Abstract
Purpose: To present a bioactivity-based explanation for posterior capsule opacification (PCO) formation after cataract surgery.Setting: Central Hospital, Vaasa, Finland.Methods: The sandwich theory was based on findings in a keratoprosthesis study in which bioactivity of the prosthesis seemed to prevent epithelial downgrowth and clinical findings of the behavior of the AcrySof® intraocular lens (IOL). The theory was formulated to explain PCO formation after cataract surgery with posterior chamber IOL implantation.Results: If the IOL were of a bioactive material, it would allow a single lens epithelial cell to bond both to the IOL and the posterior capsule. This would produce a sandwich pattern including the IOL, the cell monolayer, and the posterior capsule. The sealed sandwich structure might prevent further epithelial ingrowth and PCO.Conclusion: The degree of IOL bioactivity could explain the difference in PCO and the neodymium:YAG rates with different IOL materials. In theory, a bioactive IOL would prevent PCO better than poly(methyl methacrylate) and silicone IOLs, which have good biocompatibility but are bioinert.
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