Decreased prostaglandin E2 synthesis by lens epithelial cells cultured on heparin-surface-modified poly(methyl methacrylate)

Intraindividual aqueous flare comparison after implantation of hydrophobic intraocular lenses with or without a heparin-coated surface

PURPOSE

To assess the efficacy of a heparin-surface-modified (HSM) hydrophobic acrylic intraocular lens (IOL) (EC-1YH PAL) and the same IOL without heparin coating (EC-1Y-PAL) by the flare and cell intensity in the anterior chamber after uneventful cataract surgery.

SETTING

Department of Ophthalmology, Paracelsus Medical University Salzburg, Austria.

DESIGN

Comparative case series.

METHODS

Routine phacoemulsification with randomized implantation of an HSM IOL in 1 eye (HSM IOL group) and an uncoated IOL (uncoated IOL group) in the fellow eye was performed. Postoperative inflammation was assessed objectively using a laser flare-cell meter (FM-600) preoperatively as well as 1 day and 1 and 3 months postoperatively. Aqueous cells in the anterior chamber, distance visual acuities, and subjective manifest refraction were also evaluated at each visit.

RESULTS

One hundred eyes (50 patients) were enrolled. In both groups, the mean flare values increased significantly from preoperatively to 1 day postoperatively (P<.001) and nearly reached preoperative values by 3 months postoperatively. One day postoperatively, the mean flare value was statistically significantly lower in the HSM IOL group (14.92 photons per millisecond [ph/ms] ± 7.47 [SD]) than in the uncoated IOL group (mean 16.73 ± 7.81 ph/ms) (P=.04); there was no statistically significant difference between groups 1 and 3 months postoperatively (both P>.58). The HSM IOL group had a greater and quicker decrease in aqueous cells, reaching statistical significance 1 month postoperatively (P=.01).

CONCLUSION

The HSM IOL showed a significant lower inflammatory reaction in the early postoperative stage with a faster disappearance of inflammatory signs.

FINANCIAL DISCLOSURE

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

Heparin in the intraocular irrigating solution in pediatric cataract surgery

PURPOSE

To investigate the antiinflammatory effects of adding heparin sodium to the irrigating solution to prevent fibrinoid reaction and related long-term complications after pediatric cataract surgery.

SETTING

Department of Ophthalmology, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.

METHODS

Thirty eyes of 18 children who had cataract or other ocular surgery were included in the study. Bilateral cataract surgery was performed in 20 eyes of 10 children and bilateral secondary intraocular lens (IOL) implantation in 4 eyes of 2 children (Group 1). Four eyes of 4 children had unilateral cataract surgery and 2 eyes of 2 children with previous perforating eye injury had synechiotomy and pupilloplasty (Group 2). Heparin sodium was added to the irrigating solution during surgery in 12 left eyes of children with bilateral surgery (Group 1a) and in all eyes in Group 2. Heparin sodium was not added during surgery in 12 right eyes of children having bilateral surgery (Group 1b, control). Early and late postoperative intraocular reactions were recorded and compared.

RESULTS

In Group 1a (heparin added), 6 eyes had less fibrinoid reaction and fewer related complications such as posterior synechias, pupil irregularity, and intraocular lens (IOL) decentration than the fellow right eyes. No eye in Group 1a having primary cataract surgery had hyphema or intraocular bleeding. Hyphema occurred on the first postoperative day in 1 eye in Group 1a that had secondary IOL implantation.

CONCLUSIONS

Adding heparin sodium to the irrigating solution decreased postoperative inflammatory and fibrinoid reactions and related complications such as synechias, pupil irregularity, and IOL decentration in pediatric cataract surgery. However, the use of heparin during surgery can be risky in eyes with a defective blood-aqueous barrier such as after previous ocular surgery.

Comparative performance of intraocular lenses in eyes with cataract and uveitis

PURPOSE

To evaluate the postoperative outcomes in uveitic eyes after phacoemulsification and posterior chamber intraocular lens (IOL) implantation.

SETTING

Multicenter (19) international study.

METHODS

This prospective randomized comparative interventional case series comprised 140 eyes of 140 patients who had phacoemulsification and implantation of IOLs of various materials: hydrophobic acrylic (n = 48), silicone (n = 44), poly(methyl methacrylate) (PMMA) (n = 26), or heparin-surface-modified PMMA (HSM PMMA) (n = 22). Preoperative and postoperative grading and control of intraocular inflammation were performed. Clinically significant observations, visual outcomes, and the incidence of postoperative complications were recorded.

RESULTS

At the final follow-up, 64 eyes (46.3%) had a best corrected visual acuity of 20/40 or better, an improvement that was highly significant (P <.0001). One day after surgery, the acrylic group had the lowest inflammation values and the silicone group the highest (P =.02). The acrylic group continued to have the lowest inflammation grade values until the 3-month follow-up. The acrylic and HSM PMMA groups had the lowest incidence of relapses. Posterior capsule opacification developed in 48 eyes (34.2%), with the highest incidence in the silicone group.

