Mean Posterior Capsule Opacification Score Research Articles

Randomized multicenter trial to assess posterior capsule opacification and glistenings in two hydrophobic acrylic intraocular lenses

To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof (p = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups (p < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof (p < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.

The effect of intraocular lens material and postoperative therapy on the posterior capsule opacification development after the senile cataract surgery

Introduction/Objective. The most frequent postoperative complication of a successfully performed phacoemulsification cataract surgery is the development of posterior capsule opacification (PCO). It is caused by the proliferation and migration of the remaining residual epithelial cells. The objective of this study was to investigate the influence of two different intraocular lenses and two different anti-inflammatory drugs on the development of PCO in one-year follow-up period. Methods. Investigation included 120 patients (120 eyes), equally divided into four groups. The first two groups included patients who used non-steroid anti-inflammatory drug (NSAID) postoperatively, while the other groups had corticosteroid therapy. The first and third group got hydrophilic intraocular lenses (IOL), the second and fourth group had hydrophobic IOL. Software program EPCO 2000 was used for the analysis of PCO. Student?s t-test, Wilcoxon test, and ANOVA were used for data analysis and p &lt; 0.05 value was accepted as statistically significant. Results. After the first three postoperative months, patients from NSAID groups had mean PCO score 0.25 ?} 0.03, which was statistically significant higher (p = 0.042) comparing to corticosteroid groups. At the end of the investigation, the best result in PCO preventing was seen in the group of patients with hydrophobic IOL and corticosteroid therapy, with the mean PCO score of 0.47 ?} 0.08. Conclusion. This study has revealed that IOL made of acrylic hydrophobic material seemed to be the right choice when choosing intraocular lens to prevent PCO development. On the other hand, NSAID and corticosteroid therapy have showed similar results in preventing postoperative intraocular inflammation. This fact can be very useful in situations when corticosteroids must be used with great caution.

Long-term Posterior Capsule Opacification Reduction with Square-Edge Polymethylmethacrylate Intraocular Lens: Randomized Controlled Study

To objectively assess the long-term posterior capsule opacification (PCO) and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy rate of a square-edge (SE) polymethylmethacrylate (PMMA) intraocular lens (IOL) modification in comparison with a round-edge (RE) PMMA IOL or an SE hydrophobic acrylic IOL (SE-Acrylic). Prospective, randomized, controlled fellow eye clinical study. Ninety-four patients scheduled for bilateral phacoemulsification had an SE-PMMA IOL implanted in 1 eye. An RE-PMMA IOL was implanted in the fellow eye in 46 patients (group A), and an SE-Acrylic IOL was implanted in the fellow eye in 48 patients (group B). Randomization was used to determine group assignment and which IOL was implanted in the first eye to undergo surgery. Evaluation of Posterior Capsule Opacification (EPCO) image analysis software was used to objectively grade PCO density from standardized, high-resolution retroillumination photographs obtained annually for the first 5 postoperative years and at year9. The PCO scores and Nd:YAG capsulotomy rate. Nine-year follow-up was achieved by 72% from group A and 63% from group B. In group A, the mean PCO score was significantly lower in the SE-PMMA IOL eyes compared with the contralateral RE-PMMA eyes at all follow-up visits (P < 0.05). In group B, the mean PCO score was statistically lower in the SE-PMMA IOL eyes compared with the contralateral SE-Acrylic IOL eyes at all but the 1- and 3-year follow-up visits. Nine-year Nd:YAG capsulotomy rates were 2% for SE-PMMA IOLs versus 37% for RE-PMMA IOLs in group A (P < 0.001), and 4% for SE-PMMA IOLs versus 10% for SE-Acrylic IOLs in group B (P= 0.435). The RE-PMMA PCO rate did not plateau and continued to increase throughout the 9-year study period. This prospective, 9-year fellow eye comparison study suggests that an inexpensive PMMA IOL design modification-a squared optic edge-could significantly reduce the burden of vision-impairing secondary membrane in developing countries.

