Safety of the bag-in-the-lens implantation regarding the development of clinically significant pseudophakic cystoid macular edema: A retrospective case series study.

PURPOSE: To determine the incidence of clinically significant pseudophakic cystoid macular edema (CSPME) after phacoemulsification using the 'bag-in-the-lens' lens (BIL) implantation technique and to examine the influence of associated risk factors for clinically significant pseudophakic macular edema (CSPME), both ocular and systemic. METHODS: This retrospective study included 2419 first-operated eyes of 2419 adults who underwent phacoemulsification cataract surgery using the BIL implantation technique between January 2013 and December 2018 in the Antwerp University Hospital, Belgium. The significance of several risk factors (age, gender, previous history, intra- and postoperative complications) was examined by extraction of electronic medical files. RESULTS: The 3-month incidence of CSPME in the subgroup without risk factors was 0.00% (95% CI: 0.00 -NA). The 3-month incidence of CSPME in the subgroup with risk factors was 0.57% (95% CI 0.22-1.29%). The 3-month incidence of CSPME in the total population of 2419 patients was 0.29% (95% CI: 0.11-0.65%). The risk factors most significantly associated with CSPME included renal insufficiency (hazard ration [HR]: 5.42; 95% CI: 1.69-17.44; P = .014), exudative age-related macular degeneration (HR: 74.50, 95% CI: 25.75-215.6; P < .001) and retinal vein occlusion (HR: 22.48, 95% CI: 4.55-111.02; P = .005). CONCLUSIONS: In the absence of risk factors, the incidence of CSPME was zero. We can conclude that Primary Posterior Continuous Curvilinear Capsulorhexis (PPCCC) does not increase the risk for CSPME. Non-inferiority of the BIL implantation regarding the development of CSPME, relative to the traditional 'lens-in-the-bag' (LIB) implantation, confirms that BIL is a safe surgical technique. This study also illustrates a previously undescribed risk factor for developing CSPME, namely renal insufficiency.

Iris pigment epithelial (IPE) cysts secondary to Hodgkin's lymphoma: A case report.

Purpose: To describe a unique case of a white male who presented with reduced visual acuity, growing bilateral iris pigment epithelial (IPE) cysts and granulomatous panuveitis, probably related to Hodgkin's lymphoma. Observations: The granulomatous panuveitis was reactive to corticosteroids, but the IPE cysts were not. After extensive work-up, the patient was diagnosed with Hodgkin's lymphoma (HL) mixed cellularity type with cervical and mediastinal lymph node involvement. After starting chemotherapy, the IPE cysts shrank. Conclusions and importance: To our knowledge, IPE cysts have not been described in HL before. Therefore, this case can contribute to our knowledge of the relation between IPE cysts and hematological malignancy.

Globe Fixation Caused by Intraocular Migration of an Orbital Floor Implant.

A 30-year-old male presented with diplopia 1 month after implantation of an orbital floor plate for a blowout fracture. The orbital plate was removed 3 months later, however, the fixation bar was left in place as it had migrated full thickness through the inferior oblique muscle, sclera, choroid, and retina. After 5 years of head tilt, the patient was referred to our department with a metallic intraocular foreign body visible in fundo and an important elevation deficit. CT imaging confirmed our clinical suspicion of a retained fixation bar. The extraocular part of the fixation bar was removed via a transconjunctival inferior orbitotomy, leaving the intraocular part in place due to the high risk of ocular complications upon removal. Postoperative ocular motility improved greatly and the patient no longer experiences diplopia in daily life. Orbital plate migration is a rare complication that should be considered in de novo diplopia after orbital reconstruction.

Anterior segment optical coherence tomography and ultrasound biomicroscopy for measuring thickness of corneal and bulbar conjunctival tumours.

