Síndrome de Uveitis - Glaucoma - Hifema: Caso clínico

Introducción: El síndrome de uveítis-glaucoma-hifema (UGH) es una complicación infrecuente de las cirugías de catarata, debido a un roce mecánico ejercido por una lente intraocular (LIO) sobre el iris. Caso clínico: Un varón de 64 años, con antecedente de cirugía de catarata, presenta disminución de la agudeza visual y dolor en el ojo derecho. En el examen oftalmológico, se evidenciaron signos de uveítis anterior, presión intraocular (PIO) elevada, microhifema y una LIO de una pieza plegable en sulcus que provocaba un roce mecánico con la cara posterior del iris. El tratamiento médico fue insuficiente, por lo que se realizó una cirugía de explante de LIO de una pieza plegable y se reemplazó por una LIO de tres piezas plegables. La evolución posoperatoria fue favorable. Conclusión: Se debe sospechar de esta complicación, en pacientes con antecedente de cirugía de catarata, especialmente en casos en los cuales la LIO es de una pieza y ha sido implantada fuera del saco capsular.

Introduction: Uveitis-glaucoma-hyphema syndrome (UGH) is a rare complication of cataract surgery, due to mechanical chafing exerted by an intraocular lens (IOL) on the iris. Clinical case: A 64-year-old man with a history of cataract surgery, who presented decreased visual acuity and pain in the right eye. The ophthalmological examination revealed signs of anterior uveitis, elevated intraocular pressure (IOP), microhyphema, and a single-piece foldable IOL in the sulcus that caused a mechanical chafing with the posterior face of the iris. The medical treatment was insufficient; for this reason, a folding simple-piece IOL explant surgery was performed and replaced by a three-piece IOL. Postoperative evolution was favorable. Conclusion: Should be suspected this complication in patients with a history of cataract surgery, especially in cases in which the IOL is in single-piece and has been implanted outside the capsular bag.

Síndrome de distensión de la bolsa capsular: del diagnóstico al tratamiento / Capsular bursa distension síndrome: from diagnosis to treatment

El síndrome de distensión de la bolsa capsular es una rara complicación de la cirugía de catarata. El objetivo principal fue exponer los principales hallazgos oftalmológicos de esta enfermedad, y las diferentes alternativas de diagnóstico y tratamiento para afrontar esta infrecuente y tardía complicación de la cirugía de catarata. Consiste en la adhesión del borde de la capsulorrexis al lente intraocular, colocado en un saco capsular. Tal aposición dificulta que el líquido fluya a través de la apertura de la cápsula anterior y se acumule en el saco capsular. Se presenta un paciente masculino de 71 años con antecedentes de cirugía de catarata por facoemulsificación en el ojo derecho. Refirió que desde hace 11 meses ha notado disminución de la visión. En el examen oftalmológico del ojo derecho se constató agudeza visual sin corrección de 0,3 por cartilla de Snellen, la cual mejoró a 1,0 con una corrección de -1,00 dioptría D. La exploración con lámpara de hendidura descartó cualquier tipo de inflamación del segmento anterior. Su presión intraocular fue de 18 mmHg. Mostró una cámara anterior poco profunda, con un desplazamiento anterior del iris y un saco capsular distendido. La cápsula posterior estaba separada de la superficie posterior del LIO con contenido líquido transparente. Se diagnosticó síndrome de distensión de la bolsa capsular. Se sometió a una capsulotomía posterior con láser Nd: YAG. En la evaluación posterior, el paciente mostró agudezas visuales no corregidas de 1,0 por cartilla de Snellen en ambos ojos. El síndrome de distensión de la bolsa capsular es una complicación tardía e infrecuente de cirugía de catarata con múltiples factores de riesgo, pero de rápida solución(AU)

