Time Of Cataract Extraction Research Articles

Causes of cataract progression in glaucoma patients (report 1)

The incidence of combined cataract and glaucoma ranges from 14.6% to 76%, and increases to 85% in the case of pseudoexfoliation syndrome. Analysis of the literature revealed the influence of factors associated with glaucoma on the process of cataract development. Previously performed laser surgery or glaucoma surgery leads to cataract progression in glaucoma patients in 23.3% and 81% of cases, respectively. To solve this problem, some researchers suggest performing combined one-stage lens removal surgery with a hypotensive component, which reduces intraocular pressure and improves visual function. Up to 13.7% of cases associated with complications of glaucoma surgery lead to cataract progression. Cataract surgery in patients with glaucoma in most cases is performed at the moderate (44.6–59.8%) and advanced (18.7–30.3%) stages, which does not eliminate the theory of the influence of optic neuropathy progression on the process of cataract development. The incidence of cataract and pseudoexfoliation glaucoma comorbidity can reach 40.5–90%. Pseudoexfoliation syndrome leads to cataract progression with disruption of the suspensory apparatus of the lens due to the deposition of exfoliative material in the anterior segment of the eye. Presence of lens subluxation causes difficulties at the time of cataract extraction and increases the risk of intraoperative complications.

Outcome of Pediatric Traumatic Cataract in Upper Egypt: A Tertiary Center Study.

PurposeTo demonstrate the demographic features, causative agents, and outcome of pediatric traumatic cataract surgery in eyes without posterior segment involvement at Assiut University Hospital, Upper Egypt.Patients and MethodsThis is a retrospective study on children (aged <18 years old) who underwent traumatic cataract surgery from January to June 2019. Children with posterior segment injury and those who did not complete 6 months of postoperative follow-up were excluded. The demographic features, mechanism and time of eye injury, clinical features, surgical approach, and outcome were recorded and analyzed.ResultsThe study included 34 eyes of 34 children, 23 (68%) of them were boys. The mean age at the time of cataract surgery was 10±3.97 years. Twenty-one eyes sustained open globe injury (62%) with the most common cause of trauma was wooden sticks, while 13 eyes had closed globe injury (38%) with the most common cause of injury was thrown stones. The time interval between eye injury and cataract surgery ranged from 1 day to 9 years with a median of 2.05 months. Posterior chamber intraocular lenses were implanted in all eyes; in 33 eyes, the posterior chamber intraocular lenses were implanted primarily at the time of cataract extraction. Corrected distance visual acuity significantly improved from 2.63±0.66 LogMAR preoperatively, to 0.41±0.38 LogMAR postoperatively (p < 0.001).ConclusionPediatric traumatic cataract is commonly present in primary school age especially after open globe injury. Primary prevention through health awareness should target this age population. Useful vision can be regained with timely proper surgical intervention and posterior chamber intraocular lens implantation.Clinicaltrials.gov IdNCT04630509.

Demographic and Clinical Characteristics Associated with Minimally Invasive Glaucoma Surgery Use: An Intelligent Research in Sight (IRIS®) Registry Retrospective Cohort Analysis

Minimally invasive glaucoma surgery (MIGS) is increasingly performed at the time of cataract extraction. Understanding the demographic and clinical characteristics of patients undergoing MIGS procedures may provide insight into patient selection. This study evaluates racial-ethnic and other differences in the utilization of MIGS in persons with cataract and open-angle glaucoma (OAG). Retrospective cohort study using IRIS® (Intelligent Research in Sight) Registry data. U.S. patients aged ≥40 years with a diagnosis of OAG and no history of MIGS or cataract surgery who were undergoing cataract extraction, with or without MIGS, during 2013-2017. Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Variables assessed include age, sex, race-ethnicity, disease severity, insurance type, census region, comorbidity, and cup-to-disc ratio (CDR). The odds of MIGS utilization was greater among patients who were >60 years (OR, 1.10 [95% CI, 1.05-1.16]); African American (OR, 1.11 [CI, 1.07-1.15]), compared with white; a Medicare recipient (OR, 1.12 [CI, 1.10-1.15]), , versus privately insured; or in the Midwest (OR, 1.32 [CI, 1.28-1.36]) or Northeast (OR, 1.26 [CI, 1.22-1.30]), compared with the South. Having moderate, rather than mild, glaucoma (OR, 1.07 [CI, 1.04-1.11]) and a higher CDR (OR for 0.5 to 0.8, vs. <0.5, 1.24 [CI, 1.21-1.26]; OR for >0.8 to 1.0, vs. <0.5, 1.27 [CI, 1.23-1.32]) were also each associated with increased odds of MIGS utilization. MIGS was less likely in females (OR, 0.96 [CI, 0.94-0.98]); patients taking 5 to 7 glaucoma medications (OR, 0.94 [CI, 0.90-0.99]), compared with 1 to 2 medications; and patients with severe, compared with mild, glaucoma (OR, 0.64 [CI, 0.61-0.67]). To our knowledge, the IRIS Registry contains the largest cohort of U.S. patients with MIGS procedures reported to date. This analysis highlights the importance of capturing race-ethnicity data and other pertinent patient characteristics in electronic health records to provide insight into practice patterns. Such data can be used to assess the long-term performance of MIGS and other procedures in various patient populations.

