Fibrous membrane formation at the capsular margin in capsule contraction syndrome

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.

Proteomic analysis of aqueous humor from cataract patients with retinitis pigmentosa

A postcataract surgery complication in patients with retinitis pigmentosa (RP) is lens capsular contraction. To identify potential proteins contributing to this phenomenon, high-performance liquid chromatography/mass spectrometry-based proteomic analysis was conducted with aqueous humor samples collected from 11 patients who underwent cataract surgeries, with four patients diagnosed as RP and cataract (RP group) and the other seven with only senile cataract group. The upregulated proteins in the RP group were enriched in wound response, while downregulated proteins were enriched in cell adhesion and lens crystallins. Receptors of two dramatically upregulated proteins tenascin-C (TNC) and serotransferrin were found expressed in human lens epithelial cells (HLEs). TNC can promote primary HLEs proliferation and cell line HLE-B3 migration. This study indicates aqueous humor proteomic analysis serves as an effective way to unveil the pathogenesis of RP complications. TNC is a potential target of stimulating HLEs proliferation in RP concomitant cataract patients that worth further research.

Topical administration of a ROCK inhibitor prevents anterior subcapsular cataract induced by UV-B irradiation

The deposition of extracellular matrix (ECM)-which is mainly composed of type I collagen-in anterior subcapsular cataracts (ASCs) during epithelial-to-mesenchymal transition (EMT) of lens epithelial cells (LECs) decreases visual function. Transforming growth factor (TGF)-β is a key factor in the induction of EMT in LECs. Although Rho kinase (ROCK) plays an important role in EMT induced by TGF-β, it is unknown whether ROCK inhibition affects type I collagen expression in TGF-β-stimulated LECs and ASC formation. This was investigated in the present study both in vitro using human lens epithelium (HLE)-B3 cells and in vivo using mice with ultraviolet radiation (UVR)-B-induced cataracts. We found that TGF-β2 increased type I collagen mRNA expression in HLE-B3 cells; this was inhibited in a dose-dependent manner by treatment with the ROCK inhibitor Y-27632. UVR-B exposure caused ASC formation in mice. A histopathological examination revealed that LECs in the anterior subcapsular area were flattened and multi-layered, and had a spindle shape in cross section. Immunohistochemical analysis revealed the presence of α-smooth muscle actin and type I collagen around these flattened LECs; these opacities were reduced by topical instillation of Y-27632. These findings suggest that suppression of TGF-β signaling in LECs by topical application of a ROCK inhibitor can prevent the formation of ASCs.

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.

Elevated TGF-β2 level in aqueous humor of cataract patients with high myopia: Potential risk factor for capsule contraction syndrome

PURPOSE

To evaluate the level of transforming growth factor-β2 (TGF-β2) in the aqueous humor of highly myopic cataract patients and its correlation with capsule contraction syndrome.

SETTING

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

DESIGN

Prospective comparative case series.

METHODS

The highly myopic cataract patients were divided into the following 2 groups according to the Lens Opacity Classification System III: nuclear color (NC) 2 to 3 and NC 5 to 6. Aqueous humor TGF-β2 concentrations were assayed in the highly myopic cataract and age-related cataract groups. The TGF-β2, TGF-βRII (the type II receptor for TGF-β2), and α-smooth muscle actin (α-SMA) expressions in lens epithelial cells (LECs) were detected by real-time polymerase chain reaction and immunofluorescent staining.

RESULTS

The study comprised 40 highly myopic cataract patients (40 eyes) and 20 patients (20 eyes) with age-related cataract as the control group. Compared with the control group, the highly myopic cataract group had significantly higher TGF-β2 concentration in the aqueous humor and increased TGF-βRII expression in LECs, especially in NC 5 to 6 cases. Expression of α-SMA was barely detectable in both groups.

CONCLUSION

In highly myopic cataract patients, especially those with dark nuclei, elevated aqueous humor TGF-β2 levels and the upregulated TGF-βRII expression in LECs might contribute to the pathogenesis of capsule contraction syndrome through transdifferentiation of LECs into myofibroblasts.

FINANCIAL DISCLOSURE

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

In-the-bag decentration of an intraocular lens in a patient with a tendency to hypertrophic scarring

We report a case of rapid anterior lens capsular contraction leading to decentration of a hydrophilic acrylic lens with stiff haptics (Rayner design). To our knowledge, this is the first report to investigate early capsular contraction with folding of the haptic over the optic in a patient with a tendency toward hypertrophic scar formation.

