Extracapsular cataract extraction in diabetic eyes. The role of YAG laser capsulotomy

Cataract surgery may exacerbate preexisting diabetic retinopathy. Especially diabetics with active retinal neovascularisation are at high risk of rubeosis iridis after intracapsular cataract extraction. Thirty-five eyes previously treated with panretinal photocoagulation underwent extracapsular cataract extraction with posterior chamber lens implantation. Twenty-eight eyes with retinal neovascularisation required further Argon laser PRP after surgery. Fourteen eyes required YAG-laser capsulotomy. From the group of eyes without YAG-laser capsulotomy none developed neovascular glaucoma. From the YAG laser capsulotomy group six eyes developed rubeosis iridis and neovascular glaucoma. Our results indicate that eyes in which PRP has been performed, have an excellent prognosis after ECCE with posterior chamber lens implantation only if YAG Laser posterior capsulotomy is not performed.     

Pseudophakic retinal detachment in high axial myopia

PURPOSE: To investigate the effect of extracapsular cataract surgery with intraocular lens (IOL) implantation and neodymium:YAG (Nd:YAG) laser posterior capsulotomy on the rate of retinal detachment (RD) in myopic eyes with an axial length of 27 mm or more. SETTING: Department of Ophthalmology, University of Giessen, Germany. METHODS: This retrospective, nonrandomized study comprised the records of 386 consecutive surgical procedures in 275 patients performed between December 1985 and December 1993. In May 1994, all patients were asked by a mailed questionnaire whether they had had an RD in either eye or laser treatment for posterior capsule opacification. Responses from 190 patients concerning 253 surgical procedures were evaluated. RESULTS: The pseudophakic RD rate was 0.8% (two cases). One patient developed aphakic RD after IOL explanation. One expulsive choroidal hemorrhage occurred during secondary IOL implantation. Four eyes (1.6%) had vitreous loss, and 74 eyes (29.2%) had an Nd:YAG capsulotomy. Mean axial length was 29.2 mm +/- 1.71 (SD), mean follow-up was 3.8 +/- 2 years, and mean age at surgery was 69.8 +/- 12 years. CONCLUSION: Pseudophakia with no other risk factor posed little additional risk for RD in eyes with high axial myopia; however, Nd:YAG laser posterior capsulotomy was a risk factor for pseudophakic RD. Complicated surgery, such as a secondary procedure or vitreous loss, and young age were major causative factors.     

Combined pars plana vitrectomy, lens removal and intraocular lens implantation for complications of diabetic retinopathy. Surgical results in 120 cases

We performed combined vitrectomy, lens removal and posterior chamber intraocular lens implantation for proliferative diabetic retinopathy in 120 eyes of 101 patients. Follow-up periods ranged from 3 to 63 months, with a mean of 17 months. Three lens removal methods were used: extracapsular cataract extraction (14 eyes), phacoemulsification and aspiration (49 eyes), and pars plana phacoemulsification (57 eyes). Preoperative rubeosis iridis or neovascular glaucoma was found in 21 eyes. Gas or temporary silicone oil tamponade was employed in 32 eyes. Surgical results were good, and the postoperative vision was finger counts or below only in 13 eyes. Thus the combined surgery proved to have no serious problems. Our results indicate two important points. (1) It is best to chose either of the following two methods for the lens surgery: phacoemulsification with continuous circular capsulorhexis, self sealing sclerocorneal incision, and in-the-bag fixation of the posterior chamber lens, or pars plana phacoemulsification leaving the anterior capsule, rub off and aspirating the lens epithelial cells, continuous circular capsulorhexis, and posterior chamber lens implantation in front of the anterior capsule from a self-sealing sclerocorneal wound. (2) It is mandatory to do complete vitrectomy and cut out the vitreous gels incarcerated in the sclerotomy site.     

