Risk factors for contraction of the anterior capsule opening after cataract surgery

Effect of intraocular lens material and haptic design on anterior capsule contraction after cataract surgery: A systematic review and meta-analysis

PURPOSE

To compare anterior capsule contraction (ACC) after cataract surgery with implantation of intraocular lens (IOLs) of different materials and designs.

METHODS

We searched three electronic databases for relevant studies published up to January 1, 2023. Five randomized controlled trails (RCTs) and three cohort studies involving 1,221 eyes were included in quantitative synthesis. We extracted data, assessed their quality independently, and calculated standard mean difference (SMD) using a random-effects model. Six RCTs and one retrospective cohort were included in information summary.

RESULTS

The contraction of the anterior capsule opening area in the hydrophilic group was larger than that of the hydrophobic group from one month to one year postoperatively (P < 0.001 and P < 0.001, respectively). Specifically, the hydrophilic group showed greater contraction of the anterior capsule opening area at one month postoperatively (Standardized mean difference [SMD] = -0.73, 95% confidence interval [CI] = -0.93 to -0.52), three months (SMD = -1.04, 95% CI = -1.32 to -0.75), six months (SMD = -0.99, 95% CI = -1.24 to -0.74) and one year (SMD = -1.33, 95% CI = -2.50 to -0.16). As of one year postoperatively, the anterior capsular opening area showed a trend of decreasing over time in both groups (P = 0.046 and P = 0.050, respectively). In information summary, three studies indicated no relationship between haptic design and ACC, while the other four studies reported that the number and shape of haptic would affect ACC.

CONCLUSION

This meta-analysis suggested that the postoperative ACC after the implantation of hydrophobic IOLs was less than that induced by hydrophilic IOLs. Haptic design may also affect the degree of ACC.

Factors influencing aqueous flare after cataract surgery and its evaluation with laser flare photometry

Despite the refinement of modern cataract surgery, postoperative inflammation still constitutes a substantial amount of visual morbidity worldwide. A surrogate for intraocular inflammation and blood-aqueous barrier breakdown can be objectively quantified by Laser flare photometry (LFP). This review outlines the utility of LFP in assessing the assessment of post-cataract surgery inflammation. It highlights the impact of preoperative pathological states such as uveitis and diabetes, intraoperative techniques, including efficient phacoemulsification and direct comparisons between postoperative anti-inflammatory regimes. There is a large interobserver variation in the subjective flare measurement after cataract surgery and the continued use of LFP amongst other objective, noninvasive measurements of intraocular inflammation, particularly in the further development of cataract surgery, is recommended.

Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support

Background and Objectives: To evaluate anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation after cataract surgery in patients with weak or partially absent zonular support and assess methods of reducing these complications. Materials and Methods: For this prospective study, we enlisted cataract surgery patients in our hospital with preoperative diagnoses of weak zonules. All patients received phacoemulsification surgery with implantation of a hydrophobic acrylic IOL and capsular tension ring (CTR). ACO reductions were measured for six months after enrolment. Data on late IOL dislocations were collected five years after enrolment of the last patient. Results: Fifty-three patients were enrolled from 2011 to 2015. Over the six-month active follow-up period, ACO area reduction was 23% in patients receiving CTRs of 11 mm diameter and 8% for patients with CTRs of 12 mm, with an overall mean of 15% reduction. Five years after the last patient was enrolled, seven patients (13%) had experienced late IOL-CTR-capsular bag dislocation. For these patients, the mean ACO reduction in the first six months of follow-up was 33%, including for those who had received neodymium-doped yttrium aluminum garnet (Nd: YAG) anterior capsulotomies. Conclusion: Use of hydrophobic acrylic lenses and CTR reduces ACO contraction, with rates comparable to those after cataract surgery without ocular comorbidity. Our patients experienced a relatively high rate of late IOL-CTR-capsular bag dislocation. However, dislocated complexes were easily repositioned and few patients required IOL exchange. Frequent visits are warranted to promptly detect late complications of cataract surgery in patients with weak zonular support.

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.

[Complex morphological assessment of anterior capsule of the lens in patients with capsular contraction syndrome (a clinical case study)]

The anterior capsular contraction syndrome (ACCS) in pseudophakic patients is known to be accompanied by postoperative opacity of anterior lens capsule (ALC) and partial or full closure of anterior capsulotomy opening.

PURPOSE

To perform complex morphological assessment of ALC in patients with ACCS.