Immunohistologic study of interleukin-1, transforming growth factor-β, and α-smooth muscle actin in lens epithelial cells in diabetic eyes

PURPOSE

To assess the effects of the cytokines interleukin-1 (IL-1), transforming growth factor-beta (TGF-beta), and alpha-smooth muscle actin (alpha-SMA) in lens epithelial cells (LECs) in normal and diabetic eyes.

SETTING

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

METHODS

Ten eyes of 10 patients with diabetic mellitus and 20 normal eyes of 20 patients with senile cataract were studied. The anterior lens capsules with LECs obtained by capsulotomy during cataract surgery were cultured. The LECs obtained immediately after surgery and on the third day of culture were immunohistologically studied to assess the activities of the cytokines.

RESULTS

Interleukin-1 and TGF-beta staining showed a low level activity in some LECs in diabetic eyes but only a minimum level of activity in those in normal eyes. During culture, LECs in diabetic eyes became small and transformed into fusiform and fibroblast-like cells, and these cells were strongly stained for IL-1 and TGF-beta. Normal eyes showed little changes in cell morphology and were weakly stained for IL-1 and TGF-beta. Both with culture and with no culture, alpha-SMA showed only minimal activity in both diabetic and normal eyes, with no difference.

CONCLUSION

Lens epithelial cells after cataract surgery had low IL-1 and TGF-beta activities, and these activities increased during culture. Diabetic eyes showed higher cytokine activities and more marked morphologic changes than normal eyes, suggesting that increased proliferative activity and increased cytokine activity of LECs contribute to strong anterior capsule contraction in diabetic eyes.

Interim results of the United States investigational device study of the Ophtec capsular tension ring

PURPOSE

To evaluate the safety and efficacy of the Ophtec capsular tension ring (CTR) in providing capsular support during and/or after cataract extraction in cases of a weak or partially broken ciliary zonule.

DESIGN

Phase III multicenter, nonrandomized, investigational device study.

PARTICIPANTS

Twelve investigators at 9 sites enrolled 224 subjects and placed 255 CTRs.

METHODS

Capsular tension rings were placed in patients who were found to have a weakened or partially broken ciliary zonule comprising <34% of the circumference of the lens capsule. Two CTR models were evaluated, with noncompressed diameters of 12 mm and 13 mm. Patients were examined preoperatively, intraoperatively, and postoperatively at day 1 and months 1, 3, 6, and 12.

MAIN OUTCOME MEASURES

Rate of successful stabilization of the capsular bag and intraocular lens (IOL) centration, complications, and adverse events.

RESULTS

Interim results from this ongoing study indicate that immediately after surgery 98.8% of IOLs were centered and 1.2% of the IOLs implanted (3/251) were not centered. Subsequently, the prevalence of decentered IOLs was 1.7% (4/236) 3 months after surgery, 3.8% (8/211) 6 months after surgery, and 2.3% (4/172) 12 months after surgery. The primary complication was posterior capsular opacification, which is unlikely to be a complication of CTR insertion. Neodymium:yttrium-aluminum-garnet laser capsulotomies have been performed in 12.8% of eyes by 12 months (22/172).

CONCLUSIONS

Ophtec CTR models 275 and 276 safely provided capsular support during and after cataract surgery in cases where the zonule was weak or partially broken.

Complete occlusion of the anterior capsular opening by fibrocellular membrane associated with retained silicone oil: a clinicopathologic correlation

BACKGROUND

To report the clinicopathologic features of a fibrocellular membrane in a pseudophakic eye with retained silicone oil in the absence of any capsular contraction syndrome, necessitating repeat anterior capsulorhexis.

METHODS

Clinicopathologic report of a case.

RESULTS

Histopathologic study of the membrane showed absence of any true periodic acid Schiff-positive capsule within the specimen. Clinically, there was no evidence of any anterior capsular contraction. The fibrocellular membrane may have occurred as a result of inflammatory and mechanical effects of silicone oil in the anterior chamber or as a result of the intraocular lens design.

CONCLUSION

The authors report the clinicopathologic features of a fibrocellular membrane occluding the anterior capsular opening in a pseudophakic eye with retained silicone oil, in the absence of any capsular contraction. The stimulus for its formation may have been the inflammatory and mechanical effects of retained silicone oil in the anterior chamber.

Effect of haptic design on change in axial lens position after cataract surgery

PURPOSE

To compare the postoperative changes in anterior chamber depth (ACD) between single-piece and multipiece AcrySof intraocular lenses (IOLs) (Alcon Laboratories, Inc.) and their effect on the postoperative refractive shift.

