Posterior Capsular Opacification Research Articles

Rapid posterior capsular opacification in two patients treated for negative dysphotopsias

BackgroundNegative dysphotopsias (ND) are visual aberrations associated with in-the-bag optic intraocular lens (IOL) placement, causing arc-shaped or linear shadows. Reverse optic capture (ROC) is employed to prevent ND, yet it poses the risk of posterior capsular opacification (PCO) which usually develops within 2–5 years post-surgery due to the lens epithelial cells (LECs) proliferation and migration onto the posterior capsule. This can lead to a cloudy or hazy appearance in the visual field. Early identification of posterior capsular opacities is crucial to ensure timely intervention and minimize visual impairment.Cases presentationsWe detail the management of two cases of acute and rapidly progressive PCO two weeks post-cataract extraction (CE) and IOL placement in patients with a prior history of ND at the Bascom Palmer Eye Institute. To prevent the development of ND in the subsequent eye, both patients underwent the ROC technique, in which a 3-piece intraocular lens with silicone aspheric neutral optics (SofPort LI61AOR2300 Bausch & Lomb Inc.) was inserted. At two-weeks post-operation, both patients reported a significant progressive decrease in vision in the treated eye, and severe posterior capsular opacities were observed. A diagnosis of PCO was confirmed, and successful visual rehabilitation was achieved through the performance of a neodymium-doped yttrium aluminum garnet (ND: YAG) laser capsulotomy without complications. This case series represents the first reported instances of patients developing PCO within two weeks of CE and IOL placement using the ROC technique.ConclusionsThis case series sheds light on the occurrence of posterior capsular opacities shortly after CE and IOL placement using the ROC technique. It highlights the importance of preoperative patient education, postoperative monitoring, and prompt management of potential complications in cataract surgery.

Injectable and pH-Responsive Metformin-Loaded Hydrogel for Active Inhibition of Posterior Capsular Opacification.

Posterior capsular opacification (PCO) is a common complication following cataract surgery, which can lead to a significant vision loss. This study introduces a facile method for developing a metformin-derived hydrogel (HCM6) stabilized by dynamic covalent bonds among natural polymers. This hydrogel demonstrates antifibrotic properties, on-demand drug release, pH responsiveness, injectability, and self-healing capabilities. Our in vitro experiments confirmed that the HCM6 hydrogel exhibits excellent biocompatibility, inhibiting lens epithelial cell migration, and transforming growth factor-2β (TGFβ2)-induced α-smooth muscle actin (α-SMA) expression in lens epithelial cells. In vivo studies conducted in a rat extracapsular lens extraction (ECLE) model revealed that HCM6 significantly suppressed PCO after 21 days of implantation with no observed pathological effects on surrounding tissues or the optic nerve. According to our experimental results, the inhibitory mechanism of PCO may be attributed to metformin's suppressive effect on lens cell migration, epithelial-mesenchymal transition (EMT), and lens fiber formation. In summary, the long-acting, controllable, and on-demand release characteristics of the HCM6 hydrogel not only provide an effective strategy for preventing PCO but also offer new avenues for treating undesirable proliferative conditions in ophthalmology and beyond.

Evaluation of postoperative outcomes after cataract surgery in patients with Juvenile Idiopathic Arthritis-Associated Uveitis.

To evaluate the postoperative outcomes of cataract surgery and intraocular lens (IOL) implantation on visual outcomes and complications in pediatric patients with Juvenile Idiopathic Arthritis-Associated Uveitis. This study included 25 patients (30 eyes) with uveitis and cataracts who underwent cataract surgery. The study was conducted as a retrospective study. Patients were divided into two groups based on their preoperative treatment: those who received immunomodulatory therapy (IMT) along with systemic corticosteroids and those who received IMT in combination with a biologic therapy. Best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), macular volume (MV), and postoperative complications were assessed at various time points up to 12 months. All surgeries were performed by a single surgeon. Significant improvement in BCVA were observed postoperatively in both study groups, with approximately 80% of eyes showing improvement. Mean BCVA improved from 0.89 ± 0.63 to 0.37 ± 0.33 in group 1and from 0.82 ± 0.68 to 0.35 ± 0.31 in group 2 after 12 months. Postoperatively, there was a decrease in mean IOP, with no significant variance observed between the two groups. Complications were observed in 73% of cases, including posterior capsular opacification (PCO), secondary glaucoma, and macular edema (ME), but did not significantly differ between groups. Cataract surgery in children with uveitis associated with JIA presents significant challenges due to the risk of postoperative complications, even with adequate preoperative and postoperative care. The similar improvement in BCVA observed in both groups suggests that different systemic therapies were sufficient for satisfactory control of inflammation before and after surgery.