Posterior Capsule Opacification and Nd:YAG Rates with Two Acrylic Intraocular Lenses after Age-Related Cataract Treatment: Three-year Results

ABSTRACTObjective: To compare the incidence and intensity of posterior capsule opacification (PCO) between two intraocular lenses (IOLs) over three years. Methods: Eighty-three patients underwent cataract surgery with implantation of Acreos Adapt AO or Acrysof SA60AT. PCO values were assessed using a photographic image analysis system (EPCO 2000) and the amount of PCO at the slit lamp. Results: Mean PCO score was 2.78 ± 1.55 for the Acreos Adapt AO and 2.32 ± 1.20 for the Acrysof SA60AT (P=.229). There were no significant differences in the median EPCO values in the entire IOL optics area (0.60 ± 0.26 vs 0.58 ± 0.23; P=.745) and in the central 3-mm zone (0.28 ± 0.13 vs 0.27 ± 0.12; P=.638). Neodymium:YAG capsulotomy was performed in 28% of eyes with Acreos Adapt AO and 23.33% with Acrysof SA60AT (P=.692). Conclusion: Both IOLs had comparable PCO and Nd:YAG rates three years postoperatively.

Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons.

PurposeTo determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons.Patients and methodsEighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software.ResultsOut of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B.ConclusionB-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.

Influence of a Variable Overall Diameter Hydrophilic Acrylic Sharp-Edged Single-piece Intra-Ocular Lens on Capsule Opacification One Year after Surgery

ABSTRACTBackground: To investigate the influence of the overall intraocular lens (IOL) diameter on posterior capsule opacification (PCO) formation.Methods: In this prospective randomized clinical trial, 124 eyes of 62 patients with bilateral age-related cataract were included. Each patient received a Corneal A501D IOL in one eye and a Corneal J501D IOL in the fellow eye. Best corrected visual acuity (BCVA) and digital slitlamp photographs were taken a 1 h, 1 week, 1, 3, 6 and 12 months postoperatively. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.Results: We found a mean BCVA of 0.81 ± 0.2 for the Corneal A501D group and 0.79 ± 0.21 for the Corneal J501D group. There was no significant difference 12 months after surgery between the two IOLs (p > 0.05). Objective PCO assessment resulted in a mean PCO score (scale 0–10) of 1.65 ± 1.71 was found for the Corneal J501D group and a score of 1.54 ± 1.64 was found for the Corneal A501D group (p > 0.05). The subjective PCO assessment at 1 year resulted in a mean PCO score of 2.0 ± 1.74 in the Corneal J501D group and 2.13 ± 1.64 in the Corneal A501D group (p > 0.05).Conclusion: Both investigated IOLs showed good clinical performance regarding PCO and BCVA. Our study suggests that the use of an IOL with variable total diameter seems not to influence the rate of PCO formation.

Capsular bag opacification with a new accommodating intraocular lens

To evaluate the biocompatibility and capsular bag opacification of an accommodating intraocular lens (IOL) containing large haptic elements that separate the anterior and posterior capsules. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Bilateral phacoemulsification with IOL implantation was performed in 6 New Zealand rabbits. Each animal received a study (accommodating) IOL and a control (1-piece hydrophobic acrylic) IOL. Eyes were examined at the slitlamp from 1 day through 6 weeks postoperatively. The globes were then enucleated and evaluated grossly. Capsular bag opacification was scored from the posterior aspect (Miyake-Apple view). The eyes were then processed for complete histopathologic evaluation. At 6 weeks, the mean posterior capsule opacification (PCO) clinical score was 0.5 ± 0.3 (SD) in the study group and 3.0 ± 0.9 in the control group (P=.001, 2-tail paired t test). Anterior capsule opacification was practically absent in the study group and mild in the control group. Miyake-Apple posterior view showed a mean central PCO score of 0 ± 0 in the study group and 3.0 ± 1.1 in the control group (P=.001), peripheral PCO score of 0.7 ± 0.4 and 3.5 ± 0.8 (P=.0006), respectively, and Soemmerring ring score of 2.3 ± 0.8 and 7.0 ± 2.8 (P=.01), respectively. Histopathology showed no signs of toxicity in any eye. The study IOL maintained an expanded capsular bag secondary to the large size of the haptic elements, which appears to prevent capsular bag opacification.