Capsular bag distension syndrome is a rare complication of cataract surgery. The main objective was to expose the main ophthalmological findings of this disease and the different diagnostic and treatment alternatives to deal with this infrequent and late complication of cataract surgery. It consists of adhesion of the capsulorhexis rim to the intraocular lens, placed in a capsular bag. Such apposition makes it difficult for fluid to flow through the anterior capsule opening and accumulate in the capsular sac. We present a 71-year-old male patient with a history of cataract surgery by phacoemulsification in the right eye who 11 months ago reported decreased vision in the same eye. The ophthalmologic examination of the right eye showed an uncorrected visual acuity of 0.3 by Snellen chart, which improved to 1.0 with a correction of -1.00 D diopter. Slit lamp examination ruled out any type of anterior segment inflammation. His intraocular pressure was 18 mmHg. She showed a shallow anterior chamber, with an anterior displacement of the iris and a distended capsular sac. The posterior capsule was separated from the posterior surface of the IOL with clear fluid content. Capsular bag distension syndrome was diagnosed. He underwent posterior capsulotomy with Nd: YAG laser. On further evaluation, the patient had uncorrected visual acuities of 1.0 by Snellen chart in both eyes. Capsular bag distension syndrome is a late and infrequent complication of cataract surgery with multiple risk factors, but with rapid resolution(AU)

Inhibition of lens epithelial cell migration using different square-edge intraocular lenses in an in vitro capsular bag model / 中华实验眼科杂志

Objective:To establish an in vitro capsular bag model and compare the inhibitory effects of different 360° square-edge intraocular lens (IOL) on lens epithelial cells (LECs) migration. Methods:In vitro capsular bag model with posterior capsule opacification (PCO) was established using Transwell compartment, cell climbing slices, human collagen type Ⅳ, and IOL.The models were divided into Plate-loop HydroSmart group, C-loop HydroSmart group, and C-compensation-loop Hydrophobic group according to the different square-edge IOL implanted.A blank control group was set using the Transwell compartment without IOL.The early PCO pathological manifestations in lens epithelial cell line SRA01/04 cultured in the Transwell compartment were observed with an inverted microscope.The cell morphology in different groups was observed by hematoxylin and eosin staining.The cell counting and cell migration inhibition rate of anterior capsule and posterior capsule were calculated by Transwell assay and cell-exclusion zone assay, respectively. Results:The early pathological characteristics of PCO, such as early Soemmering ring and small Elschnig pearl, could be found in cells in the in vitro capsular bag model after 48-hour culture.The migrating cells in model groups were fibrous.No changes mentioned above were found in blank control group.The number of migrating cells in the anterior capsule of Plate-loop HydroSmart group, C-loop HydroSmart group, C-compensation-loop Hydrophobic group was 18.80±5.53, 24.67±9.80, and 34.47±10.80, respectively, and the number of migrating cells in the optical area of the posterior capsule of the three groups was 56.43±9.00, 162.20±16.38, and 121.30±12.01, respectively.The cell migration inhibition rate in the anterior capsule of Plate-loop HydroSmart group, C-loop HydroSmart group, C-compensation-loop Hydrophobic group was (92.02±1.94)%, (89.76±3.10)%, (86.27±4.54)%, respectively, and the cell migration inhibition rate in optical area of the posterior capsule of the three groups was (91.60±3.65)%, (70.14±5.35)%, (78.43±3.48)%, respectively.The number of migrating cells in the anterior capsule was lower and the cell migration rate inhibition was higher in Plate-loop HydroSmart group than C-compensation-loop Hydrophobic group, with significant differences (both at P<0.05). The number of migrating cells in the optical area of the posterior capsule and the cell migration inhibition rate was greater than those of C-loop HydroSmart group and C-compensation-loop Hydrophobic group, showing statistically significant differences (all at P<0.001). Conclusions:The in vitro capsular bag model can be used in PCO research.Compared with C-loop HydroSmart IOL and C-compensation-loop Hydrophobic IOL, Plate-loop HydroSmart IOL can more effectively inhibit the migration of LECs to the optical area of the posterior capsule.