MATERIAL AND METHODS

The study involved complex analysis of ALC that was removed due to ACCS in the pseudophakic eye in the setting of diabetes mellitus and past vitreoretinal surgery. The following examination methods were used: light-optical microscopy of ALC samples in the form of polychrome-colored semifine sections using optical microscope Leica DM-2500 (Germany), scanning microscopy of ALC surface with EVO LS10 (Carl Zeiss, Germany) microscope, analysis of chemical element composition and its variation of the ALC sample with energy-dispersive spectrometer Oxford X-Max50 (Oxford, UK).

RESULTS

Light-optical microscopy showed altered state and plication of ALC induced by proliferation from inner surface of the fibrocellular tissue, which gradually thickens (up to 360 µm) towards center and causes reduction of anterior capsulotomy opening. Scanning electron microscopy revealed presence of tissue with uneven micro-relief and a porous three-dimensional structure uncharacteristic for capsule on the surface of ALC. Thickness of the fibrous deposition significantly exceeded the thickness of ALC. Evaluation of elemental composition of the fibrocellular tissue showed elevated concentration of sulfur and phosphorus, which indicates high activity of the regenerative process. In the observed case, the regenerative process was of substitute nature because an attempt to restore the lens was accompanied by formation of connective tissue structurally different from original.

CONCLUSION

Complex assessment of an isolated ALC sample allowed revelation of the chain of pathological processes accompanying the development of ACCS.

Effect of number and position of intraocular lens haptics on anterior capsule contraction: a randomized, prospective trial

BACKGROUND

The present study aimed to evaluate the degree of anterior capsule contraction (capsulorhexis contraction) with three different single-piece, hydrophilic acrylic intraocular lenses (IOLs).

METHODS

Patients were prospectively randomized to be implanted with one of three types of IOLs during cataract surgery: the Ophtec Precizon (IOL A), the Lucid Korea Microflex (IOL B), and the Carl Zeiss Asphina (IOL C). One week, 2 weeks, and 6 months after surgery, the area of the anterior capsule opening was measured using digital retro-illumination images after dilation of the pupil. The data were then evaluated using POCOman software.

RESULTS

The study included 236 eyes of 202 patients. The area of the anterior capsule opening reduced by 3.53 ± 3.31 mm (17.06% ± 15.99%) between 1 week and 2 months post-operatively in the IOL A group, by 0.62 ± 1.32 mm (2.87% ± 6.03%) in the IOL B group, and by 1.09 ± 1.53 mm (4.72% ± 6.10%) in the IOL C group. The IOL B group showed minimal anterior capsule contraction 2 months after surgery (p < 0.001).

CONCLUSIONS

IOLs with a four-plate haptic design (IOL B) showed more anterior capsular stability than those with a two-loop plate haptic (IOL A) or two-plate haptic (IOL C) design. The number and position of haptics in a capsular bag may affect anterior capsule contraction. We assume that supporting the zonules evenly may play a role in anterior capsular stability.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN76566080 , Retrospectively registered (Date of registration: 14 Feb 2018).

[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.

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.

Bimanual anterior segment revision surgery for anterior capsule contraction syndrome associated with anterior flexion of intraocular lens haptics

PURPOSE

To report the incidence of anterior capsule contraction syndrome (ACCS) and to present a novel minimally invasive bimanual technique for anterior segment revision surgery associated with ACCS with anterior flexion of the intraocular lens haptics.

METHODS

A consecutive cohort of 268 eyes of 161 patients undergoing phacoemulsification and implantation of the same type of hydrophilic acrylic aspheric intraocular lens cohort were analysed and a novel technique of minimally invasive bimanual technique for anterior segment revision surgery is described.

RESULTS

We identified four eyes (1.5%) of three patients with advanced ACCS. Successful restoration of a clear visual axis with minimal induction of astigmatism and rapid visual rehabilitation was achieved in all four cases.

CONCLUSION

This technique is a safe and minimally invasive alternative to laser or vitrector-cut capsulotomy to restore a clear visual axis. In cases of advanced ACCS, it offers the option for haptic reposition or amputation.

Anterior capsule relaxing incisions with neodymium:YAG laser for patients at high-risk for anterior capsule contraction

PURPOSE

To examine the effect of anterior capsule relaxing incisions created with a neodymium:YAG (Nd:YAG) laser on prevention of anterior capsule contraction after cataract surgery in high-risk patients.

SETTING

Hayashi Eye Hospital, Fukuoka, Japan.