BACKGROUND/OBJECTIVE: Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) are two non-invasive imaging techniques used for the measurement of tumour thickness in corneal and bulbar conjunctival tumours. Histopathology (HP), however, remains the gold standard for the measurement of tumour thickness. The aim of this study was to determine whether AS-OCT and UBM are as accurate as HP for measuring tumour thickness. METHODS: Forty-two corneal and bulbar conjunctival tumours were imaged using AS-OCT and UBM. Images were assessed and tumour thickness was measured. Eleven patients subsequently underwent surgical excision. All specimens were measured during histopathological analysis. The correlation of the thickness measurement on HP to AS-OCT and UBM was then statistically analysed. In cases where the tumour was not excised, thickness measurement comparisons between AS-OCT and UBM were analysed. RESULTS: AS-OCT and UBM measurements of tumour thickness were found to be significantly positively correlated (p=<0.001), as were UBM and HP thickness measurements (p=0.031). HP and AS-OCT measurements, however, only showed a mild but non-significant positive correlation. CONCLUSION: Both AS-OCT and UBM are useful techniques to image and measure the thickness of corneal and conjunctival bulbar tumours. While AS-OCT provides better details than UBM, it was more limited in visualising the posterior boundary of the tumour, particularly in malignant tumours. While thickness measurements of both methodologies were correlated, neither should yet be considered as replacements to the gold standard of HP.

Pterygium Pathology: A Prospective Case-Control Study on Tear Film Cytokine Levels.

Pterygium is a common eye disease, linked to an increased exposure to UV radiation and dry environments. The associated pathology culminates in visual impairment and, in some rare cases, blindness. However, there remains a lot of uncertainty concerning the pathogenesis of this fibrovascular lesion. As the composition of the tear film provides a reflection into the pathological changes at the ocular surface, tear analysis represents an ideal approach to gain insight in the progression of disease following pterygiectomy. This study enrolled 19 patients and age/gender-matched healthy controls. Tear film levels of interleukin- (IL-) 6, IL-8, and vascular endothelial growth factor (VEGF) were investigated over time, and preoperative concentrations were linked to corneal neovascularization and pterygium size. Diminished tear film levels were found in unilateral patients who show no clinical signs of pterygium recurrence over a period of one year. Hence, our results highlight the potential of using the course of IL-6, IL-8, and VEGF levels in tears as biomarkers for recovery. In addition, when focusing on the affected eyes (i.e., primary and recurrent pterygium), we detected fold changes in preoperative cytokine concentrations to correspond with disease severity. As our proposed biomarkers did not reveal a linear relationship with corneal neovascularization nor the invasive behaviour of pterygium, no exact role in the pterygium pathology could be established. Hence, our data point to these factors being contributors rather than decisive players in the pathological processes.

Selective laser trabeculoplasty as replacement therapy in medically controlled glaucoma patients.

PURPOSE: We examined selective laser trabeculoplasty (SLT) as a replacement therapy for medically controlled open-angle glaucoma (OAG) or ocular hypertensive patients. METHODS: A prospective randomized interventional clinical trial on 143 glaucoma patients. Patients were randomized to either receiving SLT or to the control group that continued on pressure lowering medication. Data were recorded 1 hr, 1 week, 1, 3, 6, 12 and 18 months after SLT. Primary outcome was number of medications at 12 and 18 months while maintaining a predetermined target intraocular pressure (IOP). RESULTS: Selective laser trabeculoplasty (SLT) reduced number of medications from a mean of 1.5 at baseline, to 0.35 after 12 months and 0.29 after 18 months. Meanwhile, SLT achieved more than 20% IOP lowering in 95% of eyes and more than 30% IOP lowering in 86% of eyes after 18 months. Seventy-seven per cent of our eyes no longer needed any medication after SLT at 18 months. CONCLUSION: Selective laser trabeculoplasty (SLT) enabled a reduction in number of medications while maintaining good IOP control. Selective laser trabeculoplasty (SLT) was able to completely replace medical therapy in 77% of eyes after 18 months. Selective laser trabeculoplasty (SLT) as replacement therapy may reduce local and systemic side-effects and prevent adherence issues.

Randomized Prospective Study of the Use of Anti-Inflammatory Drops After Selective Laser Trabeculoplasty.

