesis is a widely reported late effect of irradiated crystalline lens. In this review the authors discussed the different aspects of radiation cataract pathogenesis, and the different mechanisms involved in the lens opacification, particularly the epithelium modifications such as epithelial cell death. The authors also reported the influence of radiation exposure on cataract formation following total body irradiation (TBI) and autologous or allogeneic bone marrow transplantation for hematologic malignancies. Moreover, the radiobiological parameters are not studied for the crystalline lens of human. We applied for the first time the linear-quadratic (LQ) and biological effective dose (BED) concept to TBI data. The calculated value of alpha/beta of 1 Gy is in the range of the values reported for the other late responding tissues. The other risk factors for cataract development after TBI such as age, gender, central nervous system boost, long-term steroid therapy and heparin administration are discussed. In terms of cataract or sicca syndrome prevention, numerous compounds have been successfully tested in experimental models or used for the prevention of radiation-induced xerostomia in patients treated for head and neck cancer. However, none of them has been clinically evaluated for ocular radiation late effects prevention. In this report the authors discussed some of the radioprotectors potentially interesting for radiation-induced cataract or sicca syndrome prevention.
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Affiliation(s)
- Y Belkacémi
- Laboratoire de toxicologie, UFR pharmacie, université Paris V. Unité de pharmacotoxicologie cellulaire, service pharmacie, 75012 Paris, France.
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Oner FH, Gunenc U, Ferliel ST. Posterior capsule opacification after phacoemulsification: foldable acrylic versus poly(methyl methacrylate) intraocular lenses. J Cataract Refract Surg 2000; 26:722-6. [PMID: 10831903 DOI: 10.1016/s0886-3350(99)00456-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the effects of foldable acrylic and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation on posterior capsule opacification (PCO). SETTING Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey. METHODS This consecutive series comprised 157 eyes having phacoemulsification with implantation of a foldable acrylic IOL with rectangular optic edges and a 5.5 mm optic (AcrySof) (n = 80 eyes) or a PMMA IOL with rounded optic edges and 5.5 mm optic (n = 77). Evaluated were incidence, location, and degree of PCO. Mean postoperative follow-up was 17.8 months +/- 1.7 (SD) (range 16 to 22 months). RESULTS Posterior capsule opacification occurred in 8.7% of eyes in the foldable acrylic IOL group and in 24.7% of eyes in the PMMA IOL group. The difference between the 2 groups was statistically significant (P < .01). Centrally located PCO was significantly lower in the acrylic group (P < .01). There were 3 eyes with severe PCO in the PMMA group and none in the acrylic group. Anterior capsule contraction and fibrosis were present in 4 eyes in the PMMA group but none in the acrylic group. Soemmering's ring cataract formation was detected in 3 eyes, all with the AcrySof IOL. CONCLUSION In addition to its optic material and rectangular optic edges, the AcrySof IOL provides additional advantages in lowering the incidence of PCO compared with rounded-edge PMMA IOLs.
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Affiliation(s)
- F H Oner
- Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey.
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Abstract
The incidence of posterior capsule opacification (PCO), the most common complication of modern cataract surgery with intraocular lens implantation, seems to have decreased slightly as a result of improved surgical and cortical cleanup techniques. However, the reported incidence is still significant. The diverse findings on PCO are the result in part of studies using different criteria to clinically judge and quantify the condition. In addition, the influence of intraocular and systemic factors are only now being identified. This second of a 2-part review of PCO focuses on (1) less subjective morphological and patient-dependent means to evaluate and quantify PCO; (2) the influence of ocular factors on PCO; (3) the influence of systemic factors on PCO; (4) available means and approaches to prevent or delay PCO.
