Dataset Information

Postoperative posterior capsular striae and the posterior capsular opacification in patients implanted with two types of intraocular lens material.

ABSTRACT:

Aim

To evaluate the incidence of postoperative posterior capsular striae (PCS) and its influence on posterior capsular opacification (PCO) in patients implanted with two types of lens material.

Setting

Tertiary eye care center in central rural India.

Study design

A prospective, observational, nonrandomized study.

Materials and methods

The study included 1247 patients having age-related cataract scheduled for removal by phacoemulsification technique and implantation of hydrophilic or hydrophobic intraocular lens (IOL). Demographic profile, nuclear grading, axial length, and IOL power were noted. Details of PCS were noted on the 1st postoperative day in patients with clear cornea. Postoperative follow-up was ensured to study the status of PCS and development of PCO.

Results

The overall incidence of PCS was 19.8% (247 out of 1247 eyes). Out of 1247 patients, 641 patients (51.4%) had hydrophilic IOL implantation and 201 eyes had PCS (31.4%) and 606 patients (48.6%) had hydrophobic IOL implantation and 46 eyes had PCS (7.6%), P = 0.04. Three and more striae were seen in 119 eyes (119/641, 18.6%) in hydrophilic group and 4 eyes (4/606, 0.66%) in hydrophobic group. Sixty-two eyes (62/201, 30.9%) in hydrophilic group with multiple PCS were reported with persistent striae after 6 months of surgery. Two eyes in hydrophobic group had persistent striae even after 3 years of follow-up. Evaluation of PCO score of the hydrophilic group was 0.6 whereas of the hydrophobic group was 0.1 (P = 0.04). Ten patients of the hydrophilic group only required neodymium-doped yttrium aluminum garnet (ND: YAG) laser capsulotomy.

Conclusion

The incidence of PCS was higher in hydrophilic than hydrophobic IOLs. Multiple PCS persisting in patients beyond 6 months after operation should be followed up for early development of PCO, particularly in patients implanted with hydrophilic IOL.

SUBMITTER: Joshi RS

PROVIDER: S-EPMC5508456 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Publications

Postoperative posterior capsular striae and the posterior capsular opacification in patients implanted with two types of intraocular lens material.

Joshi Rajesh Subhash RS

Indian journal of ophthalmology 20170601 6

<h4>Aim</h4>To evaluate the incidence of postoperative posterior capsular striae (PCS) and its influence on posterior capsular opacification (PCO) in patients implanted with two types of lens material.<h4>Setting</h4>Tertiary eye care center in central rural India.<h4>Study design</h4>A prospective, observational, nonrandomized study.<h4>Materials and methods</h4>The study included 1247 patients having age-related cataract scheduled for removal by phacoemulsification technique and implantation o ...[more]

PMID: 28643710

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Project description:Cataract is the leading cause of visual impairment, and posterior capsular opacification (PCO) is the most common long-term complication of modern cataract surgery, which can cause severe visual impairment after surgery. The proliferation, migration, and epithelial-mesenchymal transition (EMT) of residual lens epithelial cells (LECs) stimulated by growth factors and cytokines, are the key pathological mechanisms involved in the development of PCO. This study demonstrated that non-steroidal anti-inflammatory drug (NSAID), bromfenac, was capable of effectively inhibiting cell migration, overexpression of EMT markers, such as fibronectin (FN), matrix metalloproteinase 2 (MMP2), α-smooth muscle actin (α-SMA), and transcription factor Snail, and extracellular signal-regulated kinase (ERK)/glycogen synthase kinase-3β (GSK-3β) signaling induced by transforming growth factor-β2 (TGF-β2) in vitro. The inhibitory effect of bromfenac on TGF-β2-induced EMT was also verified on a primary lens epithelial cell model using human anterior capsules. Furthermore, based on ultrasonic spray technology, we developed a drug-eluting intraocular lens (IOL) using poly (lactic-co-glycolic acid) (PLGA) with sustained bromfenac release ability for the prevention of PCO development. In the rabbit models of cataract surgery, bromfenac-eluting IOL exhibited remarkable PCO prevention and inflammation suppression effects with excellent biocompatibility. In conclusion, bromfenac can inhibit TGF-β2-induced cell migration and the EMT of LECs via ERK/GSK-3β/Snail signaling. The present study offers a novel approach for preventing PCO through PLGA-based drug sustained-release IOLs. Graphical abstract TGF-β2 promoted migration and EMT of lens epithelial cells (LECs) through activation of ERK/GSK-3β/Snail signaling, which could be suppressed by bromfenac. Novel bromfenac-based drug-eluting IOLs exhibited excellent PCO prevention in vivo.Image 1 Highlights • Bromfenac inhibited TGF-β2-induced migration and EMT of LECs through ERK/GSK-3β/Snail signaling.• Drug-eluting IOLs with sustained bromfenac release were developed based on ultrasonic spray technology.• Bromfenac-eluting IOLs exhibited remarkable PCO prevention and inflammation suppression effects in vivo.• Bromfenac-eluting IOLs hold great potential for clinical application of PCO prevention.

Project description:Fibrotic posterior capsular opacification (PCO), one of the major complications of cataract surgery, occurs when lens epithelial cells (LCs) left behind post cataract surgery (PCS) undergo epithelial to mesenchymal transition, migrate into the optical axis and produce opaque scar tissue. LCs left behind PCS robustly produce fibronectin, although its roles in fibrotic PCO are not known. In order to determine the function of fibronectin in PCO pathogenesis, we created mice lacking the fibronectin gene (FN conditional knock out -FNcKO) from the lens. While animals from this line have normal lenses, upon lens fiber cell removal which models cataract surgery, FNcKO LCs exhibit a greatly attenuated fibrotic response from 3 days PCS onward as assessed by a reduction in surgery-induced cell proliferation, and fibrotic extracellular matrix (ECM) production and deposition. This is correlated with less upregulation of Transforming Growth Factor β (TGFβ) and integrin signaling in FNcKO LCs PCS concomitant with sustained Bone Morphogenetic Protein (BMP) signaling and elevation of the epithelial cell marker E cadherin. Although the initial fibrotic response of FNcKO LCs was qualitatively normal at 48 h PCS as measured by the upregulation of fibrotic marker protein αSMA, RNA sequencing revealed that the fibrotic response was already quantitatively attenuated at this time, as measured by the upregulation of mRNAs encoding molecules that control, and are controlled by, TGFβ signaling, including many known markers of fibrosis. Most notably, gremlin-1, a known regulator of TGFβ superfamily signaling, was upregulated sharply in WT LCs PCS, while this response was attenuated in FNcKO LCs. As exogenous administration of either active TGFβ1 or gremlin-1 to FNcKO lens capsular bags rescued the attenuated fibrotic response of fibronectin null LCs PCS including the loss of SMAD2/3 phosphorylation, this suggests that fibronectin plays multifunctional roles in fibrotic PCO development.

Dataset Information

Postoperative posterior capsular striae and the posterior capsular opacification in patients implanted with two types of intraocular lens material.

Aim

Setting

Study design

Materials and methods

Results

Conclusion

Publications

Postoperative posterior capsular striae and the posterior capsular opacification in patients implanted with two types of intraocular lens material.

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