PURPOSE: Evaluating the use of Indomethacin, Dexamethasone, and no anti-inflammatory treatment immediately after selective laser trabeculoplasty (SLT). MATERIALS AND METHODS: Prospective randomized clinical trial of 132 eyes. Both eyes of the patient underwent SLT. One of the eyes was treated with Indomethacin 0.1% or Dexamethasone 0.1% 3 times daily for 1 week; the other eye did not receive any anti-inflammatory treatment. Intraocular pressure (IOP) and inflammatory parameters were recorded at 1 hour, 1 week, 1, 3, and 6 months. RESULTS: Cells in the anterior chamber were present in 57% to 71% of the patients after 1 hour. About 16% to 37% of the patients reported pain/discomfort after 1 hour. Redness was present before SLT in 29% to 34% of the patients, probably due to antiglaucoma medication. After 1 hour, the amount of redness recorded raised to 32% to 42%, but the amount of patients with redness returned to pretreatment levels after 1 week. An IOP peak of >5 mm Hg above baseline IOP 1 hour after laser was present in 3% to 9% of the patients. IOP lowered 11% to 21% compared with IOP at baseline. The number of medications needed changed from 1.45 to 1.49 before, to 0.23 to 0.45 six months after SLT.No differential effects based on the kind of anti-inflammatory treatment or no treatment were found for any of the parameters. CONCLUSIONS: SLT induces little inflammation: anti-inflammatory drops do not make a significant difference in pain, redness, cells in anterior chamber, or peak IOP following SLT.The IOP-lowering effect of the SLT is not influenced by the use of Indomethacin or Dexamethasone.

To Study and Determine the Role of Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopy in Corneal and Conjunctival Tumors.

Purpose. To analyze and describe corneal and conjunctival tumor thickness and internal characteristics and extension in depth and size and shape measured by two noninvasive techniques, anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). Design. Systematic review. Methods. This systematic review is based on a comprehensive search of 4 databases (Medline, Embase, Web of Science, and Cochrane Library). Articles published between January 1, 1999, and December 31, 2015, were included. We searched for articles using the following search terms in various combinations: "optical coherence tomography", "ultrasound biomicroscopy", "corneal neoplasm", "conjunctival neoplasm", "eye", "tumor" and "anterior segment tumors". Inclusion criteria were as follows: UBM and/or AS-OCT was used; the study included corneal or conjunctival tumors; and the article was published in English, French, Dutch, or German. Results. There were 14 sources selected. Discussion. Several studies on the quality of AS-OCT and UBM show that these imaging techniques provide useful information about the internal features, extension, size, and shape of tumors. Yet there is no enough evidence on the advantages and disadvantages of UBM and AS-OCT in certain tumor types. Conclusion. More comparative studies are needed to investigate which imaging technique is most suitable for a certain tumor type.

A new glaucoma hypothesis: a role of glymphatic system dysfunction.

In a recent review article titled "A new look at cerebrospinal fluid circulation", Brinker et al. comprehensively described novel insights from molecular and cellular biology as well as neuroimaging research, which indicate that cerebrospinal fluid (CSF) physiology is much more complex than previously believed. The glymphatic system is a recently defined brain-wide paravascular pathway for CSF and interstitial fluid exchange that facilitates efficient clearance of interstitial solutes, including amyloid-ß, from the brain. Although further studies are needed to substantiate the functional significance of the glymphatic concept, one implication is that glymphatic pathway dysfunction may contribute to the deficient amyloid-ß clearance in Alzheimer's disease. In this paper, we review several lines of evidence suggesting that the glymphatic system may also have potential clinical relevance for the understanding of glaucoma. As a clinically acceptable MRI-based approach to evaluate glymphatic pathway function in humans has recently been developed, a unique opportunity now exists to investigate whether suppression of the glymphatic system contributes to the development of glaucoma. The observation of a dysfunctional glymphatic system in patients with glaucoma would provide support for the hypothesis recently proposed by our group that CSF circulatory dysfunction may play a contributory role in the pathogenesis of glaucomatous damage. This would suggest a new hypothesis for glaucoma, which, just like Alzheimer's disease, might be considered then as an imbalance between production and clearance of neurotoxins, including amyloid-ß.