DESIGN

Randomized masked clinical trials.

METHODS

Patients at high risk for anterior capsule contraction had anterior capsule relaxing incisions in either eye 3 days postoperatively. The anterior capsule opening was measured using a Scheimpflug videophotography system (EAS-1000) immediately and 1, 3, and 6 months after capsulotomy, and the percentage reduction in area was calculated. The degree of intraocular lens (IOL) decentration and tilt, posterior capsule opacification (PCO), and other complications were also assessed.

RESULTS

Of the 84 patients included, 30 had primary angle closure, 28 had pseudoexfoliation, and 26 had diabetic retinopathy. There was no significant difference in the mean opening area between fellow eyes at baseline. In patients with primary angle closure, the area was significantly greater and the percentage reduction in area was significantly less in the capsulotomy group than in the no-capsulotomy group (P≤.0428). In patients with pseudoexfoliation or diabetic retinopathy, the percentage reduction was significantly less in the capsulotomy group than in the no-capsulotomy group (P≤.0493), although there was no significant difference in area. No significant difference was found in IOL decentration or tilt, PCO, or incidence of other complications.

CONCLUSION

Neodymium:YAG laser anterior capsule relaxing incisions in the early period after cataract surgery were effective in preventing anterior capsule contraction in high-risk patients and had no adverse effects.

FINANCIAL DISCLOSURE

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

Prevention of anterior capsule contraction by anterior capsule relaxing incisions with neodymium:yttrium-aluminum-garnet laser

PURPOSE

To examine the effect of two or three neodymium:yttrium-aluminum-garnet (Nd:YAG) laser relaxing incisions made in the anterior capsular rim on prevention of anterior capsule contraction after cataract surgery.

DESIGN

Randomized clinical trials.

METHODS

One hundred patients scheduled for bilateral cataract surgery were randomized to one of two groups: two or three relaxing incisions in the left eye and no incisions in the right eye, and relaxing incisions in the right eye and no incisions in the left eye. The anterior capsule opening area was measured using Scheimpflug photography immediately after capsulotomy and at one, three, and six months after capsulotomy, and the percentage reduction was calculated. The degree of intraocular lens (IOL) decentration and tilt and of posterior capsule opacification (PCO) also were examined.

RESULTS

There was no significant difference in the anterior capsule opening area between fellow eyes at baseline (P > or = .1770). In patients who underwent two incisions, no significant difference was found between fellow eyes in the opening area (P > or = .4098) or in the percentage of reduction (P > or = .8730) throughout follow-up. In patients who underwent three incisions, the opening area in eyes with capsulotomy was significantly greater than that in eyes without capsulotomy (P < or = .0154), and the percentage reduction was significantly smaller in eyes with capsulotomy than in eyes without capsulotomy (P < or = .0016). No significant differences were found in the IOL decentration and tilt, or in PCO.

CONCLUSIONS

Three relaxing incisions made in the anterior capsule decrease the anterior capsule contraction, whereas two incisions do not.

Capsulorhexis contraction after cataract surgery: Comparison of sharp anterior edge and modified anterior edge acrylic intraocular lenses

PURPOSE

To evaluate the reduction in the anterior capsule opening after phacoemulsification, continuous curvilinear capsulorhexis, and implantation of 1 of 2 acrylic intraocular lenses (IOLs).

SETTING

Department of Ophthalmology, Vejle Hospital, Vejle, Denmark.

METHODS

Eighty-four patients (84 eyes) were included in a prospective randomized study. All had phacoemulsification followed by implantation of an IOL with a modified anterior edge (38 eyes) or a sharp anterior edge (46 eyes). One day (baseline) and 3 months postoperatively, the area of the anterior capsule opening was measured using retroillumination photographs.

RESULTS

There was a significant reduction in the area of the anterior capsule opening from 1 day to 3 months postoperatively in both groups (P<.001). There was no significant difference in the reduction in the anterior capsule opening between the modified-edge IOL and the sharp-edged IOL (P = .313). The shrinkage was independent of the area of the anterior capsule opening at baseline.

CONCLUSIONS

There was a reduction in the area of the anterior capsule opening in all patients. The design of the anterior edge of the 2 IOLs did not influence the degree of anterior capsule opening shrinkage. The shrinkage was independent of the size of the area 1 day postoperatively.

