Posterior capsule opacification

The lens epithelium as a major determinant in the development, maintenance, and regeneration of the crystalline lens

The crystalline lens is a transparent and refractive biconvex structure formed by lens epithelial cells (LECs) and lens fibers. Lens opacity, also known as cataracts, is the leading cause of blindness in the world. LECs are the principal cells of lens throughout human life, exhibiting different physiological properties and functions. During the embryonic stage, LECs proliferate and differentiate into lens fibers, which form the crystalline lens. Genetics and environment are vital factors that influence normal lens development. During maturation, LECs help maintain lens homeostasis through material transport, synthesis and metabolism as well as mitosis and proliferation. If disturbed, this will result in loss of lens transparency. After cataract surgery, the repair potential of LECs is activated and the structure and transparency of the regenerative tissue depends on postoperative microenvironment. This review summarizes recent research advances on the role of LECs in lens development, homeostasis, and regeneration, with a particular focus on the role of cholesterol synthesis (eg., lanosterol synthase) in lens development and homeostasis maintenance, and how the regenerative potential of LECs can be harnessed to develop surgical strategies and improve the outcomes of cataract surgery (Fig. 1). These new insights suggest that LECs are a major determinant of the physiological and pathological state of the lens. Further studies on their molecular biology will offer possibility to explore new approaches for cataract prevention and treatment.

Circ-POLR3A accelerates TGF-β2-induced promotion in cell viability, migration, and invasion of lens epithelial cells via miR-31/TXNIP signaling cascade

Posterior capsular opacification (PCO) is the major complication after cataract surgery and can result in secondary vision loss. Circular RNAs (circRNAs) are reported to play critical regulatory roles in multiple cell biological processes. The most common working mechanism of circRNAs is by acting as microRNA sponges. Here, we analyzed the role and mechanism of circRNA RNA polymerase III subunit A (POLR3A) in PCO. Cell viability was analyzed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Cell motility was assessed by transwell and wound healing assays. Dual-luciferase reporter and RNA-pull-down assays were performed to verify the interaction between microRNA-31 (miR-31) and circ-POLR3A or thioredoxin interacting protein (TXNIP). PCO cell model was established by treating SRA01/04 cells with transforming growth factor-β2 (TGF-β2). We found that TGF-β2 enhanced SRA01/04 cell viability, migration, and invasion abilities. Circ-POLR3A expression was upregulated in PCO tissues and TGF-β2-induced SRA01/04 cells. TGF-β2 promoted the viability and motility of SRA01/04 cells largely by upregulating circ-POLR3A. Circ-POLR3A negatively regulated the miR-31 level by directly interacting with it. Circ-POLR3A absence-induced influences in TGF-β2-induced SRA01/04 cells were partly reversed by silencing miR-31. miR-31 is directly bound to the 3'-untranslated region of TXNIP. TXNIP overexpression largely attenuated miR-31 overexpression-mediated effects in TGF-β2-induced SRA01/04 cells. Circ-POLR3A could elevate the protein expression of TXNIP by sponging miR-31. Exosomes were involved in mediating the delivery of circ-POLR3A in SRA01/04 cells. In conclusion, circ-POLR3A contributed to TGF-β2-induced promotion of cell viability, migration, and invasion of SRA01/04 cells by targeting miR-31/TXNIP axis.

Long-term prevention of capsular opacification after lens-refilling surgery in a rabbit model

Purpose

To reduce capsular opacification by a peri‐surgical treatment of the lens capsule with drugs in an in vivo rabbit model. Lens‐refilling surgery is a potential therapeutic intervention to treat patients with a cataract lens. The lens material is replaced with an injectable (bio)polymer that retains the natural mechanical and optical lens properties, therewith allowing accommodation. The occurrence of capsular opacification mediated by lens epithelial cells negatively affects accommodation and vision and should be avoided in this lens restoration approach.