Long-term Effect of Intraocular Lens vs Contact Lens Correction on Visual Acuity After Cataract Surgery During Infancy

Although intraocular lenses (IOLs) are often implanted in children, little is known whether primary IOL implantation or aphakia and contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy. To compare long-term visual outcomes with contact lens vs IOL correction following unilateral cataract surgery during infancy. This multicenter randomized clinical trial enrolled 114 infants with a unilateral congenital cataract who underwent cataract surgery with or without primary IOL implantation between 1 and 6 months of age. Data on long-term visual outcomes were collected when the children were age 10.5 years (July 14, 2015, to July 12, 2019) and analyzed from March 30 through August 6, 2019. Intraocular lens implantation at the time of cataract surgery. Best-corrected visual acuity using the electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) testing protocol. Analysis was performed on an intention-to-treat basis. Best-corrected visual acuity was measured at age 10.5 years for 110 of the 114 patients (96%) enrolled as infants. The participants included 58 girls (53%) and 52 boys (47%). Overall, 27 of the children (25%) had good (logMAR 0.30 [Snellen equivalent, 20/40] or better) visual acuity in the treated eye (12 [22%] in the IOL group and 15 [27%] in the aphakia group), but 50 children (44%) had a visual acuity of logMAR 1.00 (Snellen equivalent, 20/200) or worse (25 [44%] in the IOL group and 25 [44%] in the aphakia group). The median logMAR acuity in the treated eye was similar in children randomized to receive an IOL at the time of cataract extraction (0.89; interquartile range [IQR], 0.33-1.43 [Snellen equivalent, 20/159]) and those who remained aphakic (0.86; IQR, 0.30-1.46 [Snellen equivalent, 20/145]) (IQR, 0.30-1.46; P = .82). Although the overall difference in median visual acuity between the 2 groups was small, the estimate was imprecise (99% CI for the difference in medians was -0.54 to 0.47). As in previous phases of the study, visual acuity outcomes were highly variable with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye. Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome. ClinicalTrials.gov Identifier: NCT00212134.

Long-term results of secondary intraocular lens implantation in children under 30 months of age

PurposeTo report the long-term outcome of early secondary intraocular lens (IOL) implantation following congenital cataract extraction in a large number of eyes.MethodsData of aphakic children under 30 months of age who underwent secondary IOL implantation and had at least one year of follow-up after the surgery was reviewed. In all of the patients, a foldable three-piece acrylic IOL was implanted in the ciliary sulcus by the same surgeon using the same technique. The database studied included refractive and visual acuity (VA) outcomes and complications.ResultsFifty patients (75 eyes) were included. The average age at the time of cataract extraction was 94.20 ± 44.94 days and 20.7 ± 6.0 months in the secondary IOL implantation. After 82.32 ± 48.91 months, the VA was 0.58 ± 0.35 LogMAR and the spherical equivalent was −2.20 ± 4.19 D. There was a negative correlation between a longer follow-up period and myopia at the SE measured (P = .001). The most frequent complications included glaucoma and corectopia. Performing the secondary IOL implantation ≤ 20 months of age was not a risk factor for glaucoma development (P = 0.095).ConclusionSecondary IOL implantation under 30 months of age is an option for children with unsatisfactory management of the optic treatment. A predictable IOL power calculation and satisfactory visual outcomes compared to results of later secondary IOL implantation are possible.

Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection

PurposePatients with chronic narrow angle glaucoma (CNAG) are at increased risk of developing aqueous misdirection (AM) following intraocular surgery. We present a retrospective case series on the use of posterior capsulorrhexis with core vitrectomy by an anterior approach (CAV) at the time of cataract extraction with or without glaucoma surgery as a prophylactic measure for the prevention of AM in CNAG. MethodsRetrospective case series of six phakic eyes in four patients with CNAG and other risk factors for AM who underwent posterior capsulorrhexis and CAV at the time of cataract surgery with or without glaucoma surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and post-operative complications. ResultsSix eyes in four subjects underwent posterior capsulorrhexis with CAV at the time of cataract surgery. The case was combined with incisional glaucoma surgery in the five eyes with advanced visual field loss. The mean logMAR BCVA and IOP improved from 0.554 ± 0.398 and 25.2 ± 13 mmHg, respectively, at the pre-operative visit to 0.257 ± 0.218 and 12.2 ± 1.7 mmHg, respectively, at final follow-up. Both eyes with nanophthalmos developed non-appositional serous choroidals that resolved with atropine, but the left eye required additional treatment with synechiolysis, intraocular lens repositioning, limited AV and endocyclophotocoagulation. There were no permanent, vision-threatening complications. Conclusions and importanceCAV can be safely combined with cataract surgery and glaucoma surgery, and it may be an effective intervention in eyes with CNAG and other risk factors for AM as a prophylactic measure against the development of AM.

Longitudinal study of retinal status using optical coherence tomography after acute onset endophthalmitis following cataract surgery

PurposeTo analyse the macula imaged with optical coherence tomography (OCT) in patients treated for acute postcataract endophthalmitis.MethodsPatients presenting with acute postcataract endophthalmitis were included in this observational and multicentre study...

Primary and Secondary Intraocular Lens Implantations in Children With Pediatric Cataract: Visual Acuity and Strabismus at the Age of 2 Years and Older.

To compare the visual outcomes of primary and secondary intraocular lens (IOL) implantations and to identify the risk factors for the development of strabismus in patients with pediatric cataract. The records of the pediatric patients who had undergone cataract surgery between January 1999 and November 2014 were reviewed retrospectively. The results of the cases with cataract extraction with primary IOL implantation (primary group) and cases with secondary IOL implantation (secondary group) were compared and the risk factors for the development of strabismus were investigated. This study included 220 eyes of 148 patients who had surgery for pediatric cataract. The mean age of the patients was 6.84 ± 3.45 years (range: 2 to 17 years) for the primary group at the time of cataract extraction and primary posterior chamber IOL implantation and 8.92 ± 5.12 years (range: 2 to 18 years) for the secondary group at the time of secondary IOL implantation (P = .118). Strabismus developed in 28 patients (23.73%) in the primary group and 9 patients (30%) in the secondary group (P = .702). At the last postoperative examination, Snellen visual acuity was 0.44 and 0.28 for the primary and secondary groups, respectively (P = .013). There was a negative relationship between visual acuity and the development of strabismus (P = .048), whereas there was a positive relationship between the follow-up period and the development of strabismus (P = .008). Optic rehabilitation of the pediatric cataract is an important factor in the development of strabismus. These cases should be monitored closely. [J Pediatr Ophthalmol Strabismus. 2017;54(2):97-102.].

Visual acuity and its predictors after surgery for bilateral cataracts in children.

PurposeThe objective of this study was to investigate preoperative factors associated with postoperative visual acuity outcomes and to develop a model to predict visual acuity prognosis.MethodsA retrospective study was conducted by reviewing clinical charts of pediatric patients who underwent bilateral cataract surgery by a single surgeon (MEW) at the Storm Eye Institute. A multiple logistic regression model was constructed to predict the odds of poor postoperative visual acuity, that is, worse than 20/40, based on age at surgery, gender, primary intraocular lens (IOL) placement, ethnicity, and preoperative nystagmus.ResultsA sample size of 157 children (314 eyes) was investigated with median duration of follow-up of 6.4 years. A total of 78% of children with bilateral cataract had postoperative visual acuity of 20/40 or better. The presence of preoperative nystagmus was highly correlated with poor postoperative visual acuity (OR=6.0; 95% CLs, 2.5-14.1; P-value<0.0001). Children of age <1 year at time of cataract extraction (OR=3.2; 95% CLs, 1.4-7.6; P-value=0.0073), male gender (OR=2.3; 95% CLs, 1.1-4.5; P-value=0.02), the absence of primary IOL placement (OR=3.0; 95% CLs, 1.05-8.4; P-value=0.04), and non-Caucasian ethnicity (OR=2.0; 95% CLs, 1.02-4.03; P-value 0.0447) were associated with poor visual acuity postoperatively.ConclusionsSatisfactory visual outcomes occurred in 78% of children operated on for bilateral cataracts. Preoperative nystagmus, age <1 year at time of cataract extraction, absence of primary IOL placement, male gender, and non-Caucasian ethnicity, were all factors associated with poor postoperative visual acuity.