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Affiliation(s)
- M R Tetz
- Department of Ophthalmology, Humboldt University Berlin, Germany
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15
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Ram J, Apple DJ, Peng Q, Visessook N, Auffarth GU, Schoderbek RJ, Ready EL. Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part II: Choosing the correct haptic fixation and intraocular lens design to help eradicate posterior capsule opacification. Ophthalmology 1999; 106:891-900. [PMID: 10328386 DOI: 10.1016/s0161-6420(99)00506-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Posterior capsule opacification (PCO) is one of the most common complications of cataract surgery, and there is an urgent need to reduce its incidence. Its main treatment, neodymium:YAG (Nd:YAG) laser posterior capsulotomy, may be associated with significant morbidity and is expensive. In this study, the authors ascertain the effect of posterior chamber intraocular lens (PC-IOL) fixation and various IOL designs (rigid polymethyl methacrylate [PMMA] optic and small-incision foldable designs) on the pathogenesis of PCO. DESIGN Prospective analysis of pseudophakic eyes obtained postmortem. PARTICIPANTS A total of 3493 eyes with PC-IOLs obtained postmortem and received between 1984 and 1998. METHODS Miyake-Apple posterior photographic technique. MAIN OUTCOME MEASURES Peripheral Soemmering's ring, central PCO in the visual axis, and eyes that have had Nd:YAG laser posterior capsulotomy were analyzed and scored, and these findings were correlated with the type of fixation and IOL design. RESULTS The degree of formation of peripheral Soemmering's ring was not influenced by IOL fixation. The acrylic design revealed relatively low Soemmering's ring scores. In contrast, central PCO and Nd:YAG laser capsulotomy scores were consistently influenced by fixation. The scores were significantly lower in eyes with in-the-bag fixation. The bag-bag fixated acrylic-PMMA design and the three modern silicone IOL designs analyzed in this study had less central PCO and lower posterior capsulotomy scores than did the PMMA IOLs. CONCLUSIONS The formation of peripheral PCO (the Soemmering's ring), the precursor of clinically significant, vision-threatening PCO, is not significantly influenced by the haptic fixation pattern. It is much more dependent on the quality and thoroughness of surgical cortical cleanup. Reduction of Soemmering's ring is an important goal because the retained regenerative cortical cells within this lesion are the cells of origin of PCO. The acrylic IOL design was associated with a lessor amount of peripheral Soemmering's ring as compared with all other designs. In sharp contrast to peripheral PCO, fixation of the IOL was a highly significant factor affecting the formation and quantity of central PCO-the clinically significant opacity behind the IOL optic, measured in this series either by scoring an intact retro-optical membrane or by documenting the presence of a Nd:YAG laser posterior capsulotomy orifice. The quantity of central PCO was consistently much lower in eyes with in-the-bag fixated IOLs compared with lenses with one or both haptics out of the bag. This is best explained by the fact that secure in-the-bag fixation positions the IOL optic in the best possible position to create a barrier effect. The lowest PCO rates were generally noted with the acrylic and modern silicone IOL designs.
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Affiliation(s)
- J Ram
- Post-Graduate Institute of Medical Education & Research, Chandigarh, India
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Clark DS, Munsell MF, Emery JM. Mathematical model to predict the need for neodymium: YAG capsulotomy based on posterior capsule opacification rate. J Cataract Refract Surg 1998; 24:1621-5. [PMID: 9850901 DOI: 10.1016/s0886-3350(98)80353-2] [Citation(s) in RCA: 12] [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
PURPOSE To evaluate a model to project the estimated time required before patients having primary phacoemulsification require neodymium:YAG (Nd:YAG) laser capsulotomy. SETTING Eleven private practices in the United States. METHODS Projections of time to capsulotomy were based on assessment of the early development of posterior capsule opacification (PCO) over time. The PCO data were collected during a clinical study to evaluate MDX-RA, an investigational immunotoxin designed to limit epithelial cell growth, preventing postsurgical PCO. From the PCO data, the estimated time to Nd:YAG capsulotomy in a placebo-treated group was compared with the actual time to capsulotomy in a cohort of patients from general practice who had had phacoemulsification. RESULTS By 6 months, the mean Opacification Index in the MDX-RA group was significantly lower than that in the placebo group (P < .05) and it remained significantly lower at 12 (P < .001), 18 (P < .001), and 24 (P < .016) months. The rate of PCO in the MDX-RA group was approximately 6 times lower than that in the placebo group (P < .0004). Fifty-seven percent in the placebo group and 4% in the MDX-RA group were projected to require an Nd:YAG capsulotomy within 3 years of primary cataract surgery. Projected values for the placebo group were similar to actual values observed in the population-based cohort. CONCLUSIONS This technique could be used to predict the need for Nd:YAG capsulotomy using early measurements of PCO.
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Affiliation(s)
- D S Clark
- Medarex, Annandale, New Jersey 08801-0953, USA
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