Atypical sino-orbital inflammatory myofibroblastic tumor with bone and cerebral invasion extending to the orbit.

PURPOSE: To report the case of an atypical sino-orbital inflammatory myofibroblastic tumor. METHODS: Case report. RESULTS: A 71-year-old man presented slowly progressive painless diplopia followed by unilateral proptosis of the left eye with slight edema of the upper eyelid. Visual acuity was 0.4 with a relative afferent pupillary defect (RAPD). Abduction and depression of the left eye were limited. Imaging showed a left sino-orbital tumor with mass effect on the medial rectus muscle resulting in proptosis. The lesion showed intracranial extension through the superior orbital fissure with bone erosion and sclerotic bone reaction. Endoscopic ethmoidal, maxillary, and orbital biopsies revealed an inflammatory myofibroblastic tumor. Full blood count showed an eosinophilia while antineutrophil cytoplasmic antibodies and C-reactive protein were negative. To date, 7 cases of orbital myofibroblastic tumor have been described, though none of the prior studies have described bone invasion. CONCLUSIONS: This erosive sino-orbital inflammatory myofibroblastic tumor is a novel finding mimicking a malignant tumor.

Clinical outcomes of cataract surgery after bag-in-the-lens intraocular lens implantation following ISO standard 11979-7:2006.

PURPOSE: To assess the clinical outcomes of bag-in-the-lens intraocular lens (BIL IOL) implantation following the International Organization for Standardization (ISO) 11979-7:2006 in pediatric eyes and eyes with ocular comorbidities. SETTING: Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. DESIGN: Cohort study. METHODS: This cohort included the first series of patients having IOL implantation using the bag-in-the-lens technique. Surgeries were performed between December 1999 and September 2006. In addition to IOL implantation, the technique comprised creation of a primary posterior continuous curvilinear capsulorhexis (PCCC) equal in size to the anterior capsulorhexis. RESULTS: The study enrolled 807 eyes of 547 patients; 326 of the eyes (40.40%) had ocular comorbidity. In the 481 eyes without ocular comorbidity, the mean decimal corrected distance visual acuity was 0.52 ± 0.24 (SD) (0.276 ± 0.206 logMAR) preoperatively and 0.94 ± 0.18 (-0.012 ± 0.053 logMAR) postoperatively. The mean postoperative achieved spherical equivalent was 0.48 ± 0.83 diopter (D) and the mean targeted refraction, -0.24 ± 0.71 D. The A-constant was modified from 118.4 to 118.04. Posterior capsule opacification (PCO) did not occur in any adult eye during the follow-up. Retinal detachment after IOL implantation occurred in 10 eyes (1.24%). In 19 eyes, the iris was captured by the IOL haptics postoperatively. Hypopyon occurred in 3 patients and toxic anterior segment syndrome in 1 patient. CONCLUSION: The BIL IOL met the ISO criteria; that is, primary PCCC was safe in healthy eyes and in eyes with ocular comorbidities and no eye developed PCO over a mean follow-up of 26.1 ± 21.3 months.

Surgically induced astigmatism after intraocular lens implantation using the bag-in-the-lens technique.