Cataract and glaucoma surgery in pseudoexfoliation syndrome: a review

Pseudoexfoliation syndrome is a risk factor in cataract surgery because of the increased weakness of zonular apparatus and reduced pupillary dilatation. The surgical outcome of using phacoemulsification in the central zone, inducing minimal stress on the zonules, inserting a capsular tension ring in selected cases, and stretching the pupil mechanically in eyes with miotic pupils, may turn out to be uneventful in most cases. Postoperative fibrosis with subsequent shrinkage of the capsule is increased in these eyes, and these centripetal forces will further loosen the zonular fibres. Late in-the-bag intraocular lens dislocation is therefore anticipated to become a growing problem in the future. Despite the dysfunctioning of the blood-aqueous barrier in eyes with pseudoexfoliation syndrome, the frequency of postoperative inflammatory reaction is low due to the improvements made in surgical technique and equipment in recent years. Glaucoma frequently occurs in eyes with pseudoexfoliation syndrome. Compared with primary open-angle glaucoma, optic damage is more pronounced in these eyes at the time of diagnosis and response to medical therapy is poorer. Although responses to argon laser therapy and filtering surgery are roughly similar between the two types of glaucoma, there are indications that primary laser trabeculoplasty has a higher success rate in pseudoexfoliation glaucoma than in primary open-angle glaucoma.

Influences of optic edge design on posterior capsule opacification and anterior capsule contraction

PURPOSE

To investigate the influence of optic edge design on posterior capsule opacification (PCO) and anterior capsule contraction (ACC).

METHODS

A total of 43 eyes of 43 patients scheduled to undergo cataract surgery were included in this study. Patients received either a Sensor AR40 intraocular lens (IOL) or a Sensor AR40e IOL. The area of the anterior capsule opening (ACO) was determined by diaphanoscopy using the anterior eye segment analysis system EAS-1000 at 1 day, 1 week and 1, 3, 6 and 12 months postoperatively. Posterior capsule opacification was evaluated objectively in two ways, using either the EAS-1000 or POCOman.

RESULTS

There was no significant difference between the two groups in either ACO area or percentage reduction of ACO area at any time-point after surgery. The difference in the degree of PCO 1 year after surgery was not significant when measured by either the EAS-1000 or POCOman.

CONCLUSIONS

A sharp IOL edge is required to prevent PCO. Sharp-edged IOLs do not appear to be a risk factor for ACC.

Late in-the-bag intraocular lens dislocation: Incidence, prevention, and management

Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.

Intraocular lens factors that may affect anterior capsule contraction

PURPOSE

To examine the various factors comprising intraocular lenses (IOLs) that may affect the degree of anterior capsule contraction after cataract surgery.

DESIGN

Randomized controlled clinical trials.

PARTICIPANTS

Three hundred thirty-one patients scheduled for bilateral cataract surgery were studied to compare the degree of anterior capsule contraction in fellow eyes that received different IOLs with regard to the following factors: (1) optic material-acrylic optic versus silicone optic; (2) optic design-round-edge optic versus sharp-edge optic; (3) haptic material-polymethyl methacrylate (PMMA) loop versus polyvinylidene fluoride loop; and (4) haptic material and design-single-piece acrylic haptic versus 3-piece PMMA haptic. The 2 IOLs implanted in the fellow eyes of each patient had almost the same material and design, except for the specific factor being compared.

METHODS

All patients underwent phacoemulsification surgery with implantation of different IOLs in fellow eyes.

MAIN OUTCOME MEASURES

The area of the anterior capsule opening was measured using the Scheimpflug videophotography system at 3 days or 1 week (baseline) and at 1, 3, and 6 months after surgery. The percent reduction in the anterior capsule opening area from baseline was determined at 1, 3, and 6 months after surgery.

RESULTS

The mean percent reduction of the anterior capsule opening area was significantly greater in eyes with a silicone optic IOL than in eyes with an acrylic optic IOL. However, no significant difference was observed in the percent reduction between round-edge and sharp-edge optic IOLs, between PMMA and polyvinylidene fluoride loop IOLs, and between single-piece acrylic and 3-piece PMMA haptic IOLs. Strong associations were found in the percentage between round-edge and sharp-edge optic IOLs, between PMMA and polyvinylidene fluoride loop IOLs, and between single-piece acrylic and 3-piece PMMA haptic IOLs, whereas there was a relatively weak association between silicone and acrylic optic IOLs.

CONCLUSIONS

Among the IOL factors examined, optic material affects most significantly the degree of anterior capsule contraction, whereas optic design and haptic material and design are not strongly related to anterior capsule contraction.