The Effect of LASIK on Timing of Cataract Surgery.

To compare the age at the time of cataract surgery in patients who have undergone microkeratome-assisted LASIK versus individuals matched for axial length, cataract grade, and visual acuity with no history of refractive surgery. Retrospective chart review of patients who underwent cataract extraction between September 2013 and March 2015 at the Bascom Palmer Eye Institute. Patients had a history of either microkeratome-assisted LASIK or no prior ocular surgery. Corrected distance visual acuity (CDVA) before and after cataract extraction, uncorrected distance visual acuity (UDVA) before cataract extraction, gender, axial length, and cataract grade were assessed, along with age at the time of LASIK, age at the time of cataract extraction, and the time lapse between LASIK and cataract extraction. Fifty eyes of 38 patients were included in the LASIK group and 155 eyes of 136 patients were included in the control group. There was no significant difference between these groups with respect to gender (P = .87), CDVA before cataract extraction (P = .11), UDVA before cataract extraction (P = .09), axial length (P = .67), and cataract grade (P = .46). Mean age at the time of cataract extraction for patients in the LASIK group and control group were 64 ± 7 and 73 ± 8 years, respectively (P < .005). Negative correlations were found between age at time of cataract extraction and axial length in the LASIK and control groups (r = -0.18, P = .20 vs r = -0.36, P =. 01, respectively). Microkeratome-assisted LASIK seems to be correlated with earlier cataract extraction. Patients with a history of microkeratome-assisted LASIK under-went cataract surgery a decade sooner than patients with similar demographic and ocular characteristics. [J Refract Surg. 2016;32(5):306-310.].

Safety of Simultaneous Bilateral Intraocular Surgery Under General Anesthesia in Pediatric Patients.

Objective:To evaluate the risks and benefits of simultaneous bilateral intraocular surgery (SBIS) in pediatric patients at a university hospital in the Kingdom of Saudi Arabia, who are placed under general anesthesia for the procedure.Methods:This retrospective, noncomparative case study comprised 15 children, who underwent bilateral cataract surgery and/or primary or secondary intraocular lens (IOL) implantation in one sitting between November 2008 and July 2014. Seven patients had bilateral lensectomy primary posterior capsulotomy and anterior vitrectomy, and the remaining eight patients had bilateral IOL implantation at the capsular bag either primarily IOL implantation (two cases) at the time of cataract extraction or secondary IOL implantation at the capsular bag (six cases). Bilateral surgeries were performed sequentially by the same surgeon, with strict aseptic separation of the two surgeries, while the patient was under general anesthesia.Results:The age of the patients at the time of the surgery ranged from 7 months to 9 years (mean age 2.13 years). The patients were followed up approximately for 4 months postsurgery. There were no catastrophic complications from the anesthesia (death, asphyxia, cardiac or respiratory arrest, or seizures) nor were there any intraoperative complications that necessitated cancelation of surgery in the second eye. Postoperatively, one patient was noted to have reproliferation of lens material in one eye. However, no serious postoperative complications such as endophthalmitis, aphakic glaucoma, and hyphema were noted.Conclusion:SBIS conducted during the same operative procedure is an alternative to sequential surgery in selected pediatric patients if operative guidelines and surgical asepsis are strictly followed.

Treatment of pseudophakic posterior capsular opacification in children with secondary capsulotomy

To study preservation of the posterior capsule at the time of cataract extraction and IOL implantation with subsequent Nd:YAG capsulotomy or pars plana vitrectomy with capsulotomy (PPV/C) for treatment of posterior capsular opacification (PCO) in young children.

Evidence Based Medicine: Why should we be practicing it all the time?

Evidence Based Medicine: Why should we be practicing it all the time?