PURPOSE: To determine surgically induced astigmatism (SIA) after monofocal spherical intraocular lens (IOL) implantation using the bag-in-the-lens (BIL) technique. SETTING: Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium. DESIGN: Case series. METHODS: Adult patients had routine phacoemulsification followed by BIL IOL implantation, which requires a double capsulorhexis for IOL fixation. The 2.8 mm limbo-corneal self-sealing incision was temporally located. Preoperative and 3-month postoperative keratometries were measured by Scheimpflug imaging (Pentacam). The patients were divided into 2 groups based on corneal astigmatism. Group A0 consisted of eyes with physiological corneal astigmatism less than 1.00 diopter (D). Group A1 consisted of eyes with corneal astigmatism of 1.00 D or higher. Vector analysis of the corneal power was used to determine the SIA. RESULTS: The study comprised 100 eyes (58 patients). There was no difference in SIA between Group A0 and Group A1. The mean preoperative and postoperative keratometries were highly correlated in both groups (A0: r(2) = 0.95; A1: r(2) = 0.83). The correlation between preoperative and postoperative vectorial astigmatism was low in Group A0 (J0: r(2) = 0.24; J45: r(2) = 0.10). The mean postoperative SIA was 0.06 D @ -24 degrees in Group A0 and 0.09 D @ 6 degrees in Group A1, with an uncertainty of ± 1.00 D. CONCLUSIONS: After BIL IOL implantation, the SIA was not statistically significant. Based on these findings, the technique can be considered an option for spherocylindrical correction of corneal astigmatism of 1.00 D or more. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Clinical and histopathologic evaluation of six human eyes implanted with the bag-in-the-lens.

PURPOSE: To describe the clinical and histopathologic features of eyes implanted with the bag-in-the-lens (BIL), which involves the use of a twin capsulorhexis lens design, and performance of anterior and posterior capsulorhexes. DESIGN: Case series with clinicopathologic correlation. PARTICIPANTS: Six eyes implanted with the foldable, hydrophilic acrylic BIL, obtained postmortem at different postoperative times, from 4 patients were studied. METHODS: On the patients' death, the eyes were enucleated, immersed in fixative, and submitted for analyses under a high-frequency ultrasound unit (Artemis, Ultralink, St. Petersburg, FL; 50 MHz), gross analyses, and histopathologic analyses. Clinical data in each case were obtained by chart review. MAIN OUTCOME MEASURES: Clinical data obtained included patient demographics, preoperative evaluation, description of surgical implantation procedure, and postoperative outcomes. The postmortem evaluation included analyses of lens fixation and centration, as well as gross and histopathologic analyses of postoperative capsular bag opacification. RESULTS: The patients were aged 74.6+/-12.6 years at implantation. The postoperative time in this series ranged from 4 to 39 months. In all eyes for which the surgical implantation was uneventful (N = 5), postoperative BIL decentration was insignificant. In 1 eye, the anterior capsulorhexis was torn off, and although BIL implantation was still possible, a relative lens decentration was observed postoperatively, but without clinical significance. Although progressively larger amounts of Soemmering's ring formation were observed in the specimens with larger follow-up, the central area delimitated by the rhexis openings remained perfectly clear in all 6 eyes. CONCLUSIONS: This is the first series of human eyes implanted with the BIL, obtained postmortem at different postoperative times. BIL centration depends on the performance of centered capsulorhexes of appropriate size. The results confirm the concept of the lens design in that any proliferative/regenerative material remains confined to the intercapsular space of the capsular bag remnant outside the optic rim. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Influence of neodymium:YAG laser capsulotomy on ocular wavefront aberrations in pseudophakic eyes with hydrophilic and hydrophobic intraocular lenses.

PURPOSE: To study the influence of neodymium:YAG (Nd:YAG) laser capsulotomy on ocular wavefront aberrations. SETTING: Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. METHODS: The wavefront aberrations in pseudophakic eyes with posterior capsule opacification (PCO) were measured with an iTrace aberrometer before and after Nd:YAG laser capsulotomy. These results were analyzed using Zernike coefficients, the total and higher-order root-mean-square (RMS) values, and the wavefront peak-valley difference. In addition, a separate evaluation was performed of 2 intraocular lens (IOL) types: the hydrophilic 92S (hydrophilic IOL subgroup) and the hydrophobic AcrySof SA60AT (hydrophobic IOL subgroup). RESULTS: The study evaluated 62 pseudophakic eyes (56 patients). The RMS values in all eyes decreased significantly after Nd:YAG laser capsulotomy; the mean decrease in total RMS was 0.186 microm +/- 0.445 (SD) and in higher-order RMS, 0.138 +/- 0.223 microm. The decrease in total RMS (mean 0.325 +/- 0.372 microm) was significant in the hydrophobic IOL subgroup (n = 14) but not in the hydrophilic IOL subgroup. Before capsulotomy, there was a statistically significant difference between the 2 subgroups in the higher-order astigmatism coefficient C(4,-2). After laser capsulotomy, the difference was significantly less. CONCLUSION: Neodymium:YAG laser capsulotomy significantly reduced the wavefront RMS in the hydrophobic IOL subgroup but not in the hydrophilic IOL subgroup. The difference in the wavefront before capsulotomy may originate from a difference in the healing response of the capsular bag between the 2 IOL types.