25G PPV combined with IOL ciliary sulcus suture, fixation and replacement in the treatment of IOL capsule bag complex dislocation in the vitreous cavity / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the clinical effect of 25G pars plana vitrectomy(PPV)combined with intraocular lens(IOL)ciliary sulcus suture fixation and replacement of IOL capsular bag complex.<p>METHODS: A retrospective analysis of 21 patients(21 eyes)in our hospital who applied 25G PPV combined with IOL ciliary sulcus suture and fixation replacement in our hospital from January 2015 to January 2020 to treat the IOL capsular complex completely detached from the clinical data.<p>RESULTS: All the cases were successfully removed the dislocated IOL complex during the operation. There was no iatrogenic retinal damage. During the operation, 4 cases(4 eyes)were found to have the retina hole, 2 cases(2 eyes)were found to be retinal lattice degeneration area, which were treated with laser photocoagulation of the retina. Follow-up for 6-18mo, best corrected visual acuity(BCVA)(LogMAR)increased from 0.40±0.30 before operation to 0.33±0.25 after operation(<i>P</i>=0.040). The BCVA at the last follow-up of all cases reached the BCVA before surgery. The absolute value of the difference between the postoperative spherical equivalent power and the preoperative IOL refractive power prediction value is less than or equal to 0.75D. At the last follow-up, the position of the intraocular lenses in all cases was good, and there were no complications such as retinal detachment. <p>CONCLUSION: The technique of 25G PPV and the exchange of IOL ciliary sulcus fixation with intraocular IOL capsule complex is a safe and effective procedure for dislocation of IOL-capsular bag complex entirely into the vitreous cavity.

In-the-bag dislocation of polyfocal full-optics accommodative intraocular lens: A case report

Herein, we report a case of in-the-bag dislocation of a WIOL-CF® polyfocal full-optics intraocular lens (IOL), without a history of trauma. A 56-year-old man was referred to our hospital with the chief complaint of sudden-onset visual disturbance in his left eye. He had undergone uneventful phacoemulsification with WIOL-CF® IOL implantation in the left eye at the local clinic 7 years prior. In fundus examination, IOL-capsular bag complex dislocated into the posterior vitreous was observed. We believe this is the first report of in-the-bag dislocation of a WIOL-CF® IOL that has been subluxated or dislocated in a characteristic pattern, not an in-the-bag pattern.

Management of late-onset flocculent after-cataract with capsular bag lavage and posterior continuous curvilinear capsulorhexis

We describe our technique for the management of late-onset liquefied after-cataract (LAC) to ensure long-term visual axis clarity. The densely adherent anterior capsular rim over the intraocular lens (IOL) optic was released with the help of microvitreoretinal blade, and multiple relaxing radial incisions were made on the capsular rim to facilitate easy access to the capsular bag. A thorough capsular bag lavage was performed with the help of bimanual irrigation-aspiration. Posterior continuous curvilinear capsulorhexis (PCCC) was performed after complete aspiration of fluid after-cataract to prevent recurrence. This technique was successfully performed in 14 cases. Postoperatively, IOL was stable and an uncorrected distance visual acuity of >20/32 was achieved in all cases. No recurrence was observed in any case over a follow-up of 1 year. Our technique of capsular bag lavage with PCCC is safe and effective for the management of LAC with optimal visual and anatomical outcomes.

Observation of artificial lens implantation suture fixation into capsular bag when cataract suspensory ligament rupture without capsular tension ring / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring(CTR).METHODS:We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens (IOL) implantation fixation in our department from Jan.2012 to Dec.2016.The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera.Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the Z type suture, or to the beforehand prepared triangle scleral flap.The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations.RESULTS:All of the postoperative visual acuity improved different level.The postoperative best corrected visual acuity(BCVA) was ≥0.8 in 4 eyes(20%), 0.5-0.6 in 7 eyes(35%), 0.3-0.4 in 8 eyes(40%), 0.1 in 1 eye(5%) because of the glaucoma optic atrophy.There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment.There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved.Followed up for 6mo, displaced stitches or artificial lens shift did not occur.CONCLUSION:Without CTR, the IOL implantation and suture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.