CONCLUSIONS

Phacoemulsification with IOL implantation in selected uveitic eyes was safe and effective. Acrylic IOLs provided a better visual outcome and lower complication rate than IOLs of other materials.

Effect of heparin in the irrigation solution on postoperative inflammation and cellular reaction on the intraocular lens surface

PURPOSE

To evaluate the influence of heparin sodium in the irrigation solution on postoperative inflammation and cellular reaction on the anterior surface of a hydrophilic intraocular lens (IOL).

SETTING

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

METHODS

This randomized prospective single-surgeon study included 50 patients with senile cataract only. Half the patients received 1 mL of heparin sodium (concentration 10 IU/mL) in addition to the regular irrigating solution. In all other respects, the procedure was standardized: clear corneal incision, phacoemulsification, and implantation of a Hydroview foldable hydrogel IOL (Bausch & Lomb). The parameters of inflammation-anterior chamber flare and cells-were evaluated with the pupil dilated in a masked fashion using a Kowa FC-1000 laser flare-cell meter 1, 3, 7, 14, and 28 days and 3, 6 and 12 months postoperatively. The cellular reaction was semiquantitatively examined and analyzed by specular microscopy.

RESULTS

In both groups, flare and cell values increased on the first postoperative day and successively decreased thereafter. In the first week, the flare and cell values were significantly higher in the group without heparin sodium in the irrigating solution. Subsequently, there were no differences between the 2 groups in flare or cells. At 1 day, the heparin sodium group had statistically significantly fewer IOLs with no cells on the surface. Subsequently, no differences in cellular reaction on the IOL were observed.

CONCLUSIONS

Heparin sodium added to the standard irrigating solution reduced disturbances of the blood-aqueous barrier in the early postoperative period. There seemed to be no long-term effect, especially on cellular reaction, on the hydrophilic IOL surface.

Effect of tranilast eyedrops in preventing posterior capsule opacification: preliminary report

PURPOSE

To evaluate the effect of tranilast eyedrops in preventing fibrous opacification of the posterior lens capsule after cataract extraction and intraocular lens (IOL) implantation.

SETTING

The Second Department of Ophthalmology, Toho University School of Medicine, Tokyo, and Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan.

METHODS

This study comprised eyes having continuous curvilinear capsulorhexis and phacoemulsification/aspiration followed by implantation of a posterior chamber IOL in the capsular bag. In this prospective, randomized, controlled, and double-masked trial, tranilast 0.5% (Rizaben) eyedrops (15 eyes) or its placebo eyedrops (20 eyes) were given 4 times a day for 3 months after surgery. An anterior eye segment analysis system (EAS 1000, Nidek Co., Ltd.) was used to evaluate the degree of fibrous posterior capsule opacification (PCO) 1 week and 1 and 3 months after surgery.

RESULTS

The mean PCO density in the tranilast group was 17.1 cct +/- 4.6 (SD), 20.0 +/- 3.6 cct, and 23.0 +/- 7.7 cct (cct = computer compatible tape) at 1 week and 1 and 3 months, respectively. In the control group, it was 18.2 +/- 5.3, 30.2 +/- 7.8, and 38.4 +/- 8.0 cct, respectively. There was a significant difference in the 1 and 3 month findings between the 2 groups (P < .001).

CONCLUSION

Tranilast was effective in preventing fibrous PCO at an early postoperative stage. The possible mechanisms of its effect may be prevention of collagen synthesis by minimizing transforming growth factor type beta released during lens epithelial cell metaplasia.

Effect of intraocular lens and anterior capsule opening type on posterior capsule opacification

PURPOSE

To determine the effect of intraocular lens (IOL) type and anterior capsulectomy technique on the incidence of posterior capsule opacification.

SETTING

Department of Ophthalmology, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey.

METHODS

Three hundred two eyes of 294 patients were examined retrospectively after IOL implantation in the capsular bag performed between February 1991 and November 1996. Patients were divided into 3 groups according to IOL type: poly(methyl methacrylate) (PMMA); heparin-surface-modified PMMA (HSM PMMA); plate-haptic silicone. Envelope capsulectomy or continuous curvilinear capsulorhexis (CCC) was used. Mean follow-up was 27 months (range 12 to 33 months).

RESULTS

Posterior capsule opacification developed in 47 cases (15.6%): 21.7% in the PMMA lens group after planned extracapsular cataract extraction (ECCE), 17.4% in the HSM PMMA lens group after planned ECCE, and 7.7% in the plate-haptic silicone lens group after phacoemulsification. Posterior capsule opacification occurred less in patients who had anterior capsulectomy using the CCC technique (11.5%) than in those having an envelope capsulectomy (24.5%) (P < .05). Posterior capsule opacification was significantly less in eyes with a capsular-bag-fixated plate-haptic silicone lens than in those with a PMMA or HSM PMMA IOL (P < .05).

CONCLUSION

This study demonstrated that the anterior capsulectomy technique and the IOL type influence the incidence of PCO.