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Prevent epithelial cells from transforming, surgeon says
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LISBON, Portugal — To effectively contrast posterior capsular opacification formation, lens epithelial cells should not be “killed,” but rather prevented from transforming and differentiating, according to Marie-José Tassignon, MD.
Promising results in this direction have been obtained with her “lens in the bag” technique of IOL implantation, and she spoke about some of her successes here at the European Society of Cataract and Refractive Surgeons meeting. Both an anterior and posterior capsulorrhexis are performed, and a lens with a special all-round grooved haptic design is used to enclose the edges of both the anterior and posterior capsule.
“With this technique we have had a 0% complication rate needing YAG capsulotomy over a period of 5 years,” she said.
Images of a patient with 4 years of follow up showed a perfectly clear optic. Although a closer look showed some lens epithelial cell proliferation in the periphery, attendees could see that no cells penetrated into the capsular bag.
In order to exclude the influence of the lens material on these results, an experimental study was carried out with two IOLs produced by the same manufacturer with the same biomaterial but different designs, for lens-in-the-bag and bag-in-the-lens procedures. An additional group of patients with no lens implanted was also evaluated.
“While in the other groups there was a high rate of cell proliferation within the capsule, the same complication occurred only in two cases with the bag-in-the lens technique. In both cases this was due to the capsule not being properly captured between the lens haptics,” Dr. Tassignon said.
She concluded that the key to PCO prevention is in keeping the lens epithelial cells out of any contact that can stimulate their transformation, such as the capsular bag itself and the biomaterial of the lens, also creating a closed system in which there is no influence of the factors released by the stress of surgery and in the postoperative period.