Clinical observation of one transscleral sutured fixation intraocular lens implanted in the capsular treating traumatic lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the safety and efficacy of one transscleral sutured fixation intraocular lens implanted in the capsular treating traumatic lens dislocation. METHODS: Twelve eyes with lens subluxation from 12 patients during Mar. 2013 to Mar. 2015 were reviewed. The stopping and chopping method combined with manual nuclear extraction was performed in extent of lens subluxation less than 1/2 quadrant and transscleral sutured fixation intraocular lens implanted in the capsular. Visual acuity, best - corrected visual acuity, intraocular pressure, corneal endothelial cell count and the position of IOL were observed and recorded. RESULTS: All the surgeries were performed successfully. Patients were followed up for 6 - 12mo. During the follow-up period, the number of eyes for BCVA ≥0. 8, 0. 4 - 0. 6 and ≤0. 3 was 2, 7 and 3, respectively. It meant 66. 67% of the eyes showed BCVA in 0. 5-0. 6. Intraocular pressure and the position of all intraocular lens were normal. Effects of operation on corneal endothelial cells were slight. No complications took place in and after surgery. CONCLUSION: Without implanting capsular tension ring ( CTR ) , we successfully use the intraocular lens ( IOL) single loop suture fixation in the capsular bag for the treatment of the patient with traumatic lens dislocation. It indicates that the pressure and place shift from the use of IOL avoided by this method without implantation of CTR. This method is safe and effective for the treatment of eyes with traumatic lens dislocation.

Applications of capsular bag model in posterior capsular opacification / 中华实验眼科杂志

Posterior capsular opacification (PCO),also known as after-cataract,is the most frequent complication and the primary cause for visual decrease after extracapsular cataract surgery.At present,there is no effective way to treat PCO,so more attentions are focused on preventive reseaching of PCO and treatment methods.Although a variety of studies have increased our understanding of the pathogenesis of PCO,the cellular mechanisms responsible for PCO are still unclear.Cultured capsular bag model in vitro could effectively simulate lens capsular membrane and cells survival environment after cataract extraction and IOL implantation.However,lens capsular bag cultivation with different methods have their own characreristics.The material source,preparation methods of capsular bag model,characreristics of materials which maintain capsular bag contours and its application in PCO were reviewed.

Clinical outcomes and safety of intra-capsular bag soft-shell technique during phacoemulsification for hard nuclear cataract / 中华实验眼科杂志

Background Phacoemulsification for hard nuclear cataract is easy to cause corneal edema and posterior capsular rupture.Researches determined that soft-shell technique phacoemulsification can effectively reduce corneal edema,but the risk of posterior capsular rupture during the surgery is still existed.Whether intra-capsular bag soft-shell technique can protect the posterior capsular of lens from rupture is still unclear.Objective This study was to observe the effect of intra-capsular bag soft-shell technique phacoemulsification on hard nuclear cataract.Methods A prospective cohort study was designed.One hundred and sixty-eight eyes of 160 patients with age-related cataract and Ⅳ-Ⅴ grade of nucleus were enrolled in Affiliated Second Hospital of Zhengzhou University from November 2013 to May 2015 under the approval of Ethic Commission and informed consent of the patients.The eyes were randomized into the intra-capsular soft-shell technique group and conventional soft-shell technique group with the matched age,gender and nuclear hardness in a manner of randomized block design.A 3.0 mm incision of cataract phacoemulsification with soft-shell technique in capsular bag was performed on 80 eyes of 78 patients in the intracapsular soft-shell technique group,and conventional soft-shell technique phacoemulsification was performed on 88 eyes of 82 patients in the conventional soft-shell technique group.Intraoperative records including the cumulative dissipated energy,effective phacoemulsification time and posterior capsular changes were recorded during the surgery.Postoperative follow-up indexes included corneal edema,endothelial cell density,BCVA and intraocular pressure changes.Results The mean cumulative dissipated energy and operation duration were (20.13 ± 8.34) ％ and (14.28-±2.17) minutes in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were (19.67±5.24)％ and (15.36±3.49) minutes,showing significant differences between them (t =0.216,P =0.376;t =0.403,P-=0.518).Posterior capsular rupture occurred in 1 eye in the intra-capsular softshell technique group and 7 eyes in the conventional soft-shell technique group.The percentages of eyes with BCVA ≥ 0.5 were 78％,83％ and 92％ in postoperative 1 day,1 week and 1 month in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were 56％,71％ and 89％,with a significant increase in postoperative 1 day,1 week in the intra-capsular soft-shell technique group (x2 =5.130,P =0.027;x2 =4.361,P =0.032).The corneal endothelial cell loss rates were 6.97％ and 7.19％ in the intra-capsular soft-shell technique group and conventional soft-shell technique group respectively in postoperative 3 months,with no significant difference between them (P＞0.05).The intraocular pressure was (20.16±4.23) mmHg (1 mmHg =0.133 kPa) in postoperative 1 day in the intra-capsular soft-shell technique group,which was significantly higher than (17.38± 5.21) mmHg in the conventional soft-shell technique group (t =1.241,P =0.037).Conclusions Intra-capsular bag soft-shell technique phacoemulsification for hard nuclear cataract can decrease the intraoperative and postoperative complications and quicken the visual recovery after surgery.