Methods

An in vivo rabbit animal model was used with lens replacement with a silicone‐based gel‐like polymer and concurrent treatment of the lens epithelium with drugs. A case‐study approach was applied as both drug combinations and implantation times were varied. The following drugs were investigated for their potential to prevent capsular opacification long‐term: actinomycin D, methotrexate, paclitaxel and Tween‐20. All were administered in a hyaluronic acid vehicle. The rabbits were clinically followed for periods up to 4 years postimplantation. Eyes, corneas and lenses were analysed post‐mortem using MRI and confocal microscopy.

Results

Treatment combinations containing actinomycin D generally led to the least appearance of capsular fibrosis. The use of Tween‐20 or paclitaxel without actinomycin D resulted in much earlier and pronounced fibrotic responses. The aspect of capsular opacification was highly variable in individual animals. Application of the drugs in a hyaluronic acid vehicle appeared to be a safe method that spared the corneal endothelium.

Conclusion

The feasibility of long‐term prevention of fibrosis over a period of more than 4 years has been demonstrated in lens refilling in the rabbit model.

MicroRNA-34a suppresses human lens epithelial cell proliferation and migration via downregulation of c-Met

MicroRNAs (miRNAs) are endogenously expressed, non-coding, small RNAs which inhibit protein translation through binding to target mRNAs. Recent studies have demonstrated that miRNAs participate in the regulation of a variety of cell structures and functions including those for cell proliferation and migration. MicroRNA-34a (miR-34a), a potential effector of the p53 tumor suppressor gene, is extensively studied for its suppression of cell growth. In the present study, we investigated the function of miR-34a in human lens epithelial cells. Following confirming that miR-34a expression was increased in a P53 dependent manner in human lens epithelial cells after treatment with doxorubicin, we demonstrated that overexpression of miR-34a in the human lens epithelial cell line HLE B3 led to a significant decrease in cell proliferation and migration, with the use of MTS and transwell migration assays. Moreover, HGF enhanced the proliferation and migration of human lens epithelial cells. miR-34a was found to downregulate the expression of c-Met protein by Western blotting. Furthermore, overexpression of miR-34a downregulated the levels of phosphorylated Akt, phosphorylated ERK1/2 and other cell cycle regulators. miR-34a expression was significantly reduced in posterior capsule opacification (PCO) clinical samples. These results demonstrate that miR-34a may act as a suppressor in PCO by regulating human lens epithelial cell proliferation and migration through downregulation of c-Met.

Predictors of Successful Laser Capsulotomy for Significant Posterior Capsule Opacification after Phacoemulsification

Purpose:

This study aimed to determine the reasons behind the failure of laser capsulotomy (LC) performed for significant posterior capsular opacification (PCO).

Methods:

Eighty-eight eyes of 88 patients referred for LC at a tertiary care center were retrospectively analyzed. The data recorded included the cause of cataract, visual acuity, duration of PCO, location of PCO, intraocular lens (IOL) position, IOL type, and lens capsule status. These data were later analyzed for determining the requirement of high pulse energy during LC and the success rate of primary LC.

Results:

The mean age of the participants was 55.77 ± 18.60 years with 58 (65.9%) male patients. The mean duration between cataract and LC surgeries was 45.58 ± 37.33 months. Senile (n=58), uveitic (n=12), post-pars plana vitrectomy (PPV) (n=12), and traumatic (n=6) cataracts were the common causes. Late-presenting PCO, trauma, uveitis, sulcus placement of IOLs, irregular capsulorhexis shape, and polymethyl methacrylate (PMMA) IOLs were significantly associated with unsuccessful LC and/or higher pulse energy settings during LC.

Conclusion:

Significant PCO is often associated with cataract caused by uveitis or trauma, and after PPV. PCO associated with trauma, sulcus placement of IOLs, and PMMA IOLs may need multiple LCs.

A new endocapsular open ring for prevention of anterior and posterior capsule opacification

PURPOSE

The aim of this study is to demonstrate the functionality of a new design of a thick endocapsular open ring for prevention of anterior capsule opacification (ACO) and posterior capsule opacification (PCO).

