Anterior capsule opacification: correlation of pathologic findings with clinical sequelae

Safety and efficacy of capsular tension ring and capsular hook implantation for managing ectopia lentis in Marfan syndrome: real-world study

PURPOSE

To evaluate the safety and efficacy of capsular tension ring and capsular hook (CTR-CH) implantation in Marfan syndrome (MFS) patients with ectopia lentis (EL).

SETTING

Eye and ENT Hospital of Fudan University, Shanghai, China.

DESIGN

Retrospective propensity score-matched cohort study.

METHODS

This study included patients with MFS who had in-the-bag intraocular lens (IOL) implantation assisted by CTR-CH or modified CTR (MCTR). The safety analysis focused on the resurgery rate. The efficacy analysis compared the corrected distance visual acuity (CDVA) and the incidence of laser capsulotomy after propensity score matching (PSM).

RESULTS

This study encompassed 148 eyes that had the CTR-CH procedure and 162 eyes that received MCTR implantation. In the CTR-CH group, the median age at the time of surgery was 5 years, with a mean follow-up duration of 1.81 ± 0.4 years. 5 eyes (3.38%) required a second surgery because of retinal detachment (2, 1.35%), IOL decentration (2, 1.35%), and CH dislocation (1, 0.68%). The resurgery rate was comparable with that of the MCTR group ( P = .486). After PSM, a total of 108 eyes were recruited in each group. Postoperative CDVA was significantly improved in both groups (both P < .001), but comparable between the groups ( P = .057). The posterior capsular opacification took place earlier ( P = .046) while the anterior capsular opacification required laser capsulotomy at a later stage ( P = .037) compared with the MCTR group.

CONCLUSIONS

The CTR-CH procedure was a feasible, safe, and efficient approach for managing EL in patients with MFS.

Ocular characteristics and outcomes of phacoemulsification in patients with cataract after renal transplantation

PURPOSE

To explore ocular characteristics of patients with cataracts after renal transplantation and analyze the results of phacoemulsification combined with intraocular lens (IOL) implantation.

METHODS

Patients with cataracts after renal transplantation and control patients who underwent phacoemulsification combined with IOL implantation were enrolled. All patients underwent phacoemulsification combined with IOL implantation. Visual acuity, intraocular pressure, type of lens opacity, corneal endothelial cell density, and ocular biological parameters were evaluated before surgery. Visual prognosis, dry eye, and postoperative complications were monitored for 6 months after phacoemulsification.

RESULTS

We analyzed 25 eyes of 16 patients after renal transplantation and 30 eyes of 21 control patients. The most common type of cataract of renal transplantation group was posterior subcapsular, while the most common type of cataract of control group was cortical. Significant differences in corneal astigmatism, white-to-white ratio, and keratometry values were observed between the groups. The postoperative visual acuity of both groups significantly improved following surgery. Postoperative complications, such as the degree of anterior and posterior capsule opacification and the incidence of a requirement of neodymium-doped yttrium aluminum garnet laser capsulotomy, were significantly lower in the renal transplantation group. Moreover, secondary glaucoma occurred in two eyes in the renal transplantation group.

CONCLUSION

This study showed that cataracts after renal transplantation were mostly posterior subcapsular. Postoperative visual acuity recovered well in most patients, with reduced incidence of postoperative complications. This study suggested that phacoemulsification combined with IOL implantation was safe and effective, providing a reference for multi-focal IOL implantation in kidney transplant recipients.

Impact of anterior capsule polishing on capsule opacification and capsule bend after age-related cataract surgery

PURPOSE

To investigate the effect of anterior capsule polishing on postoperative capsule opacification and capsular bend in patients with age-related cataract displaying normal axial length.

SETTING

Eye Hospital of Wenzhou Medical University at Hangzhou.

DESIGN

Prospective self-controlled trial.

METHODS

Patients with age-related cataracts aged 56 to 84 years displaying normal axial length were enrolled. Before surgery, a coin-toss method was used to randomly select 1 eye for intraoperative 360 degrees anterior capsule polishing (polishing group); the contralateral eye received no treatment (control group). Capsular bend index (CBI), anterior capsule opacification (ACO), posterior capsule opacification (PCO), and anterior capsule opening area (ACOA) were recorded at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively using swept-source optical coherence tomography and slitlamp examination.

RESULTS

21 patients (42 eyes) were enrolled. Within-group comparisons showed that both groups had significant differences in CBI between 1 week and 1 month postoperatively, and between 6 months and 12 months postoperatively ( P < .05). Between-group comparisons revealed a significant difference in CBI at 1 week postoperatively ( P < .05); at 12 months postoperatively, there was a significant difference in ACOA ( P < .05). There were no significant between-group differences regarding ACO or PCO at any timepoint ( P > .05).

CONCLUSIONS

For patients with age-related cataracts and normal axial length, 360 degrees anterior capsule polishing can delay early capsular bag deformation without increasing the risks of ACO and PCO. This approach can also limit contraction of the anterior capsule opening.

Comparison of patient experiences and clinical outcomes between an illuminated chopper and a conventional chopper under a surgical microscope

PURPOSE

To compare patient experiences and cooperation and the clinical outcomes illuminated chopper vs conventional chopper during cataract surgery.

SETTING

4 tertiary institutions in Korea.

DESIGN

Prospective, randomized, paired-eye, controlled pilot study.