Fellow-eye comparison of posterior capsule opacification between 2 aspheric microincision intraocular lenses

To compare posterior capsule opacification (PCO) between 2 microincision hydrophilic intraocular lenses (IOLs) and with a conventional spherical hydrophobic IOL. St. Thomas' Hospital, London, United Kingdom. Prospective randomized comparative study. A microincision Acri.Smart 36A (negatively aspheric) or Akreos MI-60 (aspherically neutral) IOL was randomized to the first eye of patients with the alternative IOL implanted in the fellow eye within 3 weeks. Postoperatively, 100% and 9% logMAR corrected distance visual acuity (CDVA) were assessed. Retroillumination photographs were analyzed using the posterior capsule opacity software system. The data on PCO scores were compared with those of a conventional spherical hydrophobic IOL (Acrysof SN60AT). One hundred percent CDVA was significantly better at 12 months and 9% CDVA was better at 6, 12, and 24 months (P<.05) with the negatively aspheric IOL. One eye in each group with microincision IOLs developed capsule phimosis at 1 month. Neodymium:YAG capsulotomies were required by 2 years in 2 eyes with a negatively aspheric IOL and 8 eyes with an aspherically neutral IOL. At 24 months, the mean PCO score remained less than 10% with the conventional spherical IOL, whereas it increased with time in the negatively aspheric IOL (up to 16%) and the aspherically neutral IOL (up to 23%). The negatively aspheric IOL had a better PCO profile than the aspherically neutral IOL. This may be attributed to the difference in the edge design between the IOLs. The microincision IOLs had more PCO than the conventional 1-piece hydrophobic IOL.

Effect of a Single-Piece and a Three-Piece Acrylic Sharp-Edged IOL on Posterior Capsule Opacification

Background: To compare the intensity of posterior capsule opacification (PCO) between two intraocular lenses (IOLs) of the same optic material, but with different haptic design (1-piece vs. 3-piece).Methods: This prospective intraindividual controlled cohort study comprised eighty eyes of 40 patients with bilateral age-related cataract. Each patient received a Polylens Y10 (Polytech, Germany) 1-piece IOL in 1 eye and a Polylens Y30 (Polytech, Germany) 3-piece IOL in the contralateral eye. The IOL type in the first operated eye was randomly assigned before patient recruitment. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for regeneratory PCO. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.Results: The Polylens Y10 (1-piece) group showed significantly higher regeneratory and fibrotic PCO scores 1 year after surgery in subjective slitlamp evaluation, however not with objective evaluation using automated image-analysis software. Subjective PCO assessment resulted in a mean PCO score (scale = 0–10) of 1.6 in the Polylens Y10 group and 0.6 in the Polylens Y30 group at 1 year (p < 0.05). The mean automated image-analysis software PCO score was 1.5 in the Polylens Y10 group and 0.9 in the Polylens Y30 group (p = 0.6).Conclusion: Both investigated IOLs showed good clinical performance regarding PCO, BCVA and IOL-centration. The Polylens Y10 IOL showed slightly more regeneratory PCO than the 3-piece acrylic IOL 1 year after surgery.

Evaluation of a new single-piece 4% water content hydrophobic acrylic intraocular lens in the rabbit model

To evaluate uveal and capsular biocompatibility of a 1-piece intraocular lens (IOL) manufactured from a new hydrophobic acrylic material that incorporates a barrier step at the optic-haptic junctions. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. The study IOL (Eternity-Uni W-60) was implanted in the right eyes of 5 New Zealand rabbits and the control IOL (Acrysof SN60WF) in the left eyes. Slitlamp examination was performed 1 through 4 weeks postoperatively. After death, the globes were enucleated and fixed in formalin. Capsular bag opacification scoring (Miyake-Apple view) was then performed followed by complete histopathology. At the 4-week examination, the mean posterior capsule opacification (PCO) score was 1.5 ± 1.0 (SD) in the study group and 2.2 ± 1.09 in the control group (P=.02). Anterior capsule opacification (ACO) was not present in the study eyes and was mild in the control eyes. On gross examination, the mean central PCO score was 0.9 ± 0.65 in the study group and 1.7 ± 1.20 in the control group (P=.07); the mean peripheral PCO score was 1.3 ± 0.67 and 2.4 ± 1.14 (P=.01) and the mean Soemmerring ring score was 3.8 ± 0.44 and 4.2 ± 1.09, respectively (P=.47). Histopathology confirmed that both IOLs were equally tolerated by the rabbit eyes. In this rabbit study, the new hydrophobic acrylic material was biocompatible. The barrier step incorporated to the optic-haptic junctions has the potential to enhance PCO prevention.

