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. 1998 Oct;82(10):1182–1188. doi: 10.1136/bjo.82.10.1182

Lens epithelial cell regression on the posterior capsule with different intraocular lens materials

E Hollick 1, D Spalton 1, P Ursell 1, M Pande 1
PMCID: PMC1722372  PMID: 9924308

Abstract

BACKGROUND/AIMS—Posterior capsular opacification (PCO) is caused by proliferation and migration of lens epithelial cells (LECs) across the posterior capsule and is the commonest cause of reduced vision after cataract surgery. The influence of intraocular lens (IOL) material on the process of LEC migration was studied.
METHODS—90 eyes underwent standardised extracapsular surgery, with capsulorhexis and "in the bag" IOL placement. They were randomised to receive a three piece 6 mm lens of PMMA, silicone, or polyacrylic (AcrySof, Alcon, Fort Worth, TX, USA). On days 7, 30, 90, 180, and years 1 and 2 high resolution digitised retroillumination images were taken of the posterior capsule. The presence of LECs was determined at 90 days and 2 years, and their progression or regression was established by serial examination of images.
RESULTS—LECs were seen in 93% of silicone and 97% of PMMA IOLs at 90 days, compared with 46% of polyacrylic (p<0.001). At year 2 LECs were present in all patients with silicone or PMMA lenses, whereas 62% of patients with polyacrylic IOLs had LECs (p<0.001). Of those patients with LECs at day 90 LEC regression occurred in 8% with silicone IOLs and 15% of PMMA cases, compared with 83% of patients with polyacrylic IOLs (p<0.0001).
CONCLUSION—The presence of LECs on the posterior capsule was considerably lower with polyacrylic than PMMA or silicone IOLs and LEC regression occurred more frequently. The lower incidence of LECs and the higher rate of regression may explain why PCO formation appears to be reduced with polyacrylic lenses. This has important clinical implications for the prevention of PCO.

 Keywords: lens; cell; implant; posterior capsular opacification

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Figure 1  .

Figure 1  

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Lens epithelial cell (LEC) progression with a PMMA lens photographed at 3 months, 6 months, and 2 years postoperatively. (A) Three months after surgery the capsulorhexis lies on the anterior implant surface. A fine LEC membrane is seen on the posterior surface containing acellular spaces. (B) At 6 months the LEC membrane is thicker. The acellular spaces are more noticeable and, in some areas, have started to fill in (arrow). (C) At 2 years postoperatively the membrane is thicker with Elschnig pearl formation. Outlines of some of the previously acellular areas can still be made out.

Figure 2  .

Figure 2  

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LEC regression with a PMMA lens photographed 3 months, 6 months, and 2 years postoperatively. (A) The capsulorhexis is eccentric, lying on the anterior surface of the implant inferiorly, but is retracted off the superior aspect implant to lie on the side of the posterior capsule, forming a dense band of fibrosis. (B) and (C) Minor areas of lens epithelial cell regression can be seen between 6 months and 2 years postoperatively (arrows).

Figure 3  .

Figure 3  

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LEC progression with a silicone lens photographed at 3 months, 6 months, and 2 years postoperatively. (A) Three months postoperatively, the capsulorhexis is eccentrically placed on the implant. (B) At 6 months it has retracted off most of the anterior surface of the implant except for a small area laterally (arrows) and set up the formation of dense fibrotic bands where it comes into contact with the posterior capsule (the haptics remain in the bag). (C) At 2 years an LEC membrane can be seen around the periphery although the visual axis remains clear.

Figure 4  .

Figure 4  

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LEC regression with a silicone lens photographed at 3 months, 6 months and 2 years. (A) Three months after surgery the capsulorhexis lies on the anterior surface of the implant superiorly (arrows) but has retracted off the implant elsewhere coming into contact with the posterior capsule and forming a dense fibrotic band. (B) Six months after surgery LEC infiltration is seen on the posterior capsule (arrow). (C) Two years after surgery there has been regression of the LECs in this area (arrow).

Figure 5  .

Figure 5  

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LEC regression with a polyacrylic lens photographed at 1, 3, and 6 months postoperatively. (A) One month after surgery the capsulorhexis is eccentrically placed on the anterior IOL surface. A fine reticular lens epithelial cell network can be seen on the posterior capsule (arrows). (B) Three months after surgery there has been marked regression of these LECs. (C) This LEC regression continues 6 months postoperatively (arrow). The patient failed to attend for further follow up at 2 years.    

Figure 6  .

Figure 6  

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LEC regression with a polyacrylic lens photographed at 1 month, 3 months, and 2 years. (A) The capsulorhexis is only in contact with the implant surface for a small area superiorly. LEC infiltration can be seen in the posterior capsule at 1 month. (B) At 3 months there has been a marked regression of LECs (arrow). (C) This area has regressed further at 2 years postoperatively (arrow).

Selected References

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