METHODS

152 eyes of 76 patients who underwent bilateral cataract surgeries were enrolled in this study. The surgical method was randomly assigned to each patient's eye (1 eye using the illuminated chopper with a light source and the other using the conventional chopper under the microscope light). Patient suffering scores (the degree of strong light perception, glare, inability to fixate, anxiety, discomfort, and fear) from 0 to 10 (10 being the most severe level); cooperation score from 0 to 3 (3 being the best cooperation); operating time; and corneal endothelial cell density (ECD) preoperatively and postoperatively were compared between the 2 groups.

RESULTS

The mean patient suffering score of all 6 parameters in the iChopper group was significantly smaller than those in the control group (all P < .05). The mean patient cooperation score of the iChopper group (2.3 ± 0.8) was significantly greater than that of the control (1.6 ± 0.9; P < .001). There was no significant difference in the mean operating time and corneal ECD at each visit between the groups, albeit the mean corneal ECD was significantly decreased from baseline to 1 month after cataract surgery in both groups.

CONCLUSIONS

Phacoemulsification using the illuminated chopper provides less glare and anxiety and better cooperation during cataract surgery without increasing the operating time and damaging corneal endothelium compared with the conventional chopper.

Relationship between anterior capsule opening and direction of intraocular lens decentration

PURPOSE

To compare intraocular lens (IOL) decentration between patients in whom the continuous curvilinear capsulorhexis (CCC) completely covers the IOL optic and those in whom it incompletely covers the IOL optic and determine how an incompletely covered CCC affects the IOL position.

SETTING

Tertiary hospital in Japan.

DESIGN

Single-center retrospective study.

METHODS

57 eyes of 57 patients (mean age 70.8 ± 6.2 years) that underwent phacoemulsification and IOL (SN60WF) implantation in the bag between April 2010 and April 2015 were included in this study. The patients were classified based on whether the CCC completely (CC group) or incompletely (NCC group) covered the IOL optic using an anterior eye segment analysis system (EAS-1000). The IOL decentration of the groups was analyzed using EAS-1000 at 1 week, 1 month, 3 months, and 6 months postoperatively and compared. The relationship between the NCC location and the IOL direction at 3 months postoperatively was analyzed.

RESULTS

The NCC group (25 eyes) had a significantly higher amount of IOL decentration than the CC group (32 eyes) at 1 week, 1 month, 3 months, and 6 months postoperatively ( P < .05). There was a correlation between the direction of IOL decentration and the NCC location, and IOL decentration in the NCC group occurred in the opposite direction to the NCC area.

CONCLUSIONS

An anterior capsule opening that completely covers the IOL optic is important to control IOL decentration.

Cataract surgery in patients with retinitis pigmentosa: systematic review

Retinitis pigmentosa (RP) is an inherited bilateral retinal degenerative disease with an incidence of 1 in 4000 people. RP affects more than 1 million individuals worldwide. Although night blindness and restricted visual field are the most typical symptoms of these individuals, generalized vision loss due to cataracts can be expected in the latter stages of the disease. It has been demonstrated that posterior subcapsular cataract is the most prevalent cataract in younger individuals with RP, as opposed to age-related cataracts. Although most ophthalmologists may have a negative view of cataract surgery in patients with RP, it appears that it can play an important role in the visual restoration of patients with RP. However, there are concerns about performing cataract surgery for patients with RP. Herein, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses on databases of MEDLINE and Scopus.

Effects of intraocular lens anterior edge design on anterior capsule morphology changes following femtosecond laser-assisted capsulotomy

PURPOSE

To compare morphological changes in the anterior capsule of two intraocular lenses (IOLs) with different anterior edge designs 6 months after femtosecond laser-assisted capsulotomy surgery (FLACs).

METHODS

This study included 168 eyes from168 patients undergoing FLACs. Group A included 74 eyes from 74 patients who had an Acrysof IQ Restor SN6AD3 IOL implantation with a flat anterior edge and Group B included 94 eyes of 94 patients with a TECNIS Multifocal ZMB00 IOL implantation and a "peak-like" anterior edge. All patients were followed up for 6 months. We assessed anterior capsule morphological changes including variation of anterior opening diameters and lens epithelial cell (LEC) proliferation in four directions, variation of anterior opening area, and the level of anterior capsule opacification (ACO).

RESULTS

Variation of anterior opening diameters in 4 directions were significantly lower in Group B (P < 0.05). Obvious shrinkage ratio of anterior opening diameters and contraction of anterior opening area (P < 0.05) appeared in Group A. LEC proliferation was along the "peak" in Group B, while it spread to the edge of anterior capsule in Group A. ACO grades 6 months after operation in Groups A and B were as follows: grade I in 28.38% and 82.98% of eyes, grade II in 51.35% and 17.02% of eyes, and grade III in 20.27% and 0% of eyes, respectively.

CONCLUSIONS

These findings suggest that a "peak-like" IOL anterior edge design played an important role in maintaining the morphology of anterior capsule in the early postoperative stage.

Complete Occlusion of Anterior Capsular Opening in Patient Operated for Cataract With Penetrating Keratoplasty

A 68-year-old female underwent a full-thickness penetrating keratoplasty (PK) and developed a mature cataract for which she was operated on using the phacoemulsification technique with the implantation of polymethyl methacrylate lens. The patient developed diminished vision one month after the cataract surgery. The patient had a contraction of the anterior capsular opening. Neodymium-doped yttrium aluminum garnet laser (ND:YAG) anterior capsulotomy was performed to create an opening in the anterior capsule, following which the patient regained her vision. To the best of our knowledge, this is the first report of early anterior capsular contraction in a patient operated for PK.

[Role of ultrasound biomicroscopy in assessing the results of laser treatment in capsular contraction syndrome]

The article presents the results of ultrasound biomicroscopy (UBM) measurements of pseudophakic patients with anterior capsular contraction syndrome (CS).