SETTING

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

METHODS

This prospective randomized bilateral study with intraindividual comparison comprised 104 eyes of 52 consecutive patients with age-related cataract. All patients had standardized cataract surgery with a temporal self-sealing incision, phacoemulsification, and IOL implantation in the capsular bag. The first 30 patients received a single-piece, 5.5 mm optic IOL (AcrySof SA30) in 1 eye and a multipiece IOL (AcrySof MA30) in the other eye. Another 22 patients received the corresponding 6.0 mm optic models (AcrySof SA60 and AcrySof MA60, respectively). Anterior chamber depth measurements and evaluation of the change in ACD during the first 6 postoperative months were performed using partial coherence laser interferometry. The amount of change in capsulorhexis size during the first 6 postoperative months was assessed using standardized retroillumination photographs.

RESULTS

Single-piece IOLs shifted significantly less postoperatively than multipiece IOLs. The multipiece IOLs shifted forward, especially from 1 day to 1 month. The change in the capsulorhexis area was similar between IOL types.

CONCLUSIONS

Single-piece AcrySof IOLs shifted minimally after the first postoperative day; therefore, the prescription for spectacles in eyes with this IOL can be obtained soon after surgery.

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.

Peeling the fibrous membrane from the anterior capsule for capsulorhexis contraction after phacoemulsification in aphakic patients

We report a method for peeling the fibrous membrane from the anterior capsule without damaging the posterior capsule in patients with capsule contraction syndrome after cataract surgery. We also report 2 cases in which the technique was successfully used.

Clinical performance of Alcon SA30AL and SA60AT single-piece acrylic intraocular lenses

PURPOSE

To report the clinical performance characteristics of single-piece acrylic Alcon SA30AL and SA60AT intraocular lenses (IOLs).

SETTING

A private practice in Marshalltown, Iowa, USA.

METHODS

In a review of 2630 consecutive cases operated on from January 2000 through July 2001, ease of IOL insertion and integrity of the haptic architecture were evaluated in a prospective fashion at implantation. Subgroups of cases were studied prospectively to evaluate 3 factors: same-day incision competence after implantation (postoperative intraoperative pressure [IOP], 107 cases); 2- to 5-week A-constant validation (200 cases); 1-day, 2-week, and 1- and 5-month descriptions of optic centration with respect to pupil and capsule anatomy (79 cases); and a 1-day versus 9-month photographic comparison of IOL centration (70 cases). A retrospective evaluation of the population's diagnostic codes tabulated complications including increased postoperative iritis, cystoid macular edema, neodymium:YAG (Nd:YAG) laser intervention for posterior capsule opacification, and pseudophakic dysphotopsia. A retrospective review of a subgroup of 140 consecutive cases was done to categorize postoperative optic clarity.

RESULTS

Overall, the IOLs were easy to implant with no haptic or optic damage using a forceps or the Monarch injector. Subgroup studies confirmed good performance in the following parameters: There were no cases of incision incompetence evidenced by an abnormally low postoperative IOP. The lowest postoperative IOP was 6 mm Hg, with the overall mean IOP increasing to 29 mm Hg from the 17 mm Hg measured a mean of 102 minutes after surgery. The manufacturer's published A-constant was almost identical to that obtained in review (118.4 versus 118.38 for the SA30AL and 118.35 for the SA60AT). In verbal descriptions, IOL optic centration was assessed to be within 0.4 mm of perfect in 75 (95%) of 79 cases. Slitlamp photographs showed that 52 (98%) of 53 IOLs were in the same position 9 months after surgery as on the day of surgery. One IOL optic appeared to rotate 14 degrees. There were no cases of decentration greater than 1.0 mm in either optic centration subgroup. Given a normal postoperative topical steroid regimen, there were no cases of substantially increased or prolonged iritis. There were 17 cases (0.65%) of macular edema. An Nd:YAG laser posterior capsulotomy was performed in 0.64% (13/2044) in the SA30AL group over a mean of 9 months (range 2 to 23 months) and in 0.34% (2/586) in the SA60AL group over a mean of 5.5 months (range 5 to 6 months). Pseudophakic dysphotopsia was diagnosed in 26 eyes of 18 patients (1% of 2630 cases), with 1 patient requiring an IOL exchange. Optic glistenings were observed in 11 (11%) of 100 SA30AL cases at a mean follow-up of 8 months. No glistenings in 40 cases were seen in the SA60AT group at a mean follow-up of 3 months.

CONCLUSIONS

The single-piece acrylic lenses performed well in all regards. Although not as intense as observed with the earlier 3-piece designs, pseudophakic dysphotopsia occurred in a few patients with the single-piece acrylic lens. Intraocular lens exchanges with single-piece IOLs may be accomplished with less difficulty early rather than late.