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.

[Severe bilateral capsulorhexis contraction after cataract surgery in myotonic dystrophy: a case report]

INTRODUCTION

The Authors report the case of a 50-Year-old man with myotonic dystrophy, who developed severe bilateral capsulorhexis contracture after uneventful cataract surgery.

OBSERVATION

Phacoemulsification was performed in both eyes with implantation of intraocular lenses. The patient came to complain of decreased vision in both eyes (4/10 Parinaud 4). Visual acuity initially improved after surgery to 8/10 P2 in each eye. After 7 months for the right eye and 3 Months for the left eye, the patient presented with dramatically reduced vision, caused by a severe capsulorhexis contracture. Anterior capsulotomies with the Nd:YAG laser were performed in both eyes to treat this complication. It was sufficient on the left eye but the right eye required a surgical anterior capsulectomy to remove the IOL and the bag and put in an Artisan lens.

DISCUSSION

Capsulorhexis contracture results from fibrous metaplasia of lens epithelial cells from the anterior capsule. Myotonic dystrophy appears to predispose to the development of severe capsulorhexis contracture after phacoemulsification.

Relationship between anterior capsule contraction and posterior capsule opacification after cataract surgery in patients with diabetes mellitus

PURPOSE

To prospectively assess the relationship between contraction of the anterior capsule opening and posterior capsule opacification (PCO) after cataract surgery in patients with diabetes mellitus.

SETTING

Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Kaiya Eye Clinic, Hamamatsu, and Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaragi, Japan.

METHODS

This study comprised 45 patients (45 eyes) with diabetes mellitus who had cataract surgery. In all eyes, the anterior capsule opening area and degree of PCO were determined by diaphanoscopy using an anterior eye segment analysis system (EAS-100, Nidek, Inc.) 1 day and 1 year postoperatively.

RESULTS

There was no correlation between the size of the anterior capsule opening area 1 day after surgery and the degree of PCO 1 year after surgery (Pearson correlation coefficient [r] = 0.041; P =.79). The percentage reduction in the anterior capsule opening area from 1 day to 1 year after surgery did not correlate with the degree of PCO 1 year after surgery (r = -0.08; P =.60).

CONCLUSION

Contraction of the anterior capsule opening and PCO after cataract surgery cannot be explained by a common mechanism.

Capsular peeling in anterior capsule contraction syndrome: surgical approach and histopathological aspects

We present 4 cases of anterior capsule contraction syndrome in which progressive shrinkage of the anterior capsulorhexis developed after uneventful phacoemulsification. Three eyes were pseudophakic, and 1 eye remained aphakic. The newly formed membrane was surgically peeled from the anterior capsule, restoring the capsular bag.

Lens epithelial cell reaction after implantation of different intraocular lens materials

PURPOSE

To determine the influence of intraocular lens (IOL) material on anterior capsular opacification and membrane growth over the anterior IOL surface in patients who have undergone standardized small-incision cataract surgery and foldable IOL implantation in the capsular bag.

DESIGN

Randomized controlled trial.

PARTICIPANTS

Eighty-eight cataract patients (88 eyes).

METHODS

Patients were randomly assigned to receive one of four different foldable IOLs after phacoemulsification: Storz Hydroview H60M, Corneal ACR6D, AMO SI40NB, and Alcon AcrySof MA60BM. Examinations on days 7, 30, 90, 180, 360, and 720 after surgery included ophthalmologic examination, slit-lamp biomicroscopy, and photography using red reflex and focal illumination of the anterior IOL surface.

MAIN OUTCOME MEASURES

Best-corrected visual acuity was measured at each examination. In addition, the anterior capsule opacification and the membrane growth on the anterior IOL surface were graded according to a subjective method by the same researcher.

RESULTS

The fibrosis of the anterior capsule was more frequently observed in the group using Corneal ACR6D and AMO SI40NB. The Hydroview and ACR6D groups showed a higher percentage of cases with membrane growth from the rhexis edge on the anterior IOL surface. AcrySof showed the lowest presence of fibrosis of the anterior capsule, and no membrane growth was noted.

CONCLUSIONS

Anterior capsule opacification is an index of IOL biocompatibility. The natural location of lens epithelial cells (LECs) precludes the possibility of the IOL's design influencing the anterior capsule behavior. The local response of LECs varies according to the IOL studied. This may be related to the chemical and physical properties of the materials used in the different IOLs.