PURPOSE

To analyze the results of UBM in capsular CS before and after laser treatment.

MATERIAL AND METHODS

The study included 42 patients with capsular CS. The HI-scan ultrasound biomicroscope (Optikon, Italy) with 35 MHz UBM probe and the LPULSA SYL-9000 Premio laser (LightMed, Taiwan-USA) were used.

RESULTS

The shrinkage of the capsular bag of the lens was accompanied by a significant decrease in the diameter of the anterior capsulotomy opening, IOL decentration and its displacement towards the posterior pole of the eye, stretching or damage to the ciliary zonule, and an increase in the ciliary body thickness. In 2 cases, ruptures of the ciliary body and its separation from the place of attachment to the iris root were observed. The optimal algorithm of laser treatment was developed to minimize the risk associated with possible aggravation of the clinical manifestations of CS and possible complications during laser treatment.

CONCLUSION

UBM is an effective examination method for CS, which allows assessing the state of the capsular bag of the lens and the ciliary body, evaluating the effectiveness of laser treatment and predicting the risks associated with a high probability of complications.

Long-term uveal and capsular biocompatibility of a new fluid-filled, modular accommodating intraocular lens

PURPOSE

To evaluate long-term uveal and capsular biocompatibility of a new fluid-filled modular accommodating intraocular lens (IOL) consisting of base and fluid lenses.

SETTING

John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.

DESIGN

Experimental study.

METHODS

Bilateral phacoemulsification was performed on 8 rabbits; 1 eye received the test IOL (Juvene) and the other a hydrophobic acrylic control IOL (SA60AT). Slitlamp examinations were performed at postoperative weeks 1 and 4, and at months 2, 3, and 6. The rabbits were killed humanely at 6 months. After gross examination from the Miyake-Apple view, IOLs were removed for implant cytology. All globes were then processed for histopathologic examination.

RESULTS

Uveal biocompatibility was similar between test and control IOLs up to 6 months postoperatively. Anterior capsule opacification appeared absent in the test group, and posterior capsule opacification (PCO) was significantly less in comparison with the control group throughout the study. At 6 months, central PCO was scored as 0.12 ± 0.23 with test IOLs and as 4.0 ± 0 with control IOLs (P < .0001, 2-tailed t test: paired 2-sample for means). Histopathologic examination confirmed the relative lack of capsular opacification in test eyes in comparison to controls and the absence of toxicity in any eye.

CONCLUSIONS

Six weeks in the rabbit model corresponds to approximately 2 years in the human eye for PCO. In this model, the Juvene IOL maintained an open and expanded capsular bag, preventing overall capsular bag opacification while retaining excellent uveal and capsular biocompatibility.

Explantation/exchange of the components of a new fluid-filled, modular, accommodating IOL

PURPOSE

To evaluate the ease of replacement and capsular stability of a new fluid-filled, modular, accommodating intraocular lens (IOL) system composed of a monofocal base lens with a fluid lens clipped inside of it.

SETTING

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN

Experimental study.

METHODS

Five New Zealand rabbits underwent bilateral phacoemulsification with implantation of the test lens (Juvene, LensGen, Inc.) in both eyes (4 rabbits), or a control IOL in 1 eye (AcrySof, Alcon Laboratories, Inc.) and the test IOL in the other (1 rabbit). At 2 weeks, the 4 rabbits with bilateral Juvene IOLs had the clipped-in fluid lens exchanged for a new fluid lens in 1 eye, and the base and fluid lenses exchanged for a control lens in the contralateral eye. Slitlamp examinations were performed weekly for 4 weeks. The globes were enucleated and evaluated with ultrasound biomicroscopy, grossly from the posterior Miyake-Apple view, and histopathologically.

RESULTS

Explantation/exchange of the fluid lens was considered straightforward by the surgeon. Explantation of the base lens (4) was also safely performed, albeit more demanding, without any signs of damage to the capsular bag under clinical, ultrasound biomicroscopy, and pathological examination in the exchanged eyes. Less capsular bag opacification was observed with the Juvene lens system.

CONCLUSIONS

Explantation/exchange of the fluid lens component, or both fluid and base lenses, of this new lens system can be safely accomplished if necessary, because of its modular design and the relative lack of postoperative capsular bag opacification associated with it.

Weight of Different Intraocular Lenses: Evaluation of Toricity, Focality, Design, and Material

Purpose

To evaluate the weight of intraocular lenses (IOLs) depending on their material, dioptric power, toricity, focality, and haptic design.

Methods

Twenty-eight different IOL models from nine different medical companies (a total of 38 IOLs) and 1 capsular tension ring (CTR) were evaluated. IOLs were weighed using a precision scale, in hydrated conditions, as an approximation to their intraocular status.

Results

Hydrophilic IOLs were heavier than hydrophobic lenses (p < 0.001). Regarding toricity, no statistical differences were found comparing toric to non-toric models (p=0.1). Likewise, no differences were found between multifocal IOLs and monofocal IOLs (p=0.19). Dioptric power did not affect IOL weight: IOLs of <15DP had similar weights to those of ≥15D and IOLs of ≥24D had similar weights to those of <24 D (p=0.86 and p=0.59, respectively). Plate-design IOLs were significantly heavier than 1-piece C-loop (p < 0.001), 3-piece C-loop (p < 0.001), and 4-haptic lenses (p=0.001).

Conclusions

Of the characteristics analyzed that might influence IOL weight, lenses with hydrophilic material and plate-haptic design were found to be heavier. Toricity, focality, and dioptric power had no influence on IOL weight.