Anterior dislocation of an empty capsular bag in a pseudophakic eye: A rare case report.

Spontaneous intraocular lens (IOL) dislocation is uncommon in the absence of any ocular areas with zonular weakness or trauma. There have been no reports of spontaneous capsular bag dislocation into the anterior chamber without an IOL. We report a rare, interesting case of spontaneous capsular bag anterior dislocation, without an IOL, into the anterior chamber with no history of genetic disease, ocular trauma, or pseudoexfoliation that might predispose to a zonular abnormality.

Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation.

We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fi xed to the pars plana at both 3 and 9 o’clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and eff ective surgical option for such cases.

Liquefied after cataract and its surgical treatment.

Aims: To describe liquefi ed after cataract (LAC) and its surgical management following an uneventful phacoemulsifi cation with posterior chamber in-the-bag intraocular lens (IOL) implantation and continuous curvilinear capsulorrhexis (CCC). Design: Interventional case series. Materials and Methods: Eleven patients with LAC, following uneventful phacoemulsifi cation with CCC and in-the-bag IOL implantation were enrolled. After the basic slit lamp examination, each case was investigated with Scheimpfl ug photography and ultrasound biomicroscopy (UBM). Each case was treated with capsular lavage. Biochemical composition of the milky fl uid was evaluated and ring of anterior capsular opacity (ACO) was examined under electron microscope. Results: All 11 cases presented with blurring of vision after 6-8 years of cataract surgery with IOL implantation. All cases had IOL microvacuoles, 360° anterior capsule, and anterior IOL surface touch along with ACO, ring of Soemmering, and posterior capsule distension fi lled with opalescent milky fl uid with whitish fl oppy or crystalline deposits. Biochemically, the milky fl uid contained protein (800 mg/dl), albumin (100 mg/dl), sugar (105 mg/dl), and calcium (0.13%) and was bacteriologically sterile. Histologically, the dissected ACO showed fi brous tissue. All cases were successfully treated with capsular lavage with good visual recovery and with no complication. There was no recurrence of LAC during 2 years postoperative follow-up in any of the cases. Conclusions: LAC is a late complication of standard cataract surgery. It may be a spectrum of capsular bag distension syndrome (CBDS) without shallow anterior chamber and secondary glaucoma. Capsular bag lavage is a simple and eff ective treatment for LAC and a safe alternative to neodymium-doped y􀄴 rium aluminum garnet (Nd-YAG) capsulotomy.

Early Capsular Block Syndrome after Phacoemulsification with Posterior Chamber IOL Insertion Combined with Vitrectomy

PURPOSE: To report early capsular block syndrome (CBS) after phacoemulsification with posterior chamber intraocular lens (IOL) insertion combined with vitrectomy. METHODS: Medical records of 622 eyes of 589 patients who had combined phacoemulsification, IOL implantation and vitrectomy between March 2009 and December 2011 were retrospectively reviewed. Among patients with CBS occurring within 1 month of surgery, the patient's baseline characteristics, type of IOL and ophthalmic viscoelastic devices were analyzed. RESULTS: Nine patients (1.45%) developed CBS with typical capsular bag distension. All CBS occurred within 2 weeks after the surgery. Hydrophilic, large optics and no angulation between optic and haptic were related with the occurrence of CBS. Nd:YAG laser capsulotomy (5 eyes), and surgical capsulectomy (2 eyes) resolved CBS successfully. In 2 eyes with gas tamponade, CBS resolved without intervention with the absorption of gas. CONCLUSIONS: CBS may develop after phacoemulsification with PC IOL insertion combined with vitrectomy and/or vitreous tamponade. Hydrophilic material, large optics and no angulation were risk factors of capsular block by enhancing adhesion between the capsulorrhexis and the optic.