Incidence of retinal detachment after cataract surgery and neodymium: YAG laser capsulotomy

The objective of this retrospective study was to determine the incidence of retinal detachment (RD) in patients following cataract extraction with intraocular lens placement and after neodymium:YAG (Nd:YAG) laser capsulotomy. This study comprised 1092 patients (1168 eyes) who had cataract extraction and related procedures between January 1986 and December 1992 identified from the coding and billing database. Of the 1092 patients, 215 (244 eyes) had had Nd:YAG laser capsulotomy. Their charts were reviewed for incidence of RD, and these data were correlated with age, sex, axial length, surgical complications, and other surgical procedures done at the time of cataract extraction. The incidence of RD following phacoemulsification alone was 0.75% (6/799), with a mean time between cataract extraction and RD of 11.6 months. The cases of RD after extracapsular cataract extraction, combined phacoemulsification and trabeculectomy, combined extracapsular cataract extraction and penetrating keratoplasty, and combined phacoemulsification and anterior vitrectomy were too few to draw any conclusions. The incidence of RD following Nd:YAG laser capsulotomy was 0.82% (2/244), with a mean time of 32 months between cataract surgery and capsulotomy and 13.5 months between capsulotomy and RD. There was a statistically significant higher incidence of RD after posterior capsule rupture and anterior vitrectomy than after uncomplicated phacoemulsification (2/12 versus 6/799). In conclusion, the rate of RD after uncomplicated phacoemulsification was less than or similar to the rate found in other recent studies. It was not statistically different from the rate following phacoemulsification and Nd:YAG laser capsulotomy (0.82%). This study confirms the increased risk of RD following posterior capsule rupture and anterior vitrectomy.     

Spontaneous dislocation into the vitreous of a poly(methyl methacrylate) disc lens 9 years after surgery

A 76-year-old woman had sudden visual loss 9 years after an extracapsular cataract extraction with implantation of a poly(methyl methacrylate) disc intraocular lens (IOL) in the capsular bag. Slitlamp examination showed the disc IOL had luxated into the vitreous through a linear inferior opening in the capsular bag; the IOL lay on the retinal surface. A pars plana vitrectomy was performed. The vitreous cavity was filled with perfluorocarbon liquid, floating the IOL to behind the iris. The IOL was removed through a limbal incision, then another type of IOL was implanted in the ciliary sulcus using transscleral fixation. Thirty days after surgery, best corrected visual acuity (BCVA) was 20/20. At 2 months, total retinal detachment appeared with a large superior retinal dialysis. Another pars plana vitrectomy was performed and the scleral-fixated IOL removed through a limbal incision. Internal gas tamponade was used. The eye was left aphakic. Final BCVA was 20/25.     

Secondary cataracts in extreme myopia

INTRODUCTION: After cataract surgery there is a higher incidence of posterior capsular opacification (secondary cataract) in myopia than in normal population, and it varies from 40 to 60% [1, 2]. METHODS: Fifty myopic eyes operated for cataract at Prof. Dr. Ivan Stankovitsh Eye Department from 1988 to 1995 were examined for capsular opacification (secondary cataract). Extracapsular cataract extraction was performed in all patients and in 32 patients the posterior intraocular lens was placed. Capsular opacification was classified by type and treated with Nd:YAG laser or discussion at least 9 months to 3 years and 3 months from the operation. RESULTS: There were 13 secondary cataracts (26%) in our series of patients, of whom 22% with intraocular lenses, and 33% were aphakic patients. Visual acuity was 4/60 to 0.5. In 11 patients YAG-laser capsulotomy was performed and in one patient capsular discussion, and in one subject there was no treatment. Consequent visual acuity was 0.3 to 1.0. No correlation was found between the age, type of intraocular lens and capsular opacification. DISCUSSION: Capsular opacification is more often seen in myopic eyes and its treatment is associated with a higher rate of complications (cystoid macular oedema, rupture of anterior hyaloid, retinal detachment...) [3, 4]. It seems that posterior lens implants reduce the chance for development of posterior capsular opacification. The safest treatment is YAG-laser capsulotomy.     

A novel ALL-L3 cell line, BALM-16, lacking expression of immunoglobulin chains derived from a patient with hypercalcemia