Moxifloxacin-loaded acrylic intraocular lenses: In vitro and in vivo performance

PURPOSE

To assess the possibility of using acrylic intraocular lenses (IOLs) to ensure controlled and sustained release of moxifloxacin, an antibiotic commonly used for endophthalmitis prophylaxis after cataract surgery.

SETTING

Academic, industrial, and clinical partners from Portugal, Belgium, Iceland, and the United States.

DESIGN

Experimental study.

METHODS

The physical properties of IOLs loaded with moxifloxacin by soaking were characterized. In vitro drug-release studies were performed under hydrodynamic conditions similar to those of the eye, and the activity of the released drug was tested. In vitro cytotoxicity was evaluated, and the in vivo efficacy of the devices was assessed through rabbit experiments in which the effects of topical moxifloxacin drops (control) and moxifloxacin-loaded IOLs were compared.

RESULTS

The presence of moxifloxacin in the IOLs had little effect on the evaluated physical properties and did not induce cytotoxicity. In vitro drug release experiments showed that the IOLs provided controlled release of moxifloxacin for approximately 2 weeks. The drug remained active against the tested microorganisms during that period. Moxifloxacin-loaded IOLs and the control treatment induced similar in vivo behavior in terms of inflammatory reactions, capsular bag opacification scores, and uveal and capsule biocompatibility. The drug concentration in the aqueous humor after 1 week was similar in both groups; however, the concentration with the loaded IOLs was less variable.

CONCLUSION

The moxifloxacin-loaded IOLs released the drug in a controlled manner, providing therapeutic levels.

A Modified Femtosecond Laser Technique for Anterior Capsule Contraction Syndrome

Anterior capsule contraction syndrome (ACCS) is a rare, late complication of cataract surgery, associated with impairment of visual function. In this paper, we describe a new surgical technique to treat ACCS by femtosecond laser procedure. The femtosecond laser was used to perform an anterior capsulotomy with a customized size, in order to avoid IOL damage. After ophthalmic viscosurgical device injection in the anterior chamber, the anterior capsule flap was separated from the IOL surface by gentle hydrodissection. This manoeuvre enabled an easy and safe removal of the fibrotic material by vitreal microscissors. Our technique allowed a complete removal of the fibrotic material and opening of the capsule, with immediate complete visual acuity recovery without IOL damage. In conclusion, femtosecond laser appears to be safe and effective for treatment of ACCS with long-lasting efficacy.

Cortical aspiration - The "POPS" technique

In the present study, we describe a step-by-step technique for cortex aspiration during cataract surgery- POPS (positioning, occlusion, posterior displacement, and swiping). Firstly, the aspiration probe is positioned under the bulk of cortical fibers beyond the capsulorhexis margin. Subsequently, the aspiration port is occluded with minimal vacuum, and the occluded port is displaced posteriorly to detach the cortical fibers off the anterior capsule. Now, tangential, arc-like swiping movements are performed while gradually increasing vacuum at the same time. The fibers are brought to the center and finally aspirated. This allows complete removal of the equatorial fibers and lens epithelial cells (LEC) with the least stress to the capsulozonular complex. Unlike the conventional technique, which involves the radial pull of cortical fibers, in this technique, there is swiping and posterior displacement of the cortical fibers before pulling towards the center and aspirating. We believe this technique will ensure safer, more effective cortical and LEC removal, reducing zonular stress.

Intraocular Lenses: Overview of Designs, Materials, and Pathophysiologic Features

This article provides an overview of intraocular lenses (IOLs) currently used in cataract surgery. Aspects presented include design features related to IOL construction and sites of fixation; optic, filter, and haptic materials; as well as pathophysiologic features of uveal biocompatibility, capsular biocompatibility, and postoperative IOL opacification. This overview also includes supplementary (add-on; piggyback) lenses implanted in eyes that are already pseudophakic and considerations on IOLs used in the pediatric population. Different IOLs are made available to surgeons each year, including lenses with increasingly complex design characteristics owing to advancements in manufacturing and surgical techniques.

Budget impact analysis of lens material on the posterior capsule opacification (PCO) as a complication after the cataract surgery

Background

Over 300,000 cataract operations are performed in Poland every year, and the most common, late complication of cataract removal surgery is posterior capsule opacification (PCO). The risk of PCO depends on the lens material. Hydrophobic acrylic lenses cause PCO less frequently as lymphatic endothelial cells show lower affinity for the surface of the lens made of silicone. The objective of this study is to assess the economic impact of using hydrophobic acrylic lenses compared to using hydrophilic acrylic lenses for cataract treatment in the Polish inpatient and outpatient settings.

Methods

A budget impact analysis (BIA) compared the economic outcomes associated with using hydrophobic acrylic lenses versus using hydrophilic lenses for patients undergoing cataract surgery. The BIA predicted annual expenses in the following scenarios: performing Nd:YAG to treat PCO within 2 and 3 years after implantation of hydrophobic or hydrophilic acrylic lenses for different lens structure. Data used to assess the frequency of PCO was determined in systematic literature review. Costs of current and predicted interventions were estimated based on average data from 19 Polish hospitals. Prices of health services were taken from official public tariff lists.

Results

The use of a hydrophobic lens significantly limits the number of complications after cataract surgery relative to a hydrophilic lens. As hydrophobic lenses have a higher unit price their use increases the cost of treatment which currently is not reflected by adequate difference in price of the service. Total annual National Health Fund (NHF) expenses for 3-year follow-up model range from 139.1 million EUR to 143.1 million EUR depending on the lens structure, due to the cost of complications.