Intraocular lens centration and visual outcomes after bag-in-the-lens implantation.

PURPOSE: To examine the centration and visual outcomes after cataract surgery using the bag-in-the-lens (BIL) implantation technique. SETTING: University Hospital Antwerp, Department of Ophthalmology, Edegem, Belgium. METHODS: This study comprised 180 eyes of 125 patients who had cataract surgery with implantation of the BIL intraocular lens (IOL) between March 2002 and September 2005. Postoperative data at 5 weeks, 6 months, and 1 year were evaluated. The geometric center of the IOL, measured on a red reflex slitlamp photograph, was compared with the geometric center of the pupil and the limbus. RESULTS: The mean decentration compared with the limbus was 0.304 mm+/-0.17 (SD) at a mean angle of -24.9+/-113.3 degrees. Compared with the dilated pupil, the mean deviation was 0.256+/-0.15 mm at a mean angle of -5.2+/-119.0 degrees. The amount of decentration was stable during the postoperative follow-up period. There was no correlation between the amount of decentration and the visual outcomes (pupil: r=-0.07, P=.494; limbus: r=0.11, P=.304). CONCLUSIONS: Surgeon-controlled BIL centration was predictable 5 weeks and unchanged 6 months and 1 year postoperatively. It can therefore be concluded that capsular bag healing has no influence on BIL IOL centration over time.

Cumulative neodymium:YAG laser rates after bag-in-the-lens and lens-in-the-bag intraocular lens implantation: comparative study.

PURPOSE: To study the cumulative neodymium:YAG (Nd:YAG) laser rate after bag-in-the-lens implantation (Morcher 89A) and lens-in-the-bag implantation (Morcher 92S) of 2 intraocular lenses (IOLs) of the same biomaterial. SETTING: Department of Ophthalmology, University Hospital of Antwerp, Edegem, Belgium. METHODS: This study comprised 100 eyes of 87 patients who had the bag-in-the-lens IOL implantation between January 2000 and August 2004. The postoperative follow-up ranged between 17 and 72 months. One hundred eyes of 94 patients of the same age and with the same follow-up period received the lens-in-the-bag IOL. The cumulative Nd:YAG laser frequency rates in both groups were calculated, and the cumulative incidence rates were defined by Kaplan-Meier survival analysis. RESULTS: No Nd:YAG laser capsulotomy was performed in eyes having bag-in-the-lens IOL implantation. A laser capsulotomy was performed in 20 eyes having lens-in-the-bag IOL implantation; the cumulative frequency in this group was 2% at 1 year and 20% at 71 months, with a plateau beginning at 42 months. The cumulative incidence rate of Nd:YAG posterior capsulotomy was approximately 2% at 1 year, increasing to approximately 28% at 42 months. CONCLUSIONS: The cumulative Nd:YAG laser rate after bag-in-the-lens implantation was zero. A zero rate has not been reported with lens-in-the-bag implantation of an IOL of the same biomaterial or of other biomaterials, as published in the literature. Thus, it can be concluded that the bag-in-the-lens implantation technique has 100% effectiveness against posterior capsule opacification.

One-year follow-up of bag-in-the-lens intraocular lens implantation in 60 eyes.

