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The Prevention of Posterior Capsule Opacification - Am Multifactorial Problem

David J. Spalton
St. Thomas' Hospital, Dep. of Opththalmology, Lambeth Palace Road, London SE1 7EH


Posterior capsule opacification (PCO) results from the wound healing response of the lens epithelium to surgical injury. This can be studied in the laboratory using organ culture techniques and time lapse photography provides an elegant method for its study. Clinically posterior capsule opacification reflects the influence of a number of factors such as surgical technique, patient factors such as age and concurrent ocular disease and the intraocular lens design and material. We have developed a method for quantification of posterior capsule opacification using retoillumination photography with dedicated computer software. With this technology we have shown that there is less posterior capsule opacification if the capsulorhexis is smaller than overall diameter of the intraocular lens optic and lies on its anterior surface. Other factors of intraocular lens design which appear to be important are the overall size of the optic, (less PCO being seen with larger optic lenses) and the degree of compressibility of the haptics. If these are too rigid they produce folds in the capsule which act as tracks for future lens epithelial cell ingrowth . The most important intraocular lens factor, though, appears to be the edge profile and there is now good clinical and experimental evidence to show that a square inhibits lens epithelial cell ingrowth in comparison to round edge designs. We believe that this is due to changes in the pressure profile of the intraocular lens against the posterior capsule. A relatively poorly Understood factor is whether the intraocular lens material itself has an effect on posterior capsule opacification. We believe that this is so at least for some intraocular lens materials. PCO research though is rapidly advancing and there is every possibility that it will become a much less common problem in the next few years.


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