Conclusions

BIA indicates the possibility of introducing surcharge for the use of hydrophobic lenses, which could increase the frequency of their use and reduce the number of complications after cataract surgery. It was estimated that total NHF expenses reach the minimum value for the surcharge at the level of 9 EUR. The surcharge of 14 EUR is the maximum value that does not increase the initial NHF expenses.

Impact of anterior capsular polishing on capsule opacification rate in eyes undergoing femtosecond laser-assisted cataract surgery

Purpose:

To evaluate the impact of anterior capsular polishing on capsule opacification and contraction in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS).

Methods:

This prospective interventional comparative analysis included patients undergoing FLACS between August 2016 and May 2017. The eyes were subdivided into three groups based on the extent of intraoperative anterior capsular polishing performed: complete 360-degree polishing; inferior 180-degree polishing; and no polishing. Visual acuity, posterior capsular opacification (PCO) score, anterior capsular opacification (ACO) grade, and capsulorhexis diameter were evaluated at 1-week, 6-months, and 1-year postoperative visits.

Results:

The study included 99 eyes of 90 patients. No significant differences were observed between the three groups in ACO grade and capsulorhexis contraction at all follow-up visits. There was a statistically significant difference in PCO grade among the groups at 6-month and 1-year follow-up but it was found to be clinically insignificant. One eye in the no polishing group underwent neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy at the 1-year follow-up visit.

Conclusion:

A lower incidence of PCO was demonstrated in the 360-degree polishing group, although it was visually insignificant. No significant difference in postoperative capsular contraction was demonstrated between the cohorts up to one-year follow-up.

Comparison of postoperative axial stability of intraocular lens and capsulotomy parameters between precision pulse capsulotomy and continuous curvilinear capsulotomy: A prospective cohort study

OBJECTIVES

The aim of this study was to verify the safety and stability of precision pulse capsulotomy (PPC) by comparison of the axial stability of the intraocular lens (IOL) and the capsulotomy parameters during 6 months of follow-up after cataract surgery using PPC or the conventional method (continuous curvilinear capsulorhexis, CCC).

DESIGN

Prospective observational study.

SETTING

Tertiary referral center.

SUBJECTS

Fifty nine eyes of 59 candidates for cataract surgery.

INTERVENTIONS

PPC (33 eyes) or CCC (26 eyes).

OUTCOME MEASURES

The anterior capsule opacification grade and effective lens position (ELP) were measured 1 week and 1, 3, and 6 months postoperatively.

RESULTS

No significant difference in the mean anterior capsule opacification grade or the effective lens position was found between the PPC and CCC groups at any time point; however, the standard deviation and root mean square of the effective lens position were significantly lower in the PPC group than in the CCC group during follow-up (P = .002 and P = .011, respectively). There was a significantly lower discrepancy between the intended vs achieved capsulotomy area and better circularity in the PPC group than in the CCC group at all time points.

CONCLUSIONS

The overall variability in effective lens position was less when cataract surgery was performed using PPC than when performed using CCC. Circularity was better and had a more predictable size with PPC than with CCC.

Misdiagnosed opacification of a hydrophobic acrylic intraocular lens

A 75-year-old woman was referred for decreased visual acuity resulting from "opacification of the IOL" in the immediate period after uneventful bilateral cataract surgery with single-piece AcrySof IQ intraocular lens (IOL) implantation. A neodymium:YAG laser capsulotomy had been performed in both eyes to treat the complication. Anterior segment optical coherence tomography performed at presentation showed an opaque membrane enveloping the IOL. The membrane was peeled from the anterior IOL surface, and all adherences between the IOL and capsular bag were freed. One year later, the eyes remained stable; the uncorrected distance visual acuity was 20/20, the IOL was clear, and there was no evidence of recurrence of the membrane. Appropriate imaging for the diagnosis and surgical peeling with freeing of the adhesions between the IOL and the capsular bag were essential to the success in this case.

Circular YAG laser anterior capsulotomy for anterior capsule contraction syndrome

PURPOSE

To evaluate circular neodymium: YAG laser incision in cases of anterior capsular contraction syndrome (ACCS) by comparing it to radial Neodymium: YAG laser incision as for efficacy and safety.

SETTINGS

Ophthalmology Department, Benha University Hospitals.

METHODS

The study was done on 74 eyes of 66 patients with symptomatic ACCS. Eyes were randomly allocated to one of the two groups. Group I were treated by circular YAG laser anterior capsulotomy. Group II were treated by radial YAG laser anterior capsulotomy. All cases passed a full ophthalmic examination before laser capsulotomy, 1 week, 1 month, 6 months and 12 months after laser.

RESULTS

BCVA at the 1st week and the 1st month after the capsulotomy did not show any significant difference between the two groups; however at the 3rd and 6th months, the circular group showed better visual acuity than the radial group (p 0.001 and < 0.001, respectively). All post-YAG UCVA and BCVA were significantly higher than pre-YAG UCVA and BCVA in both groups. IOL decentration occurred in two cases in radial group. Circular group had significantly higher percentage of contraction relief (94.4%) than the radial group (66.7%) with p value 0.003.

CONCLUSION

Circular Nd:YAG anterior capsulotomy is more effective and safe than radial capsulotomy in 1-year follow-up.