PURPOSE: To report the feasibility and clinical results of implanting a bag-in-the-lens intraocular lens (IOL) designed to prevent posterior capsule opacification after cataract surgery. SETTING: Departments of Ophthalmology, University of Antwerp, Antwerp, Belgium, and University of Munich, Munich, Germany. METHODS: This prospective study comprised 63 eyes (55 patients; 7 children, 48 adults) scheduled for cataract surgery and bag-in-the-lens IOL implantation. A posterior curvilinear capsulorhexis the same size as the anterior capsulorhexis was created for IOL insertion. After surgery, lens epithelial cell (LEC) proliferation was documented every 6 months with a minimum follow-up of 12 months. RESULTS: Sixty of 63 eyes (95%) had implantation of the bag-in-the-lens IOL. Conversion to a conventional IOL was necessary in 2 cases. In 1 eye, postoperative luxation of the IOL into the vitreous occurred as a result of an oversized anterior and posterior capsulorhexis. Three eyes had early postoperative iris incarceration in the lens groove that required surgery. No LEC proliferation on the optic occurred during a mean follow-up of 22.7 months (range 12 to 64 months); LEC proliferation was confined to the peripheral capsular bag. CONCLUSION: Lens epithelial cell proliferation was mild and confined to the periphery of the capsular bag during follow-up, and the bag-in-the-lens IOL optic remained clear.

Effect of bag-in-the-lens implantation on posterior capsule opacification in human donor eyes and rabbit eyes.

PURPOSE: To evaluate bag-in-the-lens implantation by studying the feasibility of implanting a new type of intraocular lens (IOL) and the occurrence of posterior capsule opacification (PCO) in human postmortem eyes and in eyes of living rabbits. SETTING: Department of Ophthalmology, University of Antwerp, Belgium, and Netherlands Research Institute of Amsterdam, Amsterdam, The Netherlands. METHODS: The IOL was implanted in 10 postmortem human donor eyes (in vitro study) and in 17 eyes of 10 rabbits (in vivo study). The postmortem capsular bags were cultured for 4 to 6 weeks, and the rabbits were killed 1 to 5 months after implantation. All capsular bags with the bag-in-the-lens were examined by light microscopy and scanning electron microscopy. RESULTS: The IOL design was highly effective in restricting lens epithelial cell (LEC) proliferation in the remaining lens bag in human donor eyes and in rabbit eyes. In eyes in which the capsules were not positioned well within the groove of the IOL, LEC proliferation and PCO occurred. CONCLUSION: Bag-in-the-lens implantation was highly effective in preventing PCO in vitro and in vivo provided the anterior and posterior capsules were secured properly in the peripheral groove of the IOL.

In vitro study on the closure of posterior capsulorrhexis in the human eye.

PURPOSE: An unexplained clinical observation is the development of posterior capsular opacification (PCO), even when the central part of the posterior capsule has been removed. The purpose of this study was to investigate in vitro the mechanisms involved in the closure of the posterior capsulorrhexis in a capsular bag model. METHODS: A sham extracapsular cataract extraction was performed in 71 human donor eyes, followed by a central posterior capsulorrhexis 3 to 4 mm in diameter. Each capsular bag was pinned to a PMMA ring with a central hole of 5 mm and placed in a Petri dish. The capsular bags were cultured and monitored for 3 to 7 weeks by phase-contrast microscopy, after which they were prepared for light, transmission, and scanning electron microscopy. RESULTS: Proliferation of lens epithelial cells (LECs) within the posterior rhexis area was found in 22 cases (31%) of which 3 had a complete closure. In the absence of the posterior capsule, a monolayer of LECs was observed growing on a basal lamina, consisting of loosely arranged fibers. Further observations on noncultured capsular bags revealed that this basal lamina corresponds to the anterior hyaloid membrane. CONCLUSIONS: This study corroborates the clinical observation that LECs that remain after cataract extraction have the potential to proliferate, in the absence of their natural substrate, on a basal lamina of vitreous origin and are able to close the posterior capsulorrhexis partially or totally in approximately one third of cases.