Risk Of Posterior Capsule Opacification Research Articles

Частота YAG-лазерной дисцизии вторичной катаракты при имплантации объемозамещающей ИОЛ «Torsion»

Purpose. Analysis of frequency of ND: YAG-laser capsulotomy of posterior capsule opacification (PCO) in patients with intraocular correction of aphakia by Open bag IOL. Methods. Open bag IOL «Torsion» (RF Patent 2208418), manufactured by «Reper-NN Ltd.» 5,5'15,4'0.2 mm by size, were used in clinic at 752 eyes of 615 patients with age related cataract during a routine PHACO through 2.2 mm incision. Standard research methods were used in all patients includes refractometry and monitoring of IOL position by UBM-biometry before and after surgery. ND: YAG-laser capsulotomy was performed in a circle or a cross forming 4-mm hole in borders of IOL optical part. Follow-up was from one to 10 years (at mean 7.73±3.21 years). Results. ND: YAG-laser capsulotomy was performed on 32 eyes (4.25%) of 23 patients in follow-up of 5.25 to 10 years. During the period 5,25-7 years capsulotomy was performed on 15 eyes (46,87%), from 7 till 8,5 years were done on 14 eyes (43,75%), from 8,5 till 10 years was performed on 3 eyes (9,37%). Correct and stable PTHIOL position was proved by UBM method. In all patients, the parameters of CB with implanted lens did not significantly differing from those after of the ND: YAG-laser capsulotomy. Furthermore, there were no long-term complications of the CB. Conclusions. The 10-years results of open bag IOL implantation allows to conclude, that the IOL «Torsion» really can significantly reduce the risk of PCO. In addition, IOL significantly delays the time of occurrence PCO to an average of 6.99±0.9 years. Therefore, the statistic of PCO after cataract surgery with implantation of IOL should be taken into account after 5,5 – 10 years. Key words: YAG-laser discission, PCO, secondary cataract, «open bag» IOL, «Torsion».

Cellular FLICE-like inhibitory protein (cFLIP) critically maintains apoptotic resistance in human lens epithelial cells

The present study aims to understand the mechanism of the lens epithelial cell’s strong anti-apoptotic capacity and survival in the mature human lens that, on the one hand, maintains lens transparency over several decades, while on the other hand, increases the risk of posterior capsule opacification (PCO). Here we compared FHL124 cells and HeLa cells, spontaneously immortalized epithelial cell lines derived from the human lens and cervical cancer cells, respectively, of their resistance to TNFα-mediated cell death. TNFα plus cycloheximide (CHX) triggered almost all of HeLa cell death. FHL124 cells, however, were unaffected and able to block caspase-8 activation as well as prevent caspase-3 and PARP-1 cleavage. Interestingly, despite spontaneous NFκB and AP-1 activation and upregulation of multiple cell survival/anti-apoptotic genes in both cell types, only FHL124 cells were able to survive the TNFα challenge. After screening and comparing the cell survival genes, cFLIP was found to be highly expressed in FHL124 cells and substantially upregulated by TNFα stimulation. FHL124 cells with a mild cFLIP knockdown manifested a profound apoptotic response to TNFα stimulus similar to HeLa cells. Most importantly, we confirmed these findings in an ex vivo lens capsular bag culture system. In conclusion, our results show that cFLIP is a critical gene that is regulating lens epithelial cell survival.