Myo/Nog cells are present in the ciliary processes, on the zonule of Zinn and posterior capsule of the lens following cataract surgery

Myo/Nog cells, named for their expression of MyoD and noggin, enter the eye during early stages of embryonic development. Their release of noggin is critical for normal morphogenesis of the lens and retina. Myo/Nog cells are also present in adult eyes. Single nucleated skeletal muscle cells designated as myofibroblasts arise from Myo/Nog cells in cultures of lens tissue. In this report we document the presence of Myo/Nog cells in the lens, ciliary body and on the zonule of Zinn in mice, rabbits and humans. Myo/Nog cells were rare in all three structures. Their prevalence increased in the lens and ciliary body of rabbits 24 h following cataract surgery. Rabbits developed posterior capsule opacification (PCO) within one month of surgery. The number of Myo/Nog cells continued to be elevated in the lens and ciliary body. Myo/Nog cells containing alpha smooth muscle actin and striated muscle myosin were present on the posterior capsule and overlaid deformations in the capsule. Myo/Nog cells also were present on the zonule fibers and external surface of the posterior capsule. These findings suggest that Myo/Nog contribute to PCO and may use the zonule fibers to migrate between the ciliary processes and lens.

Anterior and posterior capsule densitometry levels after femtosecond laser-assisted cataract surgery

AIM

To analyze and compare five different variables over one year follow-up (1wk, 1, 3, 6 and 12mo): anterior capsule (AC), and posterior capsule (PC) area densitometry values, AC and PC linear densitometry values, and AC opening area reduction ratio after femtosecond laser-assisted cataract surgery.

METHODS

This was a prospective comparative study. Seventy-one patients underwent femtosecond laser-assisted cataract surgery on single eye between June 2014 and December 2015. A 5.0 mm diameter laser assisted anterior capsulotomy was performed on all eyes. In every post-surgery evaluation, AC opacificaction (ACO) and PC opacification (PCO) density levels were provided by Oculus Pentacam^®HR using area and linear densitometry methods. Digital images were captured with a slit-lamp Topcon photographic camera and IMAGEnet^® 5 software. The AC opening area on the digital images was measured using the Sketchandcalc area calculator and converted to reduction ratio levels.

RESULTS

Using Pearson correlation coefficient (PCC), we found no correlation (r=-0.091, P=0.46) in the twelfth month assessment between the evolution of ACO area densitometry values and PCO area densitometry values considered as independent variables. We found no correlation, using PCC (r=-0.096, P=0.43) between the evolution of ACO linear densitometry values and PCO linear densitometry values, in the twelfth month visit, working both as independent variables. AC linear densitometry levels and AC area densitometry levels continued to grow strongly from sixth to twelfth months. Analysis of the values of AC opening area reduction ratio (1wk, 1, 3, 6, 12mo) revealed statistically significant differences between the values of successive examinations but the magnitude of the change decreased. In the final period of monitoring between six and twelve months the magnitude of change was low.

CONCLUSION

Our results show strong increases of Scheimpflug ACO densitometry values from the sixth to the twelfth month while capsulorhexis area reduction ratio levels displayed a considerable decrease. We found no correlation between ACO area and linear densitometry values and PCO area and linear densitometry values, in the twelfth month examination, working as independent variables.

Biomaterial Influence on Intraocular Lens Performance: An Overview

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.

[Capsule contraction syndrome in pseudophakia]

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.

Cataracts

An estimated 95 million people worldwide are affected by cataract. Cataract still remains the leading cause of blindness in middle-income and low-income countries. With the advancement of surgical technology and techniques, cataract surgery has evolved to small-incisional surgery with rapid visual recovery, good visual outcomes, and minimal complications in most patients. With the development of advanced technology in intraocular lenses, the combined treatment of cataract and astigmatism or presbyopia, or both, is possible. Paediatric cataracts have a different pathogenesis, surgical concerns, and postoperative clinical course from those of age-related cataracts, and the visual outcome is multifactorial and dependent on postoperative visual rehabilitation. New developments in cataract surgery will continue to improve the visual, anatomical, and patient-reported outcomes. Future work should focus on promoting the accessibility and quality of cataract surgery in developing countries.

Improvement of Uveal and Capsular Biocompatibility of Hydrophobic Acrylic Intraocular Lens by Surface Grafting with 2-Methacryloyloxyethyl Phosphorylcholine-Methacrylic Acid Copolymer

Biocompatibility of intraocular lens (IOL) is critical to vision reconstruction after cataract surgery. Foldable hydrophobic acrylic IOL is vulnerable to the adhesion of extracellular matrix proteins and cells, leading to increased incidence of postoperative inflammation and capsule opacification. To increase IOL biocompatibility, we synthesized a hydrophilic copolymer P(MPC-MAA) and grafted the copolymer onto the surface of IOL through air plasma treatment. X-ray photoelectron spectroscopy, atomic force microscopy and static water contact angle were used to characterize chemical changes, topography and hydrophilicity of the IOL surface, respectively. Quartz crystal microbalance with dissipation (QCM-D) showed that P(MPC-MAA) modified IOLs were resistant to protein adsorption. Moreover, P(MPC-MAA) modification inhibited adhesion and proliferation of lens epithelial cells (LECs) in vitro. To analyze uveal and capsular biocompatibility in vivo, we implanted the P(MPC-MAA) modified IOLs into rabbits after phacoemulsification. P(MPC-MAA) modification significantly reduced postoperative inflammation and anterior capsule opacification (ACO), and did not affect posterior capsule opacification (PCO). Collectively, our study suggests that surface modification by P(MPC-MAA) can significantly improve uveal and capsular biocompatibility of hydrophobic acrylic IOL, which could potentially benefit patients with blood-aqueous barrier damage.