Pseudophakic cystoid macular oedema and posterior capsular opacification rates after combined phaco-trabeculectomy vs. phaco alone.

To assess the risk for pseudophakic cystoid macular oedema (PCME) and posterior capsular opacification (PCO) associated with combined cataract surgery and trabeculectomy compared to cataract surgery alone. Data analysis of subjects who underwent routine cataract surgery without and with concomitant trabeculectomy at the Department of Ophthalmology, Bristol Eye Hospital, the UK, between January 2008 and December 2017. Odds ratios (ORs) for PCME between the types of surgeries were calculated using univariate and multivariate regression analysis. Multivariate Cox regression controlling for age and gender was used to estimate the hazard ratio (HR) for neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomies. This study included 56 973 cataract surgeries without and 288 with concomitant trabeculectomy (phaco-trab) with a mean follow-up time of 6.9 ± 4.2 years. Baseline variables (age and gender, diabetes, pseudoexfoliation, use of pupil expansion device and postoperative follow-up time) were comparable between the groups. Postoperative rates of PCME remained non-significant between the cataract surgery and phaco-trabe groups both in uni- and multi-variate analysis (OR 0.347, 95%CI 0.049-2.477, p = 0.291). Furthermore, in Cox regression analysis adjusted for the patients' age and gender, Nd:YAG laser capsulotomy rates remained non-significant between the cataract surgery and phaco-trabe groups (HR 1.250, 95%CI 0.883-1.769, p = 0.209). In our large cohort study, combining trabeculectomy with cataract surgery did not predispose to an increased PCME or Nd:YAG laser capsulotomy rates.

Oxidative Stress, Glutaredoxins, and Their Therapeutic Potential in Posterior Capsular Opacification.

Posterior capsular opacification (PCO) is the most common long-term complication of cataract surgery. Traditionally, the pathogenesis of PCO involves the residual lens epithelial cells (LECs), which undergo transdifferentiation into a myofibroblast phenotype, hyperproliferation, matrix contraction, and matrix deposition. This process is driven by the marked upregulation of inflammatory and growth factors post-surgery. Recently, research on the role of redox environments has gained considerable attention. LECs, which are in direct contact with the aqueous humour after cataract surgery, are subjected to oxidative stress due to decreased levels of reduced glutathione and increased oxygen content compared to contact with the outer fibre layer of the lens before surgery. In this review, we examine the critical role of oxidative stress in PCO formation. We also focus on glutaredoxins (Grxs), which are antioxidative enzymes produced via deglutathionylation, their protective role against PCO formation, and their therapeutic potential. Furthermore, we discuss the latest advancements in PCO therapy, particularly the development of advanced antioxidative pharmacological agents, and emphasise the importance and approaches of anti-inflammatory and antioxidant treatments in PCO management. In conclusion, this review highlights the significant roles of oxidative stress in PCO, the protective effects of Grxs against PCO formation, and the potential of anti-inflammatory and antioxidant therapies in treating PCO.

Evaluation of Intraocular Pressure, Refraction, Anterior Chamber Depth, Macular Thickness, and Specular Microscopy Post-Neodymium-Doped Yttrium-Aluminum-Garnet Laser in Patients With Posterior Capsular Opacification.