Budget impact analysis of lens material on the posterior capsule opacification (PCO) as a complication after the cataract surgery

BackgroundOver 300,000 cataract operations are performed in Poland every year, and the most common, late complication of cataract removal surgery is posterior capsule opacification (PCO). The risk of PCO depends on the lens material. Hydrophobic acrylic lenses cause PCO less frequently as lymphatic endothelial cells show lower affinity for the surface of the lens made of silicone. The objective of this study is to assess the economic impact of using hydrophobic acrylic lenses compared to using hydrophilic acrylic lenses for cataract treatment in the Polish inpatient and outpatient settings.MethodsA budget impact analysis (BIA) compared the economic outcomes associated with using hydrophobic acrylic lenses versus using hydrophilic lenses for patients undergoing cataract surgery. The BIA predicted annual expenses in the following scenarios: performing Nd:YAG to treat PCO within 2 and 3 years after implantation of hydrophobic or hydrophilic acrylic lenses for different lens structure. Data used to assess the frequency of PCO was determined in systematic literature review. Costs of current and predicted interventions were estimated based on average data from 19 Polish hospitals. Prices of health services were taken from official public tariff lists.ResultsThe use of a hydrophobic lens significantly limits the number of complications after cataract surgery relative to a hydrophilic lens. As hydrophobic lenses have a higher unit price their use increases the cost of treatment which currently is not reflected by adequate difference in price of the service. Total annual National Health Fund (NHF) expenses for 3-year follow-up model range from 139.1 million EUR to 143.1 million EUR depending on the lens structure, due to the cost of complications.ConclusionsBIA indicates the possibility of introducing surcharge for the use of hydrophobic lenses, which could increase the frequency of their use and reduce the number of complications after cataract surgery. It was estimated that total NHF expenses reach the minimum value for the surcharge at the level of 9 EUR. The surcharge of 14 EUR is the maximum value that does not increase the initial NHF expenses.

How to handle the posterior lens capsule in children

SummaryOne of the multiple challenges posed by pediatric cataract surgery relates to the special management of the posterior capsule (PC).The risk of PC opacification is much higher in children, nearing 100% in the course of a few months with the standard techniques and intraocular lenses (IOL), even with a thorough capsular bag polishing. As the performance of a Nd:YAG laser capsulotomy can be impractical in children, an intraoperative solution is advisable. This normally involves a posterior capsulorhexis, with or without anterior vitrectomy, and either with a standard IOL or a special design such as the bag‐in‐the‐lens concept or using techniques as posterior capture of the optic.Pediatric cataracts frequently include special features as in opacities a the PC level, which can range from cellular to fibrotic, with different degrees in the maturity of fibrous membranes. In some cases as with posterior polar cataracts there may be an extreme weakness or absence of the central PC. Other situations may involve additional materials as in persistence of anterior hyperplastic primary vitreous.This presentation reviews the decision process, surgical options, and possible risks involved in dealing with the PC in pediatric cataract surgery.

Five-year incidence of Nd:YAG laser capsulotomy and association with in vitro proliferation of lens epithelial cells from individual specimens: a case control study.

BackgroundThe aims of this study were to determine the 5-year incidence of posterior capsule opacification (PCO) requiring Nd:YAG laser capsulotomy in a representative mixed cohort of cataract patients, to determine risk factors for PCO and to investigate possible association with growth of human lens epithelial cells (HLEC) in vitro.MethodsPieces of the anterior lens capsule and adhering HLEC were obtained at cataract surgery and cultured individually. After one and two weeks respectively, cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent cell layer. The 5-year incidence of Nd:YAG laser capsulotomy in this cohort was determined through medical records and by mail or telephone interviews. For statistic analyses Mann–Whitney U-test, Fisher’s exact test and binary logistic regression were used.ResultsData on treatment/no treatment for PCO was obtained from 270 patients with a median follow-up time of 57 months (range 50–64 months). The three-year cumulative incidence of PCO was 5.2% and the cumulative 5-year incidence was 11.9%. Patients who had undergone Nd:YAG laser capsulotomy were significantly younger (median 71 years) than patients who did not receive treatment for PCO (median 75 years, p = 0.022). Logistic regression demonstrated that apart from younger age, follow-up time and type of intraocular lens (IOL) were associated with risk of PCO, with hydrophilic 1-piece IOLs conferring a higher risk than hydrophobic acrylic 1-piece or 3-piece IOLs (adjusted OR = 9.4, 95% CI 2.5-35.7, p = 0.001). Of the 270 patients from whom information could be retrieved regarding PCO treatment, in vitro cell culture could be established and quantified from 185 patients. No significant difference in cell growth in vitro was shown between patients subsequently requiring/not requiring Nd:YAG laser capsulotomy.ConclusionsThe cumulative 5-year incidence of 11.9% is comparable or slightly higher than reported in other recent studies. The type of IOL was the most important risk factor for PCO in this study, whereas intrinsic proliferative capacity of the individual’s lens epithelial cells seems to be less important for subsequent PCO development.