Prevention of postoperative capsular bag opacification using intraocular lenses and endocapsular devices maintaining an open or expanded capsular bag

Postoperative capsule opacification is a multifactorial physiological consequence of cataract surgery that remains the most common complication of this procedure. A literature review that included several intraocular lenses (IOLs) and endocapsular devices studied in our laboratory found that devices maintaining the capsular bag in an open or expanded state were associated with improved bag clarity. This observed effect likely occurs secondary to the complex interactions of myriad mechanisms, which include formation of a barrier to lens epithelial cell (LEC) migration, mechanical compression of residual LECs, mechanical stretch at the level of the capsule equator, maintenance of overall bag contour, and enhanced endocapsular circulation of aqueous humor. We review the designs of endocapsular devices and IOLs that minimize the degree of postoperative capsule opacification by preventing capsular bag collapse and discuss the underlying mechanisms that contribute to this phenomenon.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

Postoperative occlusion of visual axis with fibrous membrane in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome: a case report

Background

To report a case of postoperative fibrous membrane formation occluding the visual axis in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome.

Case presentation

A 79-year-old Asian woman with pseudoexfoliation syndrome underwent uneventful phacoemulsification and implantation of one-piece hydrophilic acrylic square-edged intraocular lens (Cristalens) in the right eye. Two months later, she had blurred vision in the right eye with the best-corrected visual acuity (BCVA) of 20/40. Formation of fibrous membrane occluding the capsulorhexis opening with contraction of anterior capsule was observed, which was confirmed by anterior segment optical coherence tomography. Clear visual axis was achieved by lysis of the membrane using Nd:YAG laser. The BCVA improved to 20/20.

Conclusions

Occlusion of the visual axis with fibrous membrane can develop in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome.

Sprouty2 Suppresses Epithelial-Mesenchymal Transition of Human Lens Epithelial Cells through Blockade of Smad2 and ERK1/2 Pathways

Transforming growth factor β (TGFβ)-induced epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) plays a key role in the pathogenesis of anterior subcapsular cataract (ASC) and capsule opacification. In mouse lens, Sprouty2 (Spry2) has a negative regulatory role on TGFβ signaling. However, the regulation of Spry2 during ASC development and how Spry2 modulates TGFβ signaling pathway in human LECs have not been characterized. Here, we demonstrate that Spry2 expression level is decreased in anterior capsule LECs of ASC patients. Spry2 negatively regulates TGFβ2-induced EMT and migration of LECs through inhibition of Smad2 and ERK1/2 phosphorylation. Also, blockade of Smad2 or ERK1/2 activation suppresses EMT caused by Spry2 downregulation. Collectively, our results for the first time show in human LECs that Spry2 has an inhibitory role in TGFβ signaling pathway. Our findings in human lens tissue and epithelial cells suggest that Spry2 may become a novel therapeutic target for the prevention and treatment of ASC and capsule opacification.

Anterior capsule opacification after femtosecond laser-assisted cataract surgery: Clinical classification versus Scheimpflug device densitometry values

PURPOSE

To compare the clinical classification of anterior capsule opacification (ACO) after femtosecond laser-assisted cataract surgery with the mean density values of ACO provided by rotating Scheimpflug device (Pentacam HR) densitometry software and to determine which densitometry method correlates best with the clinical classification.

SETTING

Ophthalmology Department, Donostia University Hospital, Donostia-San Sebastian, Spain.

DESIGN

Prospective comparative study.

METHODS

Femtosecond laser-assisted cataract surgery was performed using the Victus platform between June 2014 and March 2015. Inclusion criteria were age between 55 years and 85 years, a pupil diameter larger than 6.0 mm in full mydriasis, no intraoperative complications, a curvilinear anterior capsulotomy without tears, and an intraocular lens in the correct intracapsular position at the end surgery. The ACO was measured by a clinical classification ranging from 0 to 4. In addition, ACO density was measured with the Scheimpflug device using 3 densitometry methods (area, linear, and peak).

RESULTS

The study comprised 32 eyes of 32 patients. Area and linear densitometry values provided by the Scheimpflug device had a strong correlation with the values obtained by clinical classification, whereas peak densitometry values had a very weak correlation at 6 months (area densitometry: Spearman ρ = 0.78; P < .0005; linear densitometry: ρ = 0.73; P < .0005; peak densitometry ρ = 0.21; P = .2).

CONCLUSION

The Scheimpflug device provided an objective measurement of ACO after cataract surgery.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature

Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.

Rapid anterior capsular phimosis after cataract surgery in a patient with chronic angle closure glaucoma

We report a case of complete occlusion of capsulorrhexis opening in a patient with chronic angle closure glaucoma with fixed–dilated pupil in the following 2 weeks after an uneventful cataract surgery. The capsulorrhexis diameter was intended to make between 5.0 mm and 5.5 mm, to prevent photophobia afterward. There was no evidence of zonular weakness on preoperative examination or during the surgery. Nd:YAG anterior capsulotomy was performed for capsular phimosis and to enlarge capsulorrhexis. The patient regained her visual acuity 3 days after laser treatment, and no pseudophakodonesis, intraocular lens decentration, and re-phimosis were noted at the 3-month follow-up.

Factors influencing 1-year rotational stability of AcrySof Toric intraocular lenses

PURPOSE

To investigate the 1-year rotational stability of AcrySof Toric intraocular lenses (IOLs) and factors influencing their stability.

METHODS

This retrospective study enrolled 75 patients who underwent phacoemulsification, and were implanted with an AcrySof Toric IOL for 1 year. Their preoperative clinical data were reviewed. The 1-year clinical outcomes included uncorrected visual acuity, best-corrected visual acuity and residual astigmatism. Rotation of the IOL and the grade of anterior capsular opacification (ACO; graded from 0=none to 3=severe) were evaluated after mydriasis.