Background Cataract is the leading cause of blindness globally, particularly in India. Despite advancements in surgical techniques, postoperative complications remain common, with posterior capsular opacification (PCO) being the most frequent issue. Although neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy is recommended for managing PCO, it is associated with various side effects. This study aimed to evaluate the effects of Nd:YAG laser capsulotomy on intraocular pressure (IOP), visual acuity, anterior chamber depth (ACD), macular thickness, and corneal endothelium in Indian patients. Methodology This prospective, hospital-based study was conducted in the ophthalmology department at a tertiary care center in western Maharashtra from September 2022 to June 2024. Approval from the Institutional Scientific and Ethics Committee was obtained before commencing the research. In the study, 72 eyes from 72 patients with PCO following uncomplicated cataract surgery who were undergoing Nd:YAG laser capsulotomy were included, whereas patients with corneal pathology, retinal pathology, complicated cataract surgery, or trauma were excluded. Patients with active uveitis, non-compliant patients, and those unwilling to undergo the procedure were also excluded. Written informed consent was obtained from each patient. Data were managed in Microsoft Excel, and statistical analysis was conducted using the SPSS 26.0 software. As the continuous variables exhibited skewed distribution, the Wilcoxon test was employed to assess categorical variables such as the significance of IOP and endothelial cell differences over time. A significance level of 5% was assumed, with a p-value below 0.05 considered significant. Results The mean age of patients who underwent Nd:YAG capsulotomy was 64 years, with a female predominance of 37 (51.4%). In the study, 37 (51.4%) patients had their left eye treated, while 35 (48.6%) had their right eye treated. Overall, 45 (62.5%) patients had a baseline best-corrected visual acuity (BCVA) of 6/24-6/12. At one hour post-procedure, 46 (63.9%) patients in Group II had a BCVA of 6/24-6/12, and by one week after treatment, 53 (73.6%) patients had a BCVA of >6/12-6/6. ACD was normal in all patients before and after the procedure. Two patients developed macular edema at one hour and one week after the procedure. The mean IOP at baseline, one hour, and one week were 13.5, 13.86, and 13.69 mmHg, respectively. A significant increase in IOP was observed at one hour post-procedure, along with a significant decrease in endothelial cell count compared to baseline, which also persisted at one week. Conclusions Patients undergoing Nd:YAG capsulotomy experienced an initial rise in IOP, followed by a subsequent decline. Improved visual acuity was noted in most patients at one hour and by one week. A significant decline in endothelial cell count was observed following the procedure, and macular edema was noted in two patients. Anterior chamber reaction was observed in nearly all patients, which decreased by one week. With no change in ACD following the procedure up to one week, ocular refraction was not significantly impacted in the short term. Therefore, further large-scale intervention studies are needed to evaluate the effects of Nd:YAG laser capsulotomy size and the energy used on refractive error and post-procedure complications, as well as to explore the long-term effects on IOP.

Unintended placement of intraocular lens haptics in the sulcus and its association with posterior capsular opacification in pseudophakic post-mortem eyes

ObjectiveTo assess the prevalence of unintended placement of intraocular lens (IOL) haptics in the sulcus and its association with posterior capsular opacification (PCO). DesignCross-sectional study. Participants428 post-mortem pseudophakic human eyes. MethodsEyes were obtained from the Lions Gift of Sight and imaged in Miyake-Apple view (MAV). IOL haptic placement (bag–bag, bag–sulcus, sulcus–sulcus) was determined from the MAV images. IOL-capsular bag complexes were extracted and analyzed via Automated Detector Opacification Software to quantify PCO and Soemmering's Ring (SR). SR distribution was categorized as focal, diffuse, or none. Mean differences in PCO and SR between haptic groups were assessed via Welch's t-test. Odds ratios were used to compare the risk of SR distribution patterns between both haptic groups. Sex, clinical history (diabetes, smoking, hypertension, glaucoma, cancer, age-related macular degeneration [AMD], hypercholesterolemia, cardiovascular disease), and IOL model and specifications were collected. Results20 eyes (4.67%) had unintended sulcus placement of haptics. Mean PCO (p = 0.0367) and SR (p = 0.0414) were significantly higher in sulcus eyes. Sulcus eyes were significantly more at risk of focal SR distribution (OR 8.715; p < 0.0001) and significantly less at risk of diffuse SR distribution (OR 0.168; p = .0007). Sulcus eyes had significantly higher frequencies of glaucoma (p < 0.0001) and AMD (p = 0.0023) on clinical history. ConclusionsThis study demonstrates that unintended sulcus placement of IOL haptics may be associated with an increased risk of PCO and SR formation. This study offers clinical signs of sulcus haptic placement that may prompt physicians to seek earlier appropriate intervention.