SETTING

The Institute of Vision and Optics, University of Crete and University Hospital of Heraklion, Crete, Greece.

DESIGN

Prospective, interventional pilot study.

METHODS

Fifteen patients (17 eyes) underwent cataract surgery with phacoemulsification. During surgery, a thick endocapsular open ring (peripheral capsule reconstructor) was inserted into the capsular bag, prior to intraocular lens (IOL) implantation. Six different models of IOL were implanted. Postoperatively, the degree of ACO and PCO was evaluated and described as none, mild, moderate, or severe.

RESULTS

The mean follow-up period was 30±8.06 months (range: 12-36 months). At the last follow-up, mild PCO was observed in only three eyes and mild ACO in three patients. The centration of IOLs was good in all but one eye, which had a tilted IOL.

CONCLUSION

The results of this pilot study suggest that the implantation of a new design of thick endocapsular open ring is feasible and may contribute to the prevention of PCO and ACO after cataract surgery.

Economic considerations related to choice of intraocular lens (IOL) and posterior capsule opacification frequency - a comparison of three different IOLs

PURPOSE

To evaluate the posterior capsule opacification (PCO) rates in three different modern standard intraocular lenses (IOL) and analyse the related cost.

METHODS

Retrospective study of medical records from 1527 patients who underwent uneventful cataract surgery by phacoemulsification with posterior chamber implantation of either AcrySof SN60 (n = 375), Akreos Adapt (n = 350) or Tecnis Acryl IOL (n = 801). All surgeries were performed by the same surgeon using the same surgical technique and equipment. Primary end-point was neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy for visual impairment secondary to PCO. Cost of IOL material and Nd:YAG capsulotomy for PCO was then evaluated and compared between the IOLs.

RESULTS

Mean follow-up was 41.5 months, and the only statistically significant variable of developing PCO was IOL type and individual follow-up time. Nd:YAG capsulotomy was performed in 7.47% in the AcrySof group, 17.71% in the Akreos group and 3.75% in the Tecnis group. Average cost for Nd:YAG capsulotomy per surgery was €18.75 in the AcrySof SN60 group, €44.25 in the Akreos Adapt group and €9.25 in the Tecnis Acryl group. The combined cost of cataract surgery and PCO treatment was €9.81 higher in for the Akreos Adapt group than the other two combined.

CONCLUSIONS

This retrospective study shows that the risk of PCO and Nd:YAG capsulotomy is significantly higher in hydrophilic Akreos IOL compared with both AcrySof and Tecnis hydrophobic IOLs. The increased risk of PCO in the hydrophilic IOL is related to higher total average costs for cataract surgery.

RNA Interference Targeting Snail Inhibits the Transforming Growth Factor β 2-Induced Epithelial-Mesenchymal Transition in Human Lens Epithelial Cells

Epithelial-msenchymal transition (EMT) contributes to posterior capsule opacification (PCO) type of cataract. Transcription factors Snail is a key trigger of EMT activated by transforming growth factor β (TGFβ). This study was done to investigate the effect of Snail targeting siRNA on TGFβ2-induced EMT in human lens epithelial cells. TGFβ2 treatment of cultured human epithelial cell line (HLEB3) upregulated the expression of Snail and the EMT relevant molecules such as vimentin and α-SMA but downregulated the expression of keratin and E-cadherin. After the stimulation of TGFβ2, the HLEB3 cells became fibroblast-like in morphology, and the junctions of cell-cell disappeared. TGFβ2 treatment also enhanced migration ability of HLEB3 cells. TGFβ2-induced Snail expression and EMT were significantly inhibited by Snail siRNA. By analyzing the response characteristics of HLEB3 in TGFβ2-induced EMT model with/without Snail-specific siRNA, we concluded that Snail is an element in the EMT of HLEB3 cells induced by TGFβ2. Snail siRNA targeting can block the induced EMT and therefore has the potential to suppress the development of PCO.