OBJECTIVE: The purpose of the study is to evaluate whether a posterior capsulectomy combined with anterior vitrectomy is a necessity in pediatric cataract. DESIGN: The incidence of posterior capsule opacification, the need for additional surgical interventions, and the influence of a primary posterior capsulectomy after cataract surgery in children were evaluated. The analysis was carried out by studying patients' records retrospectively or after prospective follow-up. PARTICIPANTS: In 94 eyes (69 aphakic and 25 pseudophakic), the medical records were studied retrospectively. Twenty-eight eyes (18 aphakic and 10 pseudophakic) were observed prospectively during 1 year after surgery. In 20 eyes (6 aphakic and 14 pseudophakic) of 10 patients with bilateral cataract, a prospective comparison between the 2 eyes of the same patient also was carried out. INTERVENTION: Cataract surgery through the limbus with or without a primary posterior capsulectomy was performed in 114 eyes (43 of these received a posterior chamber intraocular lens [IOL] and 71 remained aphakic). In 28 eyes, the surgery was carried out by way of the pars plana (6 eyes received an anterior chamber IOL and 22 remained aphakic). MAIN OUTCOME MEASURES: Incidence of posterior capsule opacification, the need for secondary surgical intervention, and visual acuity were measured. RESULTS: Opacification of the posterior capsule is observed in all children's eyes when a primary posterior capsulectomy (combined with an anterior vitrectomy) was not carried out. Earlier secondary cataract formation is associated with a younger age and with implantation of an IOL. Eyes undergoing a primary opening of the posterior capsule during the initial surgery of children with bilateral cataract achieved, in most cases, a better visual acuity than did their fellow eyes. CONCLUSION: Although possibly a choice in older children, a primary posterior capsulectomy combined with anterior vitrectomy is a must in younger children and particularly when implantation of an IOL is planned.     

Use of intraocular lenses in children with traumatic cataract in south India

AIMS: To assess the long term results of intraocular lens (IOL) implantation for traumatic cataract in young children in a developing country. METHODS: Prospective hospital based study of 52 children (age 2-10 years) undergoing unilateral cataract extraction and IOL insertion for traumatic cataract performed by a single surgeon in south India. Children were reviewed regularly and followed up initially for 3 years. RESULTS: There were no serious operative complications. Clinically significant posterior capsule opacification was almost universal (92%) and YAG capsulotomy or membranectomy was performed on 48 eyes. Some degree of pupil capture affected 35% of eyes and was complete in 6%. Visual acuity was 6/12 or better in 67% of eyes at the last follow up examination. CONCLUSION: The visual acuity results 3 years after implantation of posterior chamber IOLs in older children with traumatic cataracts in south India were encouraging. In developing countries where follow up is unreliable it is essential to plan to clear the axial part of the posterior capsule either at the time of surgery or soon afterwards.     

The future of intervention research at NIOSH

PURPOSE: Analysis of cataract surgery with intraocular lens implantation in children and youth performed between 1990 and 1995 in Bialystok University Eye Clinic. MATERIALS AND METHODS: Twenty patients between 5 and 19 years of age were operated. The subjects comprised 15 cases of traumatic and 5 of congenital cataract. Intraocular lens implantation was performed as a primary procedure in 18 patients and as a secondary procedure in 2 cases. RESULTS: Visual acuity of 5/50 to 5/12 was achieved in 14 patients and 5/10 to 5/5 in 6 patients. Posterior capsule opacification requiring YAG-laser capsulotomy was found in 12 patients (60%). CONCLUSIONS: Intraocular lens implantation may be a safe and effective technique for optical correction in children with traumatic and congenital cataracts.     

Macular edema caused by contraction of the posterior hyaloid in diabetic retinopathy. Surgical treatment of a series of 22 cases

We have observed some patients with diabetic macular edema who did not respond to grid laser treatment and who improved with spontaneous posterior vitreous detachment or vitrectomy. These cases have a taut and glistening vitreo-macular interface. Three such cases are presented in detail. Pars plana vitrectomy with separation of the posterior hyaloid was performed in 22 cases. All of them had proliferative diabetic retinopathy, previously treated by panretinal photocoagulation. Fourteen cases had an ineffective macular grid laser treatment. Postoperative visual acuity was improved in 19 eyes and was unchanged in three eyes. The macular edema disappeared in 12 eyes and decreased in 10. Complications included a vitreous hemorrhage in 6 eyes, a paramacular tear in 1 eye, a reghmatogenous retinal detachment in 1 eye and cataract formation in 2 eyes. Vitreous surgery can improve the visual prognosis in cases of diabetic macular edema associated with a pathological vitreo-macular interface.     