TiO2-Nanoparticle-Enhanced Sonodynamic Therapy for Prevention of Posterior Capsular Opacification and Ferroptosis Exploration of Its Mechanism.

To explore the application and potential ferroptosis mechanisms of sonodynamic therapy (SDT) using titanium dioxide nanoparticles (TiO2-NPs) as sonosensitizers for the prevention of posterior capsule opacification (PCO). We fabricated TiO2-NP-coated intraocular lenses (TiO2-IOLs) using the spin-coating method, followed by ultrasound activation of the photosensitizer TiO2. In vitro experiments were performed with human lens epithelial cells (HLECs) to explore the appropriate concentration of TiO2 and ultrasonic parameters. Investigations included reactive oxygen species (ROS) generation, glutathione (GSH) depletion, glutathione peroxidase 4 (GPX4) western blot analysis, lipid peroxidation assays, and transcriptomics analysis. Finally, TiO2-IOLs were implanted in rabbit eyes to explore the in vivo performance of SDT. Through both in vitro and in vivo experiments, the study determined that the ultrasound parameters of 5-minute duration, 1-MHz frequency, 50% duty cycle, and 1.2-W/cm2 intensity were reliable and valid for killing HLECs without damaging other ocular structures. In vitro experiments demonstrated that SDT generated excess ROS, which disrupted the mitochondrial membrane potential and significantly reduced the GSH content. Additionally, the downregulation of GPX4, accumulation of lipid peroxides, and alteration of mitochondrial morphology were observed, suggesting that ferroptosis may be the underlying mechanism. The RNA-sequencing analysis results also showed an increase in the expression of multiple pro-ferroptosis genes and the ferroptosis marker gene PTGS2. Animal experiments preliminarily demonstrated the safety and effectiveness of SDT in treating PCO in vivo. TiO2-IOLs combined with SDT effectively prevented PCO by generating ROS and intracellular ferroptosis.

Effects of intracameral tissue plasminogen activator injection on posterior capsular opacification, fibrin formation, and intraocular pressure in dogs after phacoemulsification.

To evaluate whether intracameral tissue plasminogen activator (tPA) injection is effective in regulating posterior capsular opacification (PCO), fibrin formation and intraocular pressure (IOP) after cataract surgery. Prospective study involving 30 eyes of 21 dogs that underwent phacoemulsification. Thirty eyes were randomly divided into two groups of 15 eyes (control and tPA groups). Intracameral tPA (25 μg/0.1 mL) was injected into tPA group eyes before corneal incision closure but not into the eyes of the control group. The grades of anterior fibrin formation and PCO were compared based on slit lamp biomicroscope examination at 1 and 2 weeks, 1 month, and 2-3 months postoperatively. IOP was measured using applanation tonometry every 30 min for 4 h immediately after operation and on the following morning. The IOP of the two groups at each time was compared. The grade of anterior fibrin formation and that of PCO were not significantly different between the two groups at any time point (p > .05). However, the IOP of the tPA group was significantly lower than that of the control group at each point on the day of surgery (p < .05). No complications were observed with tPA injection, except for temporary hyphema (for 3 days) in one eye. Although the intracameral tPA injection did not affect anterior fibrin formation and PCO, it effectively maintained normal IOP immediately after phacoemulsification. Thus, our findings provide valuable insights into the potential benefits of intracameral tPA injection in achieving immediate IOP control after phacoemulsification.

A study to compare the prevalence of posterior capsular opacity between patients implanted with hydrophobic acrylic intra ocular lens (IOL) versus hydrophilic acrylic intra ocular lens (IOL) in the diabetic and non-diabetic group following cataract surgery: A hospital based prospective study

: To study and compare the prevalence of posterior capsular opacity between patients implanted with hydrophobic acrylic IOL versus hydrophilic acrylic IOL in the diabetic and non diabetic group following cataract surgery. All patients with senile cataracts, whether they had diabetes or not, who visited a tertiary care hospital in Tamil Nadu between 2020 and 2022 were enrolled in this study after signing a written consent form. In this study, 200 patients underwent screening and were split into 4 equal groups.The PCO observation of patients in all 4 groups in the current study showed that Groups 3 and 4 with hydrophilic IOL found higher incidences of PCO than Groups 1 and 2 with hydrophobic IOL. In our study, more PCO was reported with hydrophilic IOL with known (Group 3) and unknown (Group 4) cases of diabetes. Regardless of the patient's level of diabetes during the course of a year-long follow-up, hydrophobic acrylic IOLs showed a greater decrease in PCO rates than hydrophilic acrylic IOLs.