Recurrent Primary Acquired Melanosis With Atypia Involving a Clear Corneal Phacoemulsification Wound

To report a case of corneal primary acquired melanosis (PAM) with atypia after cataract surgery. Retrospective case report with literature review. Excision of an elevated pigmented conjunctival lesion was performed at the time of cataract extraction by clear corneal phacoemulsification by an outside surgeon. Histopathologic examination revealed PAM with atypia. Three months after the initial surgery, recurrent melanosis involving the peripheral corneal epithelium was noted, with extension of pigment into the corneal stroma through the paracentesis site. Excision of the involved corneal epithelium and the adjacent conjunctiva was performed, and microscopically recurrent PAM with atypia was confirmed. Adjuvant cryotherapy was applied at the time of surgery, and topical mitomycin C was given postoperatively. Repeat biopsies revealed no remaining malignancy, and the intrastromal pigment has disappeared during 18 months of follow-up. We present this case to illustrate the importance of complete evaluation and treatment of potentially atypical melanocytic conjunctival lesions before proceeding with elective intraocular surgery.

New Technologies for Treating Glaucoma in Patients Undergoing Cataract Surgery

New surgical technologies, such as the ExPRESS™ shunt, iCath™ canaloplasty, Trabectome™ and endoscopic cyclophotocoagulation (ECP), have been developed to provide safe and effective control of intraocular pressure (IOP) while avoiding many of the complications associated with trabeculectomies or traditional glaucoma drainage implants. A benefit of some of the newer technologies, especially for patients for whom traditional glaucoma surgeries may not previously have been considered, is that they can be readily performed at the time of cataract extraction. Many surgeons are combining these new surgical techniques with cataract surgery because of the low rate of serious complications, limited manipulation of ocular tissue (especially the conjunctiva) and/or faster visual recovery than traditional glaucoma surgeries.

Directed Therapy: An Approach to the Improved Treatment of Exfoliation syndrome.

Exfoliation syndrome (XFS) is an age-related, generalized disorder of the extracellular matrix characterized by the production and progressive accumulation of a fibrillar extracellular material in many ocular tissues and is the most common identifiable cause of open-angle glaucoma worldwide. Exfoliation syndrome plays an etiologic role in open-angle glaucoma, angle-closure glaucoma, cataract, and retinal vein occlusion. It is accompanied by an increase in serious complications at the time of cataract extraction, such as zonular dialysis, capsular rupture, and vitreous loss. It is associated systemically with an increasing number of vascular disorders, hearing loss, and Alzheimer's disease. Exfoliation syndrome appears to be a disease of elastic tissue microfibrils. Directed therapy simply means devising specific treatments for specific diseases. There was little incentive to attempt to distinguish between various open-angle glaucomas if the treatments were essentially the same. However, this view also prevented the application of directed therapy in those instances in which such was available and applicable. Pilocarpine has multiple beneficial actions in eyes with XFS. Not only does it lower IOP, but by increasing aqueous outflow, it should enable the trabecular meshwork to clear more rapidly, and by limiting pupillary movement, should slow the progression of the disease. Theoretically, miotics should be the first line of treatment. Pilocarpine 2% q.h.s. can provide sufficient limitation of pupillary mobility without causing these side effects. In 2007, two common single nucleotide polymorphisms in the coding region of the lysyl oxidase-like 1 (LOXL1) gene located on chromosome 15 were specifically associated with XFS and XFG. LOXL1 is a member of the lysyl oxidase family of enzymes, which are essential for the formation, stabilization, maintenance, and remodelling of elastic fibers and prevent age-related loss of elasticity of tissues. LOXL1 protein is a major component of exfoliation deposits and appears to play a role in its accumulation and in concomitant elastotic processes in intra- and extraocular tissues of XFS patients. This discovery should open the way to new approaches and directions of therapy for this protean disorder.

Bilateral paediatric cataract surgery in the same session

To evaluate the results of bilateral paediatric cataract surgery in the same session with a focus on patient selection criteria, operative guidelines, and controversial issues. Departments of Ophthalmology, Inönü University Turgut Ozal Medical Center (Malatya) and Fatih University Hospital (Ankara, Turkey). This retrospective noncomparative case series comprised 39 children (78 eyes), who underwent bilateral cataract surgery and/or primary or secondary IOL implantation in one sitting. Ten patients had bilateral lensectomy-primary posterior capsulotomy-anterior vitrectomy, and the remaining 29 patients had bilateral IOL implantation either primarily (20 cases) at the time of cataract extraction or secondarily for aphakic correction (9 cases). Both eyes were treated as two separate but consecutive surgeries in the same session. Maximum possible care was taken to ensure surgical asepsis. Age at surgery ranged from 2 months to 17 years. Average follow-up was 12 months. No serious intraoperative or postoperative complications occurred leading to permanent vision loss. During the last follow-up, 91% of eyes tested had a visual acuity of 20/40 or better. Bilateral paediatric cataract surgery in one session may be a safe and useful approach alternative to sequential surgery in selected patients, if operative guidelines and surgical asepsis are strictly followed.