Prevention of capsular bag opacification with a new hydrophilic acrylic disk-shaped intraocular lens

To evaluate capsular bag opacification with a new disk-shaped single-piece hydrophilic acrylic intraocular lens (IOL) suspended between 2 haptic rings connected by a pillar of the haptic material and with a commercially available single-piece hydrophobic acrylic IOL in rabbits. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. The study IOL was implanted in the right eyes of 5 New Zealand rabbits and the control IOL in the left eyes. Slitlamp examination was performed at weeks 1 through 5. After the rabbits were humanely killed, the globes were enucleated and examined by ultrasound. Capsular bag opacification scoring from the posterior aspect (Miyake-Apple view) was then performed, followed by histopathology. Trace honeycomb posterior capsule opacification (PCO) was noted in some study eyes. All control eyes developed moderate to marked PCO, which was more pronounced at the level of the optic-haptic junction. The mean PCO score was 0.4 ± 0.22 (SD) in the study group and 3.4 ± 0.54 in the control group (P=.000179, paired t test). Minimal proliferative cortical material was confined to the space between the anterior and posterior rings of the study IOL haptics. Anterior capsule opacification was absent in study eyes and mild in control eyes. There was no contact between the anterior capsule and the anterior surface of study IOLs. The peripheral rings of the study IOL, by expanding the capsular bag and preventing IOL surface contact with the anterior capsule, appear to prevent opacification of the capsular bag. No author has a financial or proprietary interest in any material or method mentioned.

Quantitative Analysis of Posterior Capsule Opacification of Hydrophobic Acrylic Intraocular Lenses

Posterior capsule opacification (PCO) remains a common complication of modern cataract surgery, although both modification of materials used and changes in the intraocular lens (IOL) optic edge design have helped to decrease its incidence slightly. Recently, various kinds of quantitative methods have been developed for measuring PCO. The purpose of this study was to compare the quantitative analysis of PCO between different types of IOL designs. Patients enrolled in the study had age-related cataract and underwent uneventful cataract surgery and implantation of either the AcrySof MA30BA (Alcon) or the Sensor AR40e (AMO), which are differently designed hydrophobic acrylic IOLs with a sharp-edged optic design. Postoperative examination was performed at 6 months. Retroillumination photographs of each eye were obtained, and the degree of PCO was assessed using the Evaluation of Posterior Capsule Opacification (EPCO) system. Grade 1 PCO was noted in both the MA30BA and the AR40e groups. There was no significant difference in the mean PCO score between the MA30BA and AR40e groups. Although the sharp-edged optic designs of both IOLs might similarly inhibit PCO at 6 months, a long-term follow-up period is needed to determine if any PCO differences occur between these 2 hydrophobic acrylic IOLs.

Evaluation of posterior capsule opacification using a new posterior view method in rabbits

To introduce a new procedure for evaluating posterior capsule opacification (PCO) in rabbit eyes and to perform a comparative study of the single-piece and 3-piece acrylic intraocular lenses (IOLs) on PCO using the new evaluation method. Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. A single-piece or 3-piece acrylic IOL was implanted in 1 eye and the other in the contralateral eye of 5 rabbits. Three weeks after surgery, PCO was scored by Evaluation of Posterior Capsule Opacification (EPCO) in posterior view. Before the posterior view was photographed, the anterior capsule was removed from the whole optic area to eliminate disturbing anterior capsule opacification (ACO) for the PCO evaluation. Posterior capsule opacification could be well observed and viewed in the posterior view so that it could be scored by EPCO without confusion with ACO. The mean PCO score of the single-piece and 3-piece acrylic IOLs was 3.12 +/- 0.19 and 2.41 +/- 0.70, respectively (P < .05 and P = .03, respectively). The removal of ACO allowed scoring of PCO by EPCO in rabbit eyes. The single-piece acrylic IOL showed significantly more PCO than the 3-piece acrylic IOL at least 3 weeks after surgery in rabbits.