Growth inhibition of human lens epithelial cells by short hairpin RNA in transcription factor forkhead box E3 (FOXE3)

BACKGROUND

Posterior capsule opacification occurs mainly due to the remnant lens epithelial cell proliferation and migration after cataract surgery. The purpose of this study was to investigate whether small hairpin RNA (shRNA)-mediated gene silencing of transcription factor forkhead box E3 (FOXE3) can be employed to inhibit the expression of FOXE3 and suppress the growth in lens epithelial cells.

METHODS

FOXE3-targeted shRNA was transfected into a human lens epithelial cell line (HLEB-3) using Lipofectamine 2000 reagent. Quantitative PCR was used to confirm the downregulation of FOXE3 mRNA expression following infection of lens epithelial cells, and FOXE3 protein expression levels were evaluated by Western blot analysis and immunofluorescence staining. HLEB-3 cell growth after the transduction was analyzed by cell counting and MTT colorimetric assay. Cell cycle of the HLEB-3 cells was examined by flowcytometric analysis.

RESULTS

Compared with the control groups, both mRNA and protein levels of FOXE3 expression were significantly decreased in shRNA-treated groups, and cytostatic effects were obvious within 48 h after transfection. An increased incidence of G1-phase arrest was identified in FOXE3-shRNA transfected HLEB-3 cells.

CONCLUSIONS

shRNA-mediated gene silencing of FOXE3 could significantly inhibit cell growth and induce the G1-phase arrest in HLEB-3 cells. Formation of posterior capsular opacification might be repressed if lens epithelial cell growth ceases after the FOXE3 gene is silenced with molecular biology technology.

Study of antiproliferative effects of synthetic substances against lens epithelial cell line (SRA 01/04)

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.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

[Posterior capsule opacification after phacoemulsification in patients with rheumatoid arthritis]

PURPOSE

To assess the posterior capsule opacification (PCO) rate after phacoemulsification with polyacrylic intraocular lens (IOL) implantation in patients with rheumatoid arthritis (RA) compared with the controls, and to assess whether preoperative activity of RA is associated with a higher incidence of PCO.

METHODS

24 eyes of 20 RA patients operated in a period of 4 years were included in our study. A control group of 20 eyes from 20 health subjects were also included in our study. All procedures were performed by a single surgeon with the same surgical technique and postoperative medication.

RESULTS

One year postoperatively in two eyes (8.3%) of RA-patients lens epithelial cells (LEC) migration of grade 1 was observed, in controls also in two eyes (10%). No correlation was observed between age, duration of RA or preoperative activity of RA and the PCO rate.

CONCLUSION

Following acrylic IOL implantation, the PCO rate one year after surgery was 8.3% in RA patients and 10% in controls. RA patients present no higher risk for PCO development than controls.

[New methods for the prevention of posterior capsule opacification]

Even though tremendous advances have been made especially during the last 10-15 years in terms of surgical techniques and improvement of implant technology, posterior capsule opacification (PCO) still remains a serious long-term complication. New clinical and laboratory studies (especially of autopsy eyes) have improved our understanding of how IOL design and material influence PCO. Sharp edge optic designs of IOLs of various materials have been shown to significantly reduce secondary cataract. The application of pharmacological substances selectively into the capsular bag is now possible due to the development of the PerfectCapsule System for vacuum-sealed capsule irrigation. Major advances in other areas of biotechnology and immunology including gene therapeutic methods offer totally new approaches for the future in the elimination of lens epithelium cells from the capsular bag. This survey gives an update on current and future means and trends to reduce or prevent PCO formation.

Electrical inhibition of lens epithelial cell proliferation: an additional factor in secondary cataract?