Prospective evaluation of corneal endothelial cell loss after pediatric cataract surgery

PURPOSE: To study the alterations in endothelial cell count and morphology after pediatric cataract surgery using currently practiced techniques. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: In a prospective nonrandomized series comprising 20 eyes of 14 children with congenital or developmental cataract, endothelial cell loss from cataract surgery was evaluated. Mean patient age was 9.3 years (range 5 to 15 years). Extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation was performed in 11 eyes (Group 1). Primary posterior capsulotomy and anterior vitrectomy were performed with ECCE and IOL implantation in 9 eyes (Group 2). Noncontact specular microscopy was done preoperatively and 6 to 8 and 24 to 36 weeks postoperatively. Endothelial cell loss, alteration in the coefficient of variation, and the change in the number of hexagonal cells were determined by semiautomated analysis of endothelial pictures. RESULTS: Mean endothelial cell loss was 198.39 cells/mm2 (5.28%) in Group 1 and 295.17 cells/mm2 (7.50%) in Group 2 at 24 to 36 weeks. There was no statistically significant difference in alteration in endothelial cell count and morphology between the 2 groups. CONCLUSIONS: The results suggest that endothelial cell loss with currently practiced techniques of pediatric cataract surgery is within acceptable limits.     

Inhibition of posterior capsule opacification with an immunotoxin specific for lens epithelial cells: 24 month clinical results

PURPOSE: To assess the safety and effectiveness of an immunotoxin, MDX-RA, designed to inhibit posterior capsule opacification (PCO). SETTING: Eleven private practices in the United States. METHODS: This study comprised 63 eyes of 63 patients having extracapsular cataract extraction by phacoemulsification; these patients were enrolled in a Phase I/II clinical investigation of the immunotoxin MDX-RA. At the close of surgery, 21 patients were treated with placebo, 23 patients with 50 units of the immunotoxin, and 19 patients with 175 units of the immunotoxin as an aqueous solution. The patients were monitored for 24 months after primary cataract surgery using external eye and slitlamp examinations, visual acuity assessment, ophthalmoscopy, pachymetry, tonometry, endothelial cell counts, and lens capsule photography. Posterior capsule opacification, recorded on lens capsule photographs, was graded independently by a committee of 3 cataract surgeons. The incidence of neodymium:YAG (Nd:YAG) capsulotomy was projected from the opacification results. RESULTS: The immunotoxin, at the 50 unit dose, was well tolerated and effective in inhibiting PCO. At the 175 unit dose, there was a trend toward increased postoperative inflammation that was transient with no residua. From 6 to 24 months postoperatively, the 50 unit dose significantly inhibited PCO compared with the placebo (P < .05). This significant reduction in PCO translated into a significantly lower projected need for Nd:YAG capsulotomy in the 50 unit than the placebo group (P < .004). About 60% in the placebo group and 4% in the 50 unit group were projected to need an Nd:YAG capsulotomy by 3 years postoperatively. CONCLUSION: The immunotoxin was well tolerated and was effective in reducing PCO for up to 24 months after cataract surgery. Although these preliminary results are encouraging, a larger study is underway to determine whether the reduction in PCO by the immunotoxin decreases the need for Nd:YAG capsulotomy.     

Distressed or relieved? Psychological side effects of breast cancer screening in The Netherlands

PURPOSE: To compare three methods of combined cataract extraction and glaucoma surgery. METHODS: Retrospective review of 35 eyes of patients who had extracapsular cataract extraction and trabeculectomy using a corneoscleral incision (SAME), 54 eyes undergoing extracapsular cataract extraction and trabeculectomy using a separated corneal incision for cataract extraction and 43 eyes undergoing phacoemulsification and trabeculectomy. RESULTS: Ninety-one percent of the eyes in the SAME group, 85% of the SEPARATE group and 97% of the phacoemulsification and trabeculectomy group had an IOP < 22 mmHg at 6 months with or without medication (NS). Postoperative visual acuity and astigmatism were not significantly different between the groups. The number of eyes requiring YAG laser capsulotomy was significantly greater in the extracapsular cataract extraction and trabeculectomy (same and separated incision) as compared to the phacoemulsification and trabeculectomy group (P < 0.001). CONCLUSION: Phacoemulsification and trabeculectomy was not significantly more successful than the other methods of combined surgery. Although complication rates were similar, visual rehabilitation was faster and there was a reduced incidence of early posterior capsule opacification.     