SING IMT removal for unsatisfied patients: step-by-step surgery for a safe explant.

To report three cases of Smaller-Incision New-Generation Implantable Miniature Telescope (SING-IMG) explantation and three-piece acrylic intraocular lens (IOL) implantation in patients affected by late-stage dry AMD. This is a single-center cohort study. Three patients with stable dry AMD previously implanted with SING-IMT failed to adapt to the device requesting its explantation. Surgical procedures were performed under peribulbar anesthesia, with careful removal of the SING-IMT telescope through a sclero-corneal tunnel of 8 mm and implantation of a three-piece acrylic IOL. Patients underwent pre and postoperative assessments, including visual acuity measurements, endothelial cell count and intraocular pressure. Patients were followed postoperatively for at least 6 months, with particular attention to IOL stability and posterior capsule integrity. Postoperative assessments demonstrated positive outcomes, revealing no IOL dislocation or posterior capsular opacification after 6 months. Endothelial cell count diminished. Best-corrected visual acuity (BCVA) returned to values before SING-IMT implantation. In our small cohort, SING-IMT explantation appeared to be a safe option. Despite promising visual outcomes, some patients might not adapt to SING-IMT. Further studies are needed to evaluate criteria to predict telescope adaptation.

Capsular Waves: A Warning Indicator for Potentially Malpositioned Intraocular Lenses.

To share examination findings of the lens capsule which may act as an indicator for malpositioned intraocular lenses (IOL). Single large multi-specialty private practice, Houston, Texas, USA. Focused, observational case series. A review of pre-operative images of malpositioned single-piece IOLs with at least one haptic in the ciliary sulcus was conducted. The review included five cases who were referred to a single large multi-specialty private practice from June 2023 to December 2024 for an evaluation of posterior capsular opacification (PCO) and potential Nd:YAG capsulotomy. A total of five eyes which previously had undergone cataract surgery and were referred for Nd:YAG capsulotomy for PCO were identified on slit lamp examination to have capsular waves, defined as a centripetal and circumferential striated pattern of PCO that results from a fused anterior and posterior capsule with at least part of the IOL anterior to the capsule. While one eye exhibited transillumination defects and pigment dispersion, the remainder of eyes did not. In some cases, the capsular wave was the only clue to IOL malpositioning due to a small pupil. These eyes had single-piece IOLs with at least one haptic in the sulcus and required subsequent IOL repositioning or exchange. If capsular waves are seen on slit lamp exam, a thorough inspection of IOL placement should be conducted, especially before treatment with Nd:YAG capsulotomy. Capsular waves result from anterior and posterior capsule contact with an anteriorly situated IOL. This finding is a potential indicator of at least part of an IOL positioned anterior to the anterior capsule.

Evaluation of Dose-Response Relationship in Novel Extended Release of Targeted Nucleic Acid Nanocarriers to Treat Secondary Cataracts.

Purpose: The present study aimed to determine the dose-response relationship between targeted nanocarriers released from a novel, sustained release formulation and their ability to specifically deplete cells responsible for the development of posterior capsular opacification (PCO) in month-long, dynamic cell cultures. Methods: Injectable, thermosensitive poly(D,L-lactic-co-glycolic acid)-b-poly(ethylene glycol)-b-poly(D,L-lactic-co-glycolic acid) triblock copolymer hydrogels were loaded with either a low or a high dose of doxorubicin-loaded antibody-targeted nanocarriers (G8:3DNA:Dox). Human rhabdomyosarcoma cells, selected for their expression of PCO marker brain-specific angiogenesis inhibitor 1 (BAI1), were kept under dynamic media flow and received either a low or high dose of nanocarriers. Cells were fixed and stained at predetermined time points to evaluate targeted depletion of BAI1+ cells. Results: A lower dose of nanocarriers in hydrogel depleted BAI1+ cells at a slower rate than the higher dose, whereas both reached over 90% BAI1+ cellular nonviability at 28 days. Both treatment groups also significantly lowered the relative abundance of BAI1+ cells in the population compared with the control group. Conclusions: Controlled release of a lower dose of nanocarriers can still achieve therapeutically relevant effects in the prevention of PCO, while avoiding potential secondary effects associated with the administration of a higher dose.