Cataract is the most common cause of blindness but is at least curable by surgery. Unfortunately, many patients gradually develop the complication of posterior capsule opacification (PCO) or secondary cataract. This arises from stimulated cell growth within the lens capsule and can greatly impair vision. It is not fully understood why residual lens epithelial cell growth occurs after surgery. We propose and show that cataract surgery might remove an important inhibitory factor for lens cell growth, namely electric fields. The lens generates a unique pattern of electric currents constantly flowing out from the equator and entering the anterior and posterior poles. We show here that cutting and removing part of the anterior capsule as in cataract surgery significantly decreases the equatorial outward electric currents. Application of electric fields in culture inhibits proliferation of human lens epithelial cells. This inhibitory effect is likely to be mediated through a cell cycle control mechanism that decreases entry of cells into S phase from G1 phase by decreasing the G1-specific cell cycle protein cyclin E and increasing the cyclin-Cdk complex inhibitor p27kip1. Capsulorrhexis in vivo, which reduced endogenous lens electric fields, significantly increased LEC growth. This, together with our previous findings that electric fields have significant effects on the direction of lens cell migration, points to a controlling mechanism for the aberrant cell growth in posterior capsule opacification. A novel approach to control growth of lens epithelial cells using electric fields combined with other controlling mechanisms may be more effective in the prevention and treatment of this common complication of cataract surgery.

Clinical Case Notes. Recurrent posterior capsular opacification and capsulorhexis contracture after cataract surgery in myotonic dystrophy

Cataracts are well known to be associated with myotonic dystrophy. Less well known are the phenomena of recurrent posterior capsule opacification and capsulorhexis contracture post cataract surgery. Two cases are described herein of postoperative capsular complications requiring multiple capsulotomies in patients with myotonic dystrophy. It is proposed that a common aetiology may underlie both posterior capsule opacification and capsulorhexis contracture in myotonic dystrophy cases.

Water-mediated lysis of lens epithelial cells attached to lens capsule

PURPOSE

To investigate the effect of distilled deionized water (DDW) on lens epithelial cells (LECs) attached to the lens capsule.

SETTING

Wound Healing Research Laboratory, Center for Vision Research, Westmead Hospital, Sydney, NSW, Australia.

METHODS

Anterior capsulotomy specimens taken during routine cataract surgery were divided in half. One half was immersed in DDW and the other half in culture medium (control) for 1 to 5 minutes and photographed at intervals by phase-contrast microscopy. In further experiments, the capsules were exposed to DDW for 1 or 2 minutes and placed in culture for 1 week to determine whether LECs survive treatment and are capable of repopulating the lens capsule.

RESULTS

Distilled-deionized water induced marked swelling of the cytoplasm within 60 seconds of treatment. At 120 seconds, there was disruption of the plasma membranes, with few intact cells remaining. In the control capsules, confluent monolayers of LECs covered the entire capsule surface with a halo of LECs growing on the surrounding plastic well. Viable LECs were observed in 1 of 3 capsules treated for 1 minute with DDW. These did not reach confluence or grow off the capsule onto the surrounding well. No viable LECs were seen on capsules exposed to DDW for 2 minutes.

CONCLUSIONS

Short exposure of LECs to DDW induced extensive and rapid cell lysis. Distilled-deonized water may be a useful agent for instillation in the capsular bag during sealed-capsule irrigation to prevent posterior capsule opacification.

Effect of an acrylic posterior chamber intraocular lens on posterior capsule opacification in cataract patients with associated risk factors

PURPOSE

To evaluate the effect of an acrylic foldable posterior chamber intraocular lens (PC IOL) on the rate of posterior capsule opacification (PCO) in patients with associated risk factors.

SETTING

Department of Ophthalmology, Seoul National University, Seoul, Korea.

METHODS

The medical records of 570 patients who had phacoemulsification and foldable PC IOL implantation by the same surgeon from January 1, 1998, to December 31, 1999, were reviewed. Patients with risk factors for PCO (ie, young age, diabetes mellitus) received an acrylic PC IOL to decrease the opacification rate. Their rate was compared to that in patients without associated risk factors who received a foldable silicone PC IOL.