RESULTS

Of the 75 eyes analysed, 29.33% had high myopia. Residual astigmatism at 1 year (-0.76±0.47 dioptre(D)) was significantly reduced compared with the preoperative corneal astigmatism (2.08±0.71 D). The mean absolute rotation of the IOL was 8.83±5.26°. Toric IOL rotation was significantly and positively correlated with the degree of residual astigmatism in the T3 (Pearson's r=0.552, p<0.001) and T4 groups (Pearson's r=0.622, p=0.003). Regarding factors associated with IOL rotation, toric IOL rotation was positively correlated with axial length (AXL; Pearson's r=0.335, p=0.003) and negatively correlated with ACO grade (Spearman's r=-0.541, p<0.001). On multiple linear regression analysis, only AXL (B=0.889, p=0.031) and ACO grade (B=-3.216, p<0.001) were predictors of toric IOL rotation (R(2)=0.397).

CONCLUSIONS

Long AXL is a risk factor for toric IOL rotation, while higher ACO grade may decrease toric IOL rotation, indicating that reducing the polishing of anterior capsule may improve the rotational stability of a toric IOL.

TRIAL REGISTRATION NUMBER

NCT02182921.

A prospective evaluation of posterior capsule opacification in eyes with diabetes mellitus: a case-control study

AIM

To compare the development of posterior capsule opacification (PCO) between eyes with and without diabetes mellitus after single-piece hydrophobic acrylic intraocular lens implantation 4 years postoperatively.

METHODS

In this prospective, observational case-control study carried out at Iladevi Cataract and IOL Research Centre, Ahmedabad, India, 75 consecutive eyes with diabetes mellitus (cases) were compared with 75 age-matched eyes with age-related cataract (controls). A detailed, preoperative and posterior segment evaluation was carried out in eyes with diabetes mellitus to detect the presence or absence of diabetic retinopathy (DR). The Mann-Whitney U-test was applied to compare the differences in the development of PCO between the two groups.

RESULTS

There was no difference in median PCO between cases and controls at 1 month (2.0 vs 1.50, P<0.068), but cases had a higher median PCO at 12 months (2.95 vs 1.30, P<0.001). At 4 years, there was no significant difference in median PCO between cases and controls (3.75 vs 2.25, P=0.273). The duration of diabetes increased the incidence of PCO at 4 years (P=0.02). Severity of DR had no influence on the progress of PCO at 4 years (P=0.69).

CONCLUSION

Diabetes mellitus did not increase the incidence of PCO at 4 years. The duration of diabetes increased the risk of PCO. The severity of retinopathy did not influence the development of PCO.

Influence of a variable overall diameter hydrophilic acrylic sharp-edged single-piece intra-ocular lens on capsule opacification one year after surgery

BACKGROUND

To investigate the influence of the overall intraocular lens (IOL) diameter on posterior capsule opacification (PCO) formation.

METHODS

In this prospective randomized clinical trial, 124 eyes of 62 patients with bilateral age-related cataract were included. Each patient received a Corneal A501D IOL in one eye and a Corneal J501D IOL in the fellow eye. Best corrected visual acuity (BCVA) and digital slitlamp photographs were taken a 1 h, 1 week, 1, 3, 6 and 12 months postoperatively. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.

RESULTS

We found a mean BCVA of 0.81 ± 0.2 for the Corneal A501D group and 0.79 ± 0.21 for the Corneal J501D group. There was no significant difference 12 months after surgery between the two IOLs (p > 0.05). Objective PCO assessment resulted in a mean PCO score (scale 0-10) of 1.65 ± 1.71 was found for the Corneal J501D group and a score of 1.54 ± 1.64 was found for the Corneal A501D group (p > 0.05). The subjective PCO assessment at 1 year resulted in a mean PCO score of 2.0 ± 1.74 in the Corneal J501D group and 2.13 ± 1.64 in the Corneal A501D group (p > 0.05).

CONCLUSION

Both investigated IOLs showed good clinical performance regarding PCO and BCVA. Our study suggests that the use of an IOL with variable total diameter seems not to influence the rate of PCO formation.

Posterior capsule opacification with 3 intraocular lenses: 12-year prospective study

PURPOSE

To compare posterior capsule opacification (PCO) with 3 intraocular lenses (IOLs) 12 years postoperatively.

SETTING

St. Erik Eye Hospital, Stockholm, Sweden.

DESIGN

Randomized clinical trial.

METHODS

Patients having unilateral standard phacoemulsification were randomized to implantation of a round-edged heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) IOL, a round-edged silicone IOL, or a sharp-edged hydrophobic acrylic IOL. The neodymium:YAG (Nd:YAG) capsulotomy rates and timing from surgery were recorded. Survival analysis was used to compare Nd:YAG rates. Retroillumination images were taken to evaluate PCO.

RESULTS

After 12 years, there was no significant difference in the fraction or severity of PCO between the silicone IOL and acrylic IOL. The HSM PMMA IOL had a significantly higher PCO fraction than the silicone IOL (P<.05), but not more than the acrylic IOL. There was no difference in PCO severity between the HSM PMMA IOL and the other 2 IOLs. The silicone IOL had higher median capsulotomy-free survival (>150 months) than the acrylic IOL (108 months) and the HSM PMMA IOL (53 months). Overall survival without Nd:YAG capsulotomy did not differ between the acrylic and silicone IOLs or between the silicone and HSM PMMA IOLs; however, overall survival was significantly better with the acrylic IOL than with the HSM PMMA IOL (P<.001).

CONCLUSIONS

After 12 years, there was no difference in PCO or overall survival without capsulotomy between the acrylic IOL and the silicone IOL. The HSM PMMA IOL had a significantly higher PCO fraction than the silicone IOL and lower overall survival than the acrylic IOL.