Journal of Cataract and Refractive Surgery

Purpose: To evaluate the role of posterior optic edge design and the effect of anterior capsule polishing on peripheral fibrotic posterior capsule opacification (PCO).Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria.Methods: This randomized prospective study comprised 144 eyes of 72 patients with bilateral age-related cataract. Each patient had standardized cataract surgery in both eyes by the same surgeon. Group 1 (46 patients) received a round-edged hydrophobic acrylic IOL (AMO Sensar® AR40) in 1 eye and a sharp-edged hydrophobic acrylic IOL (AMO Sensar® OptiEdge AR40e) in the other eye. Group 2 (26 patients) received a silicone IOL (Pharmacia CeeOn® 911A) with a truncated optic in both eyes. In this group, the anterior capsule was extensively polished in 1 eye and was left unpolished in the other eye. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for fibrotic PCO. The intensity of PCO was subjectively graded (score 0 to 4) by 2 masked examiners.Results: Subjective PCO scores correlated well between the 2 examiners (r = 0.88). In Group 1, the mean PCO score was 0.26 for the OptiEdge AR40e IOL and 0.90 for the AR40 IOL (P<.01). In Group 2, the mean PCO score was 0.24 in eyes with a polished capsule and 0.17 in eyes in which the capsule was not polished (P = .31).Conclusions: The sharp-edged OptiEdge AR40e IOL led to significantly less peripheral fibrotic PCO 1 year postoperatively than the round-edged AR40 IOL. In eyes with the sharp-edged silicone 911A IOL, anterior capsule polishing caused no significant difference in fibrotic PCO.

Influence of optic edge design and anterior capsule polishing on posterior capsule fibrosis

Purpose: To evaluate the role of posterior optic edge design and the effect of anterior capsule polishing on peripheral fibrotic posterior capsule opacification (PCO). Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: This randomized prospective study comprised 144 eyes of 72 patients with bilateral age-related cataract. Each patient had standardized cataract surgery in both eyes by the same surgeon. Group 1 (46 patients) received a round-edged hydrophobic acrylic IOL (AMO Sensar ® AR40) in 1 eye and a sharp-edged hydrophobic acrylic IOL (AMO Sensar ® OptiEdge AR40e) in the other eye. Group 2 (26 patients) received a silicone IOL (Pharmacia CeeOn ® 911A) with a truncated optic in both eyes. In this group, the anterior capsule was extensively polished in 1 eye and was left unpolished in the other eye. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for fibrotic PCO. The intensity of PCO was subjectively graded (score 0 to 4) by 2 masked examiners. Results: Subjective PCO scores correlated well between the 2 examiners ( r = 0.88). In Group 1, the mean PCO score was 0.26 for the OptiEdge AR40e IOL and 0.90 for the AR40 IOL ( P<.01). In Group 2, the mean PCO score was 0.24 in eyes with a polished capsule and 0.17 in eyes in which the capsule was not polished ( P = .31). Conclusions: The sharp-edged OptiEdge AR40e IOL led to significantly less peripheral fibrotic PCO 1 year postoperatively than the round-edged AR40 IOL. In eyes with the sharp-edged silicone 911A IOL, anterior capsule polishing caused no significant difference in fibrotic PCO.

Inhibition of posterior capsule opacification: The effect of colchicine in a sustained drug delivery system

We investigated the effect of colchicine in a sustained drug delivery system on posterior capsule opacification (PCO) in rabbit eyes. A polymer matrix wafer, which diffused colchicine at a steady rate, was implanted in the capsular bag of 34 eyes after the lens material was removed by endocapsular phacoemulsification. Three different drug concentrations were used in the rabbit eyes, which were compared with control eyes containing the polymer matrix wafer without colchicine. The mean PCO score was highest in the control group without colchicine and increased steadily over 12 weeks. The rate of PCO formation in all eyes treated with colchicine was significantly lower than in the control group. There was no statistically significant improvement in PCO inhibition with the higher colchicine dosages. Side effects included inflammatory anterior chamber reaction and corneal and retinal complications and were most notable with the highest drug concentration. Slow release of colchicine reduces PCO formation in the rabbit. The optimal biocompatible dosage must be carefully determined and warrants further investigation.