Article | Published:

Posterior capsular opacification after cataract surgery

Subjects

Abstract

This is a review of the current status of clinical research on the prevention of posterior capsular opacification (PCO), which is now the commonest complication of cataract surgery occurring in up to 50% of patients by 2 to 3 years after the operation. PCO is caused by lens epithelial cells retained in the capsular bag following surgery which then proliferate, migrate and transform to myofibroblasts. Interest in the prevention of PCO has centred around surgical technique, pharmacological methods to remove or destroy lens epithelial cells and changes in intraocular lens material and design. Changes in surgical technique have little effect in prevention of PCO although a capsulorhexis size which lies on the optic diameter appears to be beneficial. Many different cytotoxic drugs and pharmacological agents have been used experimentally to prevent PCO but the problem has limited damage only to lens epithelial cells. So far, no method has been shown to be safe for clinical use. Current interest is centred once again on the intraocular lens itself, particularly the material that it is made from and changes in its edge profile.

Additional information

D.J.S. is a consultant to Alcon, USA and Medarex, USA on intraocular lens biocompatibility

References

  1. 1

    Apple DJ, Solomon KD, Tetz MR, Assia El, et al. Posterior capsular opacification. Surv Ophthalmol 1992;37:73–115.

  2. 2

    Schaumberg DA, Dana MR, Christen WG, Glynn RJ . A systematic overview of the incidence of posterior capsule opacification. Ophthalmology 1998;105:1213–21.

  3. 3

    Liu CS, Wormstone IM, Duncan G, et al. A study of human lens cell growth in vitro: a model for posterior capsule opacification. Invest Ophthalmol Vis Sci 1996;37:906–14.

  4. 4

    Kurusaka D, Kato K, Nagamoto T . Presence of alpha smooth muscle actin in lens epithelial cells of aphakic rabbit eyes. Br J Ophthalmol 1996;80:906–10.

  5. 5

    Tassignon M-J, De Groot V, Vervecken F, van Tenten Y . Secondary closure of posterior continuous curvilinear capsulorhexis in normal eyes and eyes at risk from postoperative inflammation. J Cataract Refract Surg 1998;24:1333–8.

  6. 6

    Steinberg EP, Javitt JC, Sharkey PD, et al. The content and cost of cataract surgery. Arch Ophthalmol 1993;111:1041–9.

  7. 7

    Pande MV, Ursell PG, Spalton DJ, et al. High resolution imaging of the posterior capsule after cataract surgery. J Cataract Refract Surg 1997;23:1521–7.

  8. 8

    Sparrow JM, Brown NAP, Shun-Shin GA, Bron AJ . The Oxford modular cataract image analysis system. Eye 1990;4:638–48.

  9. 9

    Khalifa MA . Polishing the posterior capsule after extracapsular extraction of the senile cataract. J Cataract Refract Surg 1992;18:170–3.

  10. 10

    Hollick EJ, Spalton DJ, Meacock WR . The effect of capsulorhexis size on posterior capsule opacification. Am J Ophthalmol 1999; (in press).

  11. 11

    Duncan G, Wormstone IM, Liu CS, et al. Thapsigargin coated intraocular lenses inhibit human lens cell growth. Nature Med 1997;3:1026–8.

  12. 12

    Tetz MR, Ries WR, Lucas MS, et al. Inhibition of posterior capsule opacification by an intraocular lens bound sustained drug delivery system: an experimental animal study and review of the literature. J Cataract Refract Surg 1996;22:1070–8.

  13. 13

    Nishi O, Nishi K, Yamada Y, Mizumoto M . Effect of indomethacin coated posterior chamber intraocular lenses on postoperative inflammation and posterior capsule opacification. J Cataract Refract Surg 1995;21:574–8.

  14. 14

    Clark DS, Munsell M, Emery J . Inhibition of posterior capsule opacification with an immunotoxin specific for lens epithelial cells: 24 month clinical results. J Cataract Refract Surg 1998;24:1621–5.

  15. 15

    Meacock WR, Spalton DJ, Hollick EJ . A double blind prospective ocular safety study of the use of an anti-lens epithelial cell antibody to prevent posterior capsule opacification. J Cataract Refract Surg (submitted).

  16. 16

    Pearlstein CS, Lane SS, Lindstrom RL . The incidence of secondary posterior capsulotomy in convex posterior vs convex anterior posterior chamber intraocular lenses. J Cataract Refract Surg 1988;14:578–80.

  17. 17

    Sterling S, Wood T . Effect of intraocular lens convexity on posterior capsular opacification. J Cataract Refract Surg 1986;12:655–7.

  18. 18

    Downing JE . Long term discission rate after placing posterior chamber lens with the convex surface posterior. J Cataract Refract Surg 1986;12:651–4.

  19. 19

    Ursell PG, Spalton DJ, Pande MV, et al. The relationship between intraocular lens biomaterials and posterior capsule opacification: a 2 year prospective randomised trial comparing PMMA, silicone and polyacrylic lenses. J Cataract Refract Surg 1998;24:352–60.

  20. 20

    Oshika T, Suzuki Y, Kizaki H, Yaguchi S . Two year study of a soft intraocular lens. J Cataract Refract Surg 1996;22:104–9.

  21. 21

    Hollick EJ, Spalton DJ, Ursell PG, et al. The effect of PMMA, silicone and polyacrylic lenses on posterior capsule opacification 3 years after surgery. Ophthalmology 1998;106:49–54.

  22. 22

    Ursell PG, Spalton DJ, Pande MV . Anterior capsule stability in eyes with intraocular lenses made of PMMA, silicone and AcrySof. J Cataract Refract Surg 1997;23:1532–8.

  23. 23

    Hollick EJ, Spalton DJ, Ursell PG, Pande MV . Lens epithelial cell regression on the posterior capsule with different intraocular lens materials. Br J Ophthalmol 1998;82:1182–8.

  24. 24

    Nagata T, Wantanabe I . Optic sharp edge or convexity: comparison of effects on posterior capsule opacification. Jpn J Ophthalmol 1996;40:397–403.

  25. 25

    Oshika T, Nagata T, Ishii Y . Adhesion of lens capsule to intraocular lenses of polymethylmethacrylate, silicone and acrylic foldable materials: an experimental study. Br J Ophthalmol 1998;82:549–53.

Download references

Author information

Correspondence to David J Spalton.

Rights and permissions

To obtain permission to re-use content from this article visit RightsLink.

About this article

Further reading