Inhibitory effect of propylene glycol mannate sulfate on growth of rabbit lens epithelial cells in vitro / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the inhibitory effect of rabbit lens epithelial cell(RLEC)survival and growth by propylene glycol mannate sulfate(PGMS)on the rabbit capsular bag in vitro.METHODS;Capsular bags were prepared from rabbit eyes after extracapsular cataract extraction(ECCE)and incubated in 0.2,0.4,0.8g/L PGMS in 2,5,10 minutes incubation periods.After treatment,the capsular bags were cultured for 7 days in Dulbecco minimum essential medium(DMEM)supplemented with 50mL/L fetal calf serum(FCS).The specimens were examined with light microscopy and transmission electron microscopy(TEM).Capsular bags without receiving PGMS only served as controls.RESULTS:PGMS inhibited the proliferation of RLEC in the manner of concentration and time dependentment.At the threshold protocol of incubation in PGMS at 0.8g/L for 5 or 10 minutes,proliferative activity of cells were largely arrested and nearly no RLEC was seen on the posterior capsule(P＜0.05).Control group had no effect on structure and proliferative activity of RLEC,and the growth proceeded rapidly so that the posterior capsule were totally covered by a confluent monolayer of cell by the end of 7 days.Under TEM,the cells in the control group were tightly arrayed with clearly defined cellular boundary and structure;while cellular deformity and undefined intracellular structure could be seen in the 0.4g/L and 0.8g/L experimental groups.CONCLUSION:PGMS can effectively inhibit the proliferation of RLEC.

Inhibitory Effects of Paclitaxel and Cisplatin on Transdifferentiation of Lens Epithelial Cells into Fibroblast

PURPOSE: This study investigated the inhibitory effects of Paclitaxel by altering tubulin assembly and cisplatin exposure by binding DNA of the lens epithelial cells (LECs) during epithelial cell cultures in the capsular bag model. METHODS: In the capsular bag model, the LECs were cultured with exposure to Paclitaxel (1, 10, 100 nM) and Cisplatin (1, 10, 100 micro M) for 3 min. The effect of Paclitaxel and Cisplatin was analyzed by observing the cell number of fibroblasts per field, Western blots for type IV collagen, TUNEL assay and the Proliferating Cell Nuclear Antigen (PCNA) and Bromodeoxyuridine (BrdU) incorporated proliferating cells. RESULTS: An increase in concentration of Paclitaxel and Cisplatin resulted in a decrease in the number of fibroblasts and spindle-shaped cells. The number of proliferating cells showing PCNA positivity and BrdU incorporation in the nuclei was decreased in a dose dependent manner by treatments of Paclitaxel and Cisplatin. Expression of type IV collagen also decreased after treatment with these two agents. Results of the TUNEL assay showed no change in the apoptosis of cells with regard to an increase in concentration of Paclitaxel and Cisplatin. CONCLUSIONS: This study showed inhibitory effects of Paclitaxel and Cisplatin on the proliferation and transdifferentiation of LECs into fibroblasts using the capsular bag model.

New Model of Capsule Measuring Ring: The Possibility to Predict the Capsular Bag Diameter

PURPOSE: This study evaluates the capsular bag diameter (CBD) with a capsular tension ring (CTR) following cataract surgery and analyzes the predictive factors correlated with capsular bag size to predict CBD preoperatively. METHODS: We inserted the CTR before intraocular lens (IOLs) implantation in 25 eyes undergoing cataract surgery. The axial length (AL), anterior chamber depth (ACD), and lens thickness were measured and keratometry and corneal size were checked preoperatively. Also, the continuous curvilinear capsulorhexis size was measured at 7 days postoperative, and CBD was calculated with CTR in a dilated state at 1day, 1week, 1 month, and 2 months postoperative. RESULTS: The mean CBD gradually decreased from 11.30+/-1.76 mm at 1 day, 10.86+/-1.06 mm at 1 week, 10.23+/-1.43 mm at 1 month, and 9.88+/-1.31 mm at 2 months. The AL (R=0.657), ACD (R=0.481), and corneal size (R=0.348) had a positive correlation with CBD at 1 week postoperative. The AL (P=0.000) and ACD (p=0.015) were statistically significant predictive factors for CBD. CONCLUSIONS: Calculating CBD with the CTR helps to improve visual acuity following cataract surgery after implantation of IOLs having appropriate sizes predicted with AL, ACD, and corneal size.