Unilateral lifebuoy cataract: A case report.

Lifebuoy cataract is a rare congenital condition characterized by lens thinning. Due to its rarity, detailed treatment reports and standardized surgical approaches are limited. This study aims to enhance the current body of knowledge by presenting comprehensive case reports and describing surgical techniques for the treatment of lifebuoy cataracts. A 14-year-old boy was diagnosed with a congenital cataract in his right eye at the age of 9, which was left untreated. The patient visited our hospital due to progressive visual impairment. The visual acuity of the right eye was counting fingers at 30 cm. The uncorrected visual acuity of the left eye was 20/100, whereas the best corrected visual acuity was 20/20. The intraocular pressures were 18 mm Hg (left eye) and 20 mm Hg (right eye). Slit-lamp microscopy revealed central calcification of the lens capsule in the right eye and slightly opaque cortical tissue in the periphery, with no observable lens nucleus. Anterior segment optical coherence tomography (CASIA2, TOMEY, Nagoya, Japan) of the right eye showed fused anterior and posterior capsules and an absence of the lens nucleus, leading to a diagnosis of lifebuoy cataract. Cataract surgery was performed on the right eye. Following a 2.4-mm sclerocorneal incision and trypan blue staining, continuous curvilinear capsulorrhexis was performed around the central opacity. The surrounding cortex was removed using irrigation and aspiration, while a viscoelastic agent was injected between the central calcified membrane and the posterior capsule. The membranous tissue was carefully peeled away and removed using forceps. Despite residual posterior capsular opacification, posterior capsulotomy was not performed due to concerns about vitreous prolapse. The intraocular lens was fixed within the capsule. Ten days post-surgery, the remaining posterior capsular opacification was treated with neodymium-doped yttrium aluminum garnet laser capsulotomy. The uncorrected visual acuity and best corrected visual acuity of the right eye improved to 20/100 and 20/50, respectively. This case report demonstrates a successful surgical approach for a lifebuoy cataract, highlighting its unique morphology and the need for careful, specialized techniques. These findings aim to guide ophthalmologists in managing this rare condition, potentially improving patient care.

Human Primary Lens Epithelial Cultures on Basal Laminas Studied by Synchrotron-Based FTIR Microspectroscopy for Understanding Posterior Capsular Opacification.

Human primary lens epithelial cultures serve as an in vitro model for posterior capsular opacification (PCO) formation. PCO occurs when residual lens epithelial cells (LECs) migrate and proliferate after cataract surgery, differentiating into fibroblastic and lens fiber-like cells. This study aims to show and compare the bio-macromolecular profiles of primary LEC cultures and postoperative lens epithelia LECs on basal laminas (bls), while also analyzing bls and cultured LECs separately. Using synchrotron radiation-based Fourier transform infrared (SR-FTIR) (Bruker, Karlsruhe, Germany) microspectroscopy at the Spanish synchrotron light source ALBA, we observed that the SR-FTIR measurements were predominantly influenced by the strong collagen absorbance of the bls. Cultured LECs on bls showed a higher collagen contribution, indicated by higher vas CH3, CH2 and CH3 wagging and deformation, and the C-N stretching of collagen. In contrast, postoperative LECs on bls showed a higher cell contribution, indicated by the vsym CH2 peak and the ratio between vas CH2 and vas CH3 peaks. The primary difference revealed using SR-FTIR is the greater LEC contribution in spectra recorded from postoperative lens epithelia compared to cultured LECs on bls. IR spectra for bl, cultured LECs and postoperative lens epithelia could be valuable for future research.