Pediatric cataract management with variations in surgical technique and aphakic optical correction

PURPOSE: The purpose of the study was to compare the results of three techniques of cataract surgery in children. Two methods included intraocular lens (IOL) implantation and one used contact lens correction of aphakia. DESIGN: Nonrandomized clinical trial. PARTICIPANTS: Seventy-seven eyes of 50 children between the ages of 2 1/2 and 16 years who had cataract surgery for the treatment of uncomplicated cataract. INTERVENTION: Thirty-one eyes underwent a "conventional" style of implantation, and a "phaco-style" of surgery was used in 24 eyes. A contact lens was used as the primary means of aphakic correction in 22 eyes. MAIN OUTCOME MEASURES: The visual results and complications of each type of surgery were compared. RESULTS: Corrected visual acuities did not differ significantly between the three groups 6 months after surgery. The incidence and type of complications were significantly different. Better lens centration, less long-term iris changes, or wound-related problems were observed with "phaco-style" modification of the technique of IOL insertion. CONCLUSIONS: Pediatric IOL insertion eliminated the need for contact lens wear and did not lead to a significantly different corrected visual acuity 6 months after surgery compared with lensectomy with contact lens correction. Adoption of some of the techniques of modern small-incision cataract surgery for pediatric IOL procedures produces a significant reduction in postoperative anterior segment complications compared with a standard limbal approach. Such modifications allow pediatric IOL insertion to be a safe alternative for the correction of pediatric aphakia.     

The role of vitrectomy for diabetic retinopathy

BACKGROUND: Diabetic retinopathy is an important cause of severe vision loss. The risk of vision loss from diabetic retinopathy is substantially reduced by intensive control of diabetes and appropriate laser surgery for proliferative diabetic retinopathy and diabetic macular edema. METHODS: The Diabetic Retinopathy Vitrectomy Study (DRVS) helped identify the indications and most propitious time for performing diabetic vitrectomy for nonresolving vitreous hemorrhage. The DRVS also highlighted the risks and potential complications of vitrectomy surgery. RESULTS: Diabetic persons with severe vision loss from severe proliferative diabetic retinopathy are candidates for vitrectomy after vitreous hemorrhage and severe fibrous changes in the retina. CONCLUSION: In cases in which vision loss occurs, pars plana vitrectomy frequently can restore useful vision, and reduce the risk of vision loss from traction retinal detachment.     

Susac syndrome

An 88-year-old woman had uneventful extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation in her right eye. Seven weeks later, an anterior vitrectomy with removal of the IOL was performed because of endophthalmitis resistant to topical and systemic amoxicillin, cephalosporin, aminoglycoside, and steroids. Microbiological examination of the vitreous biopsy, capsule, and anterior chamber fluid disclosed Pseudomonas stutzeri, gram-negative nonfermentative bacteria sensitive to tetracycline, ceftazidime, gentamicin, ofloxacin, and piperacillin. Pseudomonas stutzeri should be considered in the treatment of delayed-onset endophthalmitis.     

Posterior chamber intraocular lens use in children

PURPOSE: The authors report on the efficacy of intraocular lens implantation during pediatric cataract surgery and the results of a consecutive series of intraocular lens implantation in children. METHODS: Twenty-one children underwent implantation of intraocular lenses in 23 eyes. Twenty-one surgeries were primary implantation immediately following anterior lensectomy. Two surgeries were secondary implantations. Primary posterior capsulectomy was performed in 18 of 21 primary implantations. All but two eyes underwent a primary anterior vitrectomy. Topical prednisolone acetate was administered in all cases. Oral prednisone was administered in 17 of 23 cases. Pre- and postoperative visual acuity, cycloplegic refraction, and postoperative complications related to inflammation such as intraocular lens (IOL) capture, IOL decentration, and posterior capsule opacification were examined. RESULTS: Eighteen of 23 eyes have achieved a visual acuity of 20/40 or better. None of the cases in which oral prednisone was used developed complications related to postoperative inflammation. One of the six cases (17%) in which oral prednisone was not used developed such complications. CONCLUSION: Intracular lens implantation accompanied by primary posterior capsulectomy, anterior vitrectomy, and management of postoperative inflammation appears to provide appropriate and safe optical rehabilitation in children.     

Echo color Doppler imaging of carotid vessels in hemodialysis patients: evidence of high levels of atherosclerotic lesions