RESULTS

In the patients without diabetes mellitus, the PCO rate in patients younger than 60 years with an acrylic PC IOL and in patients older than 60 years with a silicone PC IOL were similar. In patients older than 60 years, the rate of PCO was significantly lower in patients with diabetes mellitus and an acrylic PC IOL than in patients without diabetes mellitus with a silicone foldable PC IOL.

CONCLUSIONS

The rate of PCO in patients with risk factors for PCO with an acrylic PC IOL was similar to or lower than that in patients without risk factors with a foldable silicone PC IOL. Therefore, acrylic PC IOLs are preferable, particularly in patients with risk factors for PCO.

Predicting posterior capsule opacification: value of early retroillumination imaging

PURPOSE

To investigate the value of early retroillumination imaging of the posterior capsule in predicting the eventual development of posterior capsule opacification (PCO).

SETTING

Ophthalmology Department, St. Thomas' Hospital, and Department of Physics, King's College, London, United Kingdom.

METHODS

All patients with retroillumination images of the posterior capsule taken 6 months and 2 years after uneventful phacoemulsification with in-the-bag intraocular lens (IOL) implantation were selected. The images were taken using the same hardware and analyzed with the same software to calculate the percentage area of the posterior capsule covered by lens epithelial cells. The percentage area of PCO with all IOL types 6 months postoperatively was correlated with that at 2 years.

RESULTS

One hundred forty patients had analyzable images at 6 months and 2 years. Of these, 63 had a poly(methyl methacrylate) (PMMA) IOL (Pharmacia 812A or Storz P497UV), 33 an acrylic (Alcon AcrySof MA30 or SA30), 22 a silicone (Allergan SI-30), and 22 a hydrophilic acrylic (Bausch & Lomb Hydroview H60). The correlation of the percentage area of PCO at 6 months with that at 2 years resulted in an r value of 0.71 (P <.0001) in the entire group. The r value was 0.48 in the PMMA group and 0.86 in the foldable IOL group (P <.0001) (r value: AcrySof, 0.66; silicone, 0.82; Hydroview, 0.75).

CONCLUSIONS

Retroillumination imaging of the posterior capsule 6 months after cataract surgery predicted the PCO outcome at 2 years in eyes with foldable IOLs.

Performance of a truncated-edged silicone foldable intraocular lens in Indian eyes

PURPOSE

To study the role of truncated-edged silicone foldable intraocular lenses (IOLs) in preventing posterior capsule opacification (PCO) in Indian eyes.

SETTING

Cornea and Anterior Segment Service, L.V. Prasad Eye Institute, Hyderabad, India.

METHODS

This prospective study evaluated 39 Indian patients (39 eyes) with a mean age of 55.4 years who had uneventful implantation of the CeeOn Edge 911A IOL (Pharmacia). All IOLs were placed in the bag. Except in 4 patients, the capsulorhexis margin overlapped 360 degrees on the IOL optic periphery. The mean follow-up was 10.9 months (range 6.5 to 13.0 months); 32 patients were followed for 1 year.

RESULTS

Intraoperatively, posterior capsule fibrosis was noted in 7 patients. Diffuse haze was noted in the IOL optic in 1 patient. Clinically significant PCO did not occur in any case. One patient had clinically nonsignificant (grade 1) PCO at the 6- and 12-month follow-up visits. Although epithelial pearl accumulation (Soemmering's ring) was seen beyond the edge of the IOL in the 32 patients followed for 1 year, the epithelial pearls were central only in the patient with grade 1 PCO. Significant cell deposits were noted in 1 patient who had fibrinous uveitis at the 1-week postoperative visit; both resolved by 1 month. All eyes achieved a best corrected visual acuity of 20/30 or better.

CONCLUSIONS

The CeeOn Edge 911A IOL was well tolerated in Indian eyes, and the posterior capsule remained clear. Larger patient groups with a longer follow-up will provide more useful information.