This issue of ACTA, printed and electronic

This issue of <i><scp>ACTA</scp></i>, printed and electronic

Comparison of monofocal intraocular lenses for uncomplicated age-related cataract

Background: The Health Technology Assessment Unit at the Alberta Heritage Foundation for Medical Research (AHFMR) has prepared a report on the safety, efficacy and effectiveness of foldable monofocal intraocular lenses (IOLs) (silicone and acrylic) over polymethylmethacrylate (PMMA) IOLs for the treatment of uncomplicated age-related cataract. In this article the author describes the methods and findings of the AHFMR report.Methods: A systematic literature search of 10 electronic databases (1991 to May 1999) was conducted for the AHFMR assessment. The quality of the studies was analysed by means of explicit criteria.Results: Eight studies with a follow-up time of at least 6 months were located that compared the three types of IOL. Decentration and tilt were not an issue for any of the IOLs evaluated. The posterior capsule opacification and capsulotomy rates were lower among patients with the soft acrylic lens over a follow-up period of 2 to 3 years than among patients with the PMMA or silicone lens.Interpretation: On the basis of weak scientific evidence, foldable acrylic IOLs appear to offer greater short- to medium-term (3 years) benefits than PMMA and silicone lenses in regard to biocompatibility, anterior capsular stability and risk of posterior capsule opacification. There appears to be little good-quality information to guide ophthalmologists, consumers and provincial health care funders in their choice of the most appropriate type of IOL.

The Madurai Intraocular Lens Study IV: posterior capsule opacification

PURPOSE: To estimate the cumulative incidence of posterior capsule opacification 4 years after surgery in patients who participated in the Madurai Intraocular Lens Study and had extracapsular cataract extraction with posterior chamber intraocular lens implantation. METHODS: In the Madurai Intraocular Lens Study, 1,700 patients with best-corrected visual acuity 20/120 or worse in the better eye had extracapsular cataract extraction with posterior chamber intraocular lens implantation, and 1,474 (86.7%) of these completed the 1-year follow-up examination. From this group of 1,474 pseudophakic patients, 400 were randomly selected for reexamination 4 years after the original surgery. The eye that was operated on was examined by an ophthalmologist who was involved in the 1-year follow-up examinations and posterior capsule opacification grading. A grading of I to III was used to reflect the degree of opacification. With grades II and III, posterior capsule opacification detectable with an undilated pupil was present in the central axis. RESULTS: Three hundred twenty-seven (81.8%) of the selected population were examined between October 1997 and December 1998. Thirty-four (8.5%) were confirmed as being deceased, and 39 (9.8%) were unavailable for follow-up. The median age was 60 years, and 57.2% were women. The 4-year incidence of grade II or III posterior capsule opacification, including eyes already treated with laser capsulotomy, was 13.1% (95% confidence interval [CI], 9.7% to 17.3%). Each year of increased age was associated with a decreased risk of posterior capsule opacification (odds ratio, 0.96; 95% CI, 0.92 to 1.00). Based on best-corrected visual acuity of 20/40 or worse without co-existing pathology, the 4-year incidence of posterior capsule opacification was 13.5%. CONCLUSION: Because patients with relatively mature cataracts routinely receive extracapsular cataract extraction with posterior chamber intraocular lens implantation instead of the traditional intracapsular extraction, the subsequent need for laser capsulotomy may be less than that anticipated, based on previous reports.