Comparison of effect and safety of phacoemulsification surgery performed by resident and attending physicians.

The objective of this study is to compare the effect and safety of phacoemulsification surgery performed by resident and attending physicians. This was a retrospective study. Eyes with cataract who underwent phacoemulsification surgery at the First Affiliated Hospital of Ningbo University between January 2021 and December 2023 were reviewed. All the patients were followed up for at least 12 months and were divided into two groups according to the surgery performer. SPSS was used to analyze data, considering p < 0.05 significant. Overall, 316 patients with cataract in group 1 (surgery performed by resident physician, n = 181) and group 2 (surgery performed by attending physician, n = 135) were reviewed. There were no statistically significant differences in patient demographics variables and cataract grade between the groups. The resident surgeon used more cumulative dissipate energy (15.00 ± 7.25 vs. 10.83 ± 6.52, p < 0.001) and operation time (20.46 ± 5.69 vs. 12.59 ± 4.61 min, p < 0.001) to complete the surgery. Also, the ECL in group 1 was higher (14.87 ± 5.00 vs. 10.77 ± 4.46, p < 0.001). The eyes had significant visual improvement in both groups postoperatively (p < 0.05), but at the 12-month follow-up, eyes in group 2 had better best-corrected visual acuity [0.10 (0.00, 0.22) vs. 0.10 (0.10, 0.22) logMAR, p = 0.039]. Except for month 1, the intraocular pressure was no statistical difference in group 1 and group 2 (14.65 ± 2.52 vs. 15.30 ± 2.34 mmHg, p = 0.019). Cases in group 1 were more likely to undergo intraoperative and postoperative complications (37 vs. 14, p = 0.031), including cornea edema (p = 0.025), capsule tear (p = 0.044), and posterior capsular opacification (p = 0.027). The effect of phacoemulsification surgery performed by the resident physician is satisfying, but compared to the attending physician, the higher probability of complications should be paid more attention.

Objective analysis of capsulorrhexis factors and posterior capsular opacification in 420 postmortem eyes

ObjectiveTo evaluate the capsulorrhexis structure in postmortem eyes and determine factors associated with posterior capsular opacification (PCO). DesignExperimental study. ParticipantsPostmortem pseudophakic human eyes (n = 420). MethodsPostmortem eyes were obtained and examined. Photographs were taken of the eyes in Miyake-Apple view and of the extracted lens-capsule complexes. PCO and Soemmering's ring (SR) were quantified using automated detector opacification software as factors of intensity and area. Miyake-Apple views and ImageJ were used to assess capsulorrhexis diameter, area of anterior capsule-optic overlap, length of the shortest anterior capsular leaflet, and area and angle of capsulorrhexis-optic nonoverlap. Linear regression analysis and Welch's t test were used to determine the relationship of these factors with PCO and SR. All analyses were repeated in sample groups specific to the 5 most common intraocular lens models. ResultsCapsule-optic overlap was positively correlated with PCO (P < 0.0001) and SR (P = 0.0016). Capsulorrhexis diameter was negatively correlated with PCO (P < 0.0001) and SR (P = 0.014). Leaflet length was positively correlated with PCO (P = 0.009). Area and angle of capsulorrhexis-optic nonoverlap were not correlated with PCO or SR. Slopes and coefficients of determination were relatively low for all significant results. ConclusionsThe pathogenesis of PCO development after cataract surgery is multifactorial. This study shows that with modern operating technology, capsulorrhexis factors have at best a modest influence on PCO formation. Factors such as time from surgery to death and intraoperative techniques such as laser capsule polishing, posterior capsule vacuuming, and cortical cleanup are likely to play a more significant role.

Refractive Lens Exchange: A Review.

In recent decades, technical advancements in lens surgery have considerably improved safety and refractive outcomes. This has led to a much broader range of indications for refractive lens exchange (RLE). Effective restoration of uncorrected distance and near visual acuity is possible with modern presbyopia correcting intraocular lenses (IOLs). Hyperopic patients who are fully presbyopic were identified as ideal candidates for RLE. For myopic patients, an increased risk of retinal detachment has been reported, which leads to a higher threshold to perform RLE in this patient group. The most frequent postoperative complications include posterior capsular opacification, deviation from the target refraction and cystoid macular edema. Thus, adequate planning of surgery, careful patient selection, as well as comprehensive counseling are crucial for successful RLE.