BACKGROUND: Although a variety of approaches to manage cataracts in children have been studied, no consensus exists on the optimum approach. The authors, therefore, conducted a prospective, nonrandomized, consecutive study to evaluate three most commonly adopted methods of management of pediatric cataracts. METHODS: Lensectomy anterior vitrectomy (LAV), extracapsular cataract extraction with intraocular lens implantation (ECCE + IOL) and ECCE, primary posterior capsulotomy, anterior vitrectomy with IOL (ECCE + PPC + AV + IOL) were the surgical procedures performed. Aphakia in the LAV group was corrected with spectacles or contact lenses. Intraoperative and postoperative results were analyzed. Discrete variables among the three groups were compared using chi square test. RESULTS: One hundred ninety-two eyes were included in the study. There was no statistically significant difference in the intraoperative complications in the three groups. During a mean follow-up period of 11.3 months, postoperative obscuration of the visual axis was seen in 43.7% of eyes in the ECCE + IOL group and in 3.65% of eyes in the ECCE + PC + AV + IOL (p < 0.001). Two of the seven patients in the LAV group in whom contact lenses were prescribed developed corneal infiltrates. Severe postoperative anterior uveitis occurred in 15.9% and 13.8% of eyes in the ECCE + PPC + AV + IOL and ECCE + IOL groups, respectively. None of the eyes that underwent LAV developed this complication (P < 0.001). There was no statistically significant difference in the incidence of retinal detachment, endophthalmitis, or glaucoma in the three groups. CONCLUSION: Of the three approaches, ECCE + PPC + AV + IOL was conducive to at least short-term maintenance of a clear visual axis, provided optimum refractive correction, and was not associated with increased risk of short-term complications. Continued follow-up of these eyes is necessary to conclude on the long term results of this technique.     

Cataract surgery combined with transpupillary silicone oil removal through planned posterior capsulotomy

OBJECTIVE: The purpose of the study was to evaluate transpupillary removal of silicone oil combined with cataract surgery in patients after pars plana vitrectomy. DESIGN: A prospective case-control study. PARTICIPANTS: Fifty consecutive patients underwent cataract surgery combined with removal of silicone oil, which had served as intraocular tamponade after pars plana vitrectomy. In 28 patients, silicone oil was removed through a planned posterior capsulotomy, and in 22 patients, silicone oil was removed through pars plana sclerotomies. All patients were operated on by the same surgeon. INTERVENTIONS: Pars plana vitrectomy, cataract surgery, and silicone oil removal were performed. MAIN OUTCOME MEASURES: Frequencies of retinal redetachment, secondary cataract, cystoid macular edema, and vitreous hemorrhage; visual acuity; intraocular pressure; and duration of surgery and visual rehabilitation were measured. RESULTS: Frequencies of postoperative vitreous hemorrhage (1 of 28 [4%] vs. 10 of 22 [45%]) and secondary cataract (0 of 28 vs. 6 of 22 [27%]) were significantly lower (P < 0.05; chi-square test), and duration of surgery and visual rehabilitation were significantly shorter (P < 0.01) for patients with transpupillary silicone oil removal than for patients with drainage of silicone oil through pars plana sclerotomies. Rate of retinal redetachment (4 of 28 [14%] vs. 4 of 22 [18%]), time of retinal redetachment (36 +/- 32 postoperative days vs. 54 +/- 65 days), frequency of dislocated intraocular lenses (1 of 28 vs. 0 of 22), and postoperative visual acuity did not vary significantly between the two groups. Persisting comeal endothelial decompensation and clinically significant cystoid macular edema due to cataract surgery were not observed in any patient. CONCLUSIONS: Silicone oil removal can be combined with cataract surgery. In view of a decreased frequency of postoperative vitreous hemorrhage, reduced rate of secondary cataract, and shorter duration of surgery and visual rehabilitation, transpupillary drainage of silicone oil through a planned posterior capsulotomy compares favorably with removal of silicone oil through pars plana sclerotomies. Retinal redetachment usually occurs within the first 3 postoperative months.     

Degenerated lens epithelial cells in rabbit and human eyes after intraocular lens implantation

PURPOSE: To evaluate the role of lens epithelial cells (LECs) in posterior capsule opacification. SETTING: Departments of Ophthalmology and Pathology, Wakayama Medical College, Department of Anatomy, Kansai Shinkyu College, and Department of Ophthalmology, Kobe Kaisei Hospital, Japan. METHODS: We examined the presence of degenerated LECs on the capsules of the eyes of rabbits and a patient after intraocular lens (IOL) implantation. Phacoextraction of a crystalline lens and IOL implantation were done in 5 albino rabbits under general anesthesia. The animals were killed after 2 months. Lens capsules were removed and fixed. During vitreous surgery, a lens capsule with an IOL was removed from a patient. Ultrathin sections of specimens were studied by transmission electron microscopy. RESULTS: Presumed LECs proliferated between the posterior capsule and the IOL in association with collagenous matrix. Debris from the degenerated cells and destroyed intracellular organelles was also seen. CONCLUSION: Lens epithelial cells proliferating on the posterior capsule cannot survive indefinitely.