Removal of lens epithelial cells to delay anterior capsule–intraocular lens adherence

To test the theory that removing lens epithelial cells at the time of cataract extraction with intraocular lens (IOL) implantation or refractive lens exchange might decrease the rate at which the anterior capsule becomes adherent to the lens optic postoperatively, we performed the technique in approximately 200 eyes that were considered likely to require postoperative IOL exchange. In 4 eyes that had an IOL exchange procedure 6 to 12 weeks after the primary procedure, the anterior capsule was nonadherent or weakly adherent to the lens optic.

Pediatric cataract surgery in Nepal

Purpose: To describe the first pediatric cataract surgery case series report from Nepal. Setting: Tilganga Eye Center, Kathmandu, Nepal. Methods: This study comprised a consecutive series of 112 eyes of 85 children having cataract surgery with intraocular lens (IOL) implantation. General anesthesia of ketamine combined with peribulbar block was used in all patients. Patients' demographics, cataract type and presenting symptoms, surgical intervention, preoperative and postoperative visual acuities, and follow-up clinical examinations were recorded. Results: Seventy-three eyes (65.2%) of 53 patients had extracapsular cataract extraction with posterior capsulotomy, anterior vitrectomy, and posterior chamber IOL implantation (ECCE+PCAP+AV+PCIOL), and 39 eyes (34.8%) of 32 patients had cataract extraction and IOL implantation with an intact posterior capsule (ECCE+PCIOL). Of all patients, the mean age at surgery was 6.2 years ± 4.3 (SD). The median age in the ECCE+PCAP+AV+PCIOL group was 4.7 years and in the ECCE+PCIOL group, 11.0 years. The mean follow-up was 5.4 ± 5.3 months. The most common postoperative complication in the ECCE+PCIOL group was visual axis/posterior capsule opacification, which was seen in 18 eyes (46.2%) compared to 4 eyes (5.5%) in the ECCE+PCAP+AV+PCIOL group. Visual acuity improved with surgery in both groups. The leading cause of poor outcomes was deprivation amblyopia. There were no anesthesia-related complications. Conclusions: Implantation of an IOL at the time of cataract extraction under combined systemic ketamine and peribulbar lidocaine anesthesia appeared to be well tolerated and produced significant visual improvement in pediatric patients in Nepal. Primary posterior capsulotomy and AV helped prevent visual axis opacification without a significant increase in complications.

Effect of surgical technique on in vitro posterior capsule opacification

Purpose To compare the effect of different cataract extraction surgical techniques on residual lens epithelial cell (LEC) density and cell regrowth rates using an in vitro model of posterior capsule opacification (PCO). Setting Comparative Ophthalmology Research Laboratories, North Carolina State University, Raleigh, North Carolina, USA. Methods Lens capsule explants were prepared from freshly enucleated canine globes after extracapsular cataract extraction (ECCE), phacoemulsification, or phacoemulsification followed by capsule vacuuming. Initial cell density on the capsule and cell proliferation were determined by phase contrast microscopy. The effects of the surgical technique on time to confluent growth of the cells across the posterior lens capsule were determined. Results Residual cell density on the remaining anterior capsule immediately after lens removal was 31.6% ± 19.3%, 16.1% ± 8.9%, and 7.7% ± 5.7% in the ECCE, phacoemulsification, and phacoemulsification/capsule-vacuuming groups, respectively. Time to confluence (range 5.0 to 6.3 days) was not significantly different among the 3 groups when the lens capsules were cultured in serum-supplemented media. The confluence rate was significantly longer (by approximately 5 to 7 days) in the phacoemulsification/capsule-vacuuming group than in the other 2 groups when the capsules were cultured in serum-free media. Conclusions Phacoemulsification with and without anterior and equatorial capsular vacuuming led to less initial LEC density in the capsular bag than ECCE. However, because cell proliferation rates among the 3 groups were only marginally affected, near 100% removal of LEC at the time of cataract extraction may be necessary to prevent PCO.