Photo-crosslinked hydrogel as injectable intraocular lens for cataract surgery implantation

Cataract is the leading cause of the blindness worldwide. Natural lens removal followed with intraocular lens (IOL) implantation is the main clinical treatment for cataract. However, the shape and the optical power of current IOLs were fixed, which were not favorable for patients, especially for children with congenital cataracts. An injectable IOL is an immerging replacement for a regular IOL due to the accommodation of external packing shapes. In this study, we developed a rapid, in situ gelation of an injectable photo-crosslinked hydrogel as an injectable IOL material. In this investigation, injectable hydrogel (G/D hydrogel) was fabricated from Gelatin methacrylate (GelMA) and N- (3, 4-dihydroxyphenylidene ethyl) methacrylamide (DMA) via photo-crosslinking for injectable IOL applications. Different preparation parameters such as the concentration, proportion, light intensity, and curing time were optimized based on the gelation time, swelling ratio, and mechanical properties of the produced G/D hydrogels. The results of in vitro cellular experiments showed that the G/D hydrogel had good and stable clearance of lens epithelial cells. The hydrogel was implanted into the eyes of the young rabbits for 1 month, and the results also showed that injectable G/D hydrogel can obtain good intraocular implants and have inhibitory effects on posterior capsular opacification. Thus such photo-crosslinked G/D hydrogel can serve as an injectable IOL application in cataract surgery.

A clinical study of the neodymium-doped yttrium–aluminium–garnet laser posterior capsulotomy: Visual outcome and early complications

Objectives: The objectives of this study were as follows: To study the efficacy of neodymium-doped yttrium–aluminium–garnet (Nd:YAG) laser capsulotomy in posterior capsular opacification (PCO) by analysing the visual outcome. To study any other early complications seen following Nd:YAG laser capsulotomy. Materials and Methods: A prospective interventional study was done in the Department of Ophthalmology of a tertiary care hospital in the Marathwada region of Maharashtra. A total of 55 eyes developing PCO after cataract surgery were included in the study from November 2022 to October 2023. Routine pre-laser evaluation using slit-lamp biomicroscopy, intraocular pressure (IOP) measurements and dilated fundus examination was done. Thirty-eight patients had undergone manual small incision cataract surgery with polymethyl methacrylate intraocular lens (IOL) implantation and 17 patients had undergone phacoemulsification surgery with acrylic foldable IOL implantation. The patient was then followed up on Days 2, 7, 30, and 3 months to look for any early post-laser complications. Results: A total of 55 eyes were included in the study. The age group of patients included in the study is from 50 to 75 years. Most of the patients 21 were in the age group of 56–60 years. Twenty (36%) were male and 35(63%) females; thus, female preponderance is seen. On retro-illumination of the slit lamp, 9 (16.3%) patients had severe PCO having vision ≤3/60, 24 (43.6%) patients had moderate PCO with vision 3/60–6/60 and 22 (40%) patients had mild PCO with vision 6/60–6/18. Forty-seven patients (85%) had visual acuity of more than 6/12 at the end of 3 months. In most patients, an appropriate central capsulotomy was achieved within the total energy of 60 mJ but in three cases more than 100 mJ energy was used due to the thick posterior capsule. About 6% of subjects showed increased IOP of more than 21 mm Hg but returned to normal level within 1 week. Mild uveal reaction in the form of anterior chamber flare and cells was seen in 2% of cases. IOL pitting was seen in 5 (8%) cases. One (2%) patient had a vision of 3/60 and a significant increase in macular thickness at day 7 post-laser which decreased at 1 month follow-up by appropriate treatment. No evidence of any retinal tears or retinal detachment seen. Conclusion: PCO is a common delayed complication seen after cataract surgery. This opacification decreases the vision of the patient to affect day-to-day activities. It can be easily managed on an outdoor basis by a non-invasive and effective Nd:YAG laser posterior capsulotomy procedure. This procedure has been shown to increase the visual outcome and has fewer complications which can be managed easily.