Inhibitory Effects of Imatinib Mesylate on Transdifferentiation of Lens Epithelial Cells into Fibroblast

PURPOSE: To investigate whether Imatinib mesylate (IM) could inhibit the transdifferentiation of the lens epithelial cells (LECs) into fibroblasts using the capsular bag model. METHODS: In the capsular bag model, LECs were cultured by exposure to IM at various concentrations for 3 min. The effect of IM was analysed by observing the covering area, numbers of alpha-SMA positive cell, and BrdU incorporated proliferating cells. The same analysis was performed in the culture of LECs with TGF-beta. RESULTS: The covering area was significantly decreased by the treatment of 30 micro M IM, and the positive cells for alpha-SMA and BrdU were also decreased by IM treatment in a dose dependent manner. In addition, increasing TGF-beta concentration accelerated transdifferentiation, but suppressed the acceleration of the transdifferentiation induced by TGF-beta. CONCLUSIONS: In the capsular bag model, IM effectively inhibited not only the transdifferentiation of LECs into fibroblasts but also the TGF-beta induced acceleration of the transdifferentiation.

Differentiation and Transdifferentiation of Lens Epithelial Cells in Capsular Bag Model Culture

PURPOSE: To investigate the differentiation of lens epithelial cells (LECs) to lens fiber, and the transdifferentiation of LECs to fibroblast in capsular bag culture. METHODS: After observing the changes of LECs by using phase-contrast microscopy, we observed a cross section of capsular bag by using light microscope (LM) and electron microscope (EM). In addition, the expressions of alpha A-crystallin, a marker of differentiation of LEC to lens fiber, and of alpha-smooth muscle actin, a marker of LEC to fibroblast, were examined during the culture period by western blot. RESULTS: On phase-contrast microscopy, 7 to 14 days after culture, the portion of LECs was gradually elongated and cytoplasm became transparent, so that the differentiation resembled lens fiber. One to 7 days after culture, the portion of LECs changed to spindle shape and the transdifferentiation resembled fibroblast. LM and EM observations indicated that changes of each LEC were lens fiber, and fibroblast. According to Western blot, the expression of alpha A-crystallin was increased by 10 days after culture. The alpha-smooth muscle actin showed an increased expression 10 to 30 days after culture. CONCLUSIONS: From the capsular bag model, we observed the resemblances of the differentiation and transdifferentiation of LECs with lens fiber and fibroblast.

Inhibitory Effects of Mitomycin-C and 5-Fluorouracil on the Proliferation of Lens Epithelial Cells using Capsular Bag Model

PURPOSE: We investigated the inhibitory effects of mitomycin-C (MMC) and 5-fluorouracil (5-FU) on the proliferation of the lens epithelial cells (LECs) depending on time and concentration during the epithelial cell culture using capsular bag model. METHODS: We cultured LECs using capsular bag model after exposure to various time and concentration of MMC and 5-FU. We compared the half coverage time and appearance of posterior capsule by LECs. We examined the proliferative and inhibitory effect on LECs using BrdU immune staining. We observed the morphologic change of LECs on histologic section. RESULTS: Half coverage time of posterior capsule by LEC was 18.2 +/- 3.5 days in control group, whereas 27.5 +/- 3.8 days and 26.8 +/- 4.2 days when treated with 0.2 mg/ml MMC, 50 mg/ml 5-FU for 3 minutes, repectively. The increase of concentration and the exposure time of MMC or 5-FU resulted in the delay of coverage time of posterior capsule by LECs and reduction of BrdU incorporation in the nucleus of proliferating cells. On histologic section, reduction of LECs' multilayering and few cytoplasmic organells were observed. CONCLUSIONS: Using capsular bag model, we found the inhibitory effect of MMC and 5-FU on LECs proliferation depending on the concentration and exposure time. Capsular bag model would be contribute to the study about after-cataract.