Hara T, Azuma N, Chiba K, Ueda Y. Anterior capsular opacification after endocapsular cataract surgery. Effect of optic size on posterior capsule opacification: 5.5 mm versus 6.0 mm AcrySof intraocular lenses. National Library of Medicine In traumatic cataracts, the incidence of PCO is significantly higher and has been quoted to be as high as 92% at the three-year follow-up (81). PCO sets in at a later stage, typically at 14-16 months. Comparison of 4 methods for quantifying posterior capsule opacification. A randomized study of the efficacy of hydrodissection - special reference to intraoperative performance. In vitro experiments showed that hydrodissection with 1% preservative-free lidocaine may help diminish the number of live LECs in the anterior capsule by facilitating cortical clean-up, by loosening the desmosomal area of cell-cell adhesion with decreased cellular adherence, or by a direct toxic effect (138). Jacob TJ. official website and that any information you provide is encrypted Legler UF, Apple DJ, Assia EI, Bluestein EC, et al. The normal pre-planned differentiation of LECs leads to the formation of pearl-like structures in the posterior capsule known as bladder cells (40). The thorough removal of residual cortical fibers reduces the number of mitotically active cells that have the potential to proliferate and migrate across the central visual axis (88). Adenovirus mediated Bax, procaspase 3 gene transfer, and distilled water have led to a reduction of PCO in the rabbit model (139). This ring provides a closed environment, which restricts the migration of the LECs towards the central posterior capsule. And even though the conventionally accepted incidence of 1 to 2 percent is low, the reality may be much lower, according to research1 conducted by Christopher Rudnisky, MD, a professor at the University of Alberta in Edmonton, Canada. When you have cataract surgery, your ophthalmologist removes your eye's cloudy lens. Another system that captures high resolution images is the EAS-1000 system (Scheimpflug videophotography) (50). But the bottom line is we havent achieved anything that approaches a good way to eliminate PCO, Dr. Koch says. The sharp capsule bend appears to represent a physical hindrance, which may induce contact inhibition of cell movement (108). Does it feel like your cataract is coming back even after a surgery to correct it? Nishi et al suggest that IOLs with a sharp optic edge create an acute bend in the posterior capsule and this helps to a large extent in retarding the development of central PCO (107). Effect of ultraviolet radiation on cataract formation. Saika S, Miyamoto T, Ishida I, Tanaka T, et al. Trivedi RH, Werner L, Apple DJ, et al. An eye with posterior capsule opacification before (A) and after Nd: YAG posterior capsulotomy (B). PCO evaluation with OCT is based on peak intensity (PI) and posterior capsule thickening (PCT), with PCT indicating the distance between two reflectivity spikes with an approximate axial resolution of 10 m. Sacu et al (114) noted that the capsule-IOL contact on optical coherence tomography was on the 10th day with a single piece acrysof, on the 13th day with a three-piece acrysof, and on the 15th day with a three-piece silicone IOL. In pediatric eyes, AcrySof IOL implantation with appropriate management of the posterior capsule helps in retarding the development of central PCO maintaining a clear visual axis in a majority of the cases (155, 157). Yag Capsulotomy Duncan G, Wormstone IM, Liu CS, Marcantonio JM, et al. Cataract surgery risks include: Inflammation; Infection; Bleeding; Swelling; Drooping eyelid; . Ultra High-Resolution (UHR) OCT images using 1.4 m axial 3.0 m transverse resolutions have corresponded to the histology sections (53). Sacu S, Menapace R, Wirtitsch M, Buehl W, et al. Wolken MA, Oetting TA. Linnola RJ, Werner L, Pandey SK, et al. IOL design, optic size and edge, and its material are important considerations in retarding the development of PCO. Left: View through the infrared camera of the femtosecond laser during primary posterior laser capsulotomy. Anterior capsule opacification in eyes with and without anterior LEC scrapping. Photodynamic actions of indocyanine green and trypan blue on human lens epithelial cells. Dr. Donnenfeld says that he uses multifocals and extended-depth-of-focus intraocular lenses about 15 percent of the time. Animal studies and in vitro models have been used to assess the mechanism of PCO formation (30, 31). In clinical studies, PCO can be assessed by either comparing the presence or absence of PCO within the central visual axis or comparing the Nd: YAG capsulotomy rates (40, 41). Recently a transconjunctival sutureless vitrectomy system has been employed (161). Meacock WR, Spalton DJ, Stanford MR. Role of cytokines in the pathogenesis of posterior capsule opacification. Digitally acquired retro-illumination photography allows quick acquisition of PCO images. Dr. Rudnisky evaluated the incidence of RD from an administrative dataset of patients from all age groups who received foldable implants with square edges and were followed-up at 90,120 and 150 days, and then six months and one year post-Nd:YAG capsulotomy. McLean SM, Mathew MR, Kelly JB, Murray SB, et al. Images with no clinical PCO produce very low scores in the analysis (44). We really need to look at different ways of retarding or preventing PCO, Dr. Mamalis says. Even though our paper shows that the incidence of retinal detachment is lower than what we thought, its still not zero. The development of PCO is a very dynamic process and involves three basic phenomena: proliferation, migration, and differentiation of residual LECs. Dr. Snyder acknowledges that the YAG procedure is a cost and an inconvenience, and access to care can be a problem in some rural communities, but it remains a good solution., Many surgeons agree the 1 to 2 percent RD rate following Nd:YAG capsulotomy may not be representative of todays clinical practice. Surgical prevention of posterior capsule opacification. The quest for its eradication goes on. Another technique, originally called Dodick phacolysis, was derived from Dr. Jack Dodicks initial work in the 1990s, and uses Nd:YAG laser energy to emulsify the lens. Matsushima H, Iwamoto H, Mukai K, Obara Y. The appearance of SMA gives a retractile property to the cell, causes wrinkling of the posterior capsule, and forms fibrous PCO. A capsulotomy that is larger than the pupil diameter under scotopic conditions may prevent disturbances of vision such as monocular diplopia (150). Neumayer T, Findl O, Buehl W, Georgopoulos M. Daily changes in the morphology of Elschnig pearls. Measuring the anterior capsule opening after cataract surgery to assess capsule shrinkage. Valuation of neodymium: yttrium-aluminum-garnet capsulotomies in eyes implanted with AcrySof intraocular lenses. The ring contains residual LECs, residual cortical fibers, and differentiated LECs. At two years, that rate is low single digits., Dr. Koch puts the rate of PCO development at, five to seven years postop at probably 75 percent, even with contemporary square-edged IOLs. Copyright 2023 Jobson Medical Information LLC unless otherwise noted. Several authors have evaluated the role of polishing the anterior capsule on the development of PCO when using silicone IOLs. Obviously headlights are worse. Despite its initial appeal, however, total elimination of LECs may not be a panacea, warns Dr. Koch. PCO Yag Capsulotomy | Posterior Capsule Opacification | South Florida Its likely youve developed posterior capsule opacification, or PCO. Irrigating Solution. Residual cortex may also promote proliferation of PCO. It is known as a plaque which can either be in the anterior and/or posterior capsule. Selective and specific targeting of lens epithelial cells during cataract surgery using sealed-capsule irrigation. This scar tissue prevents light from reaching your retina, which is critical to your ability to see, because it converts light into impulses that travel through the optical nerve to the brain, where it is recognized as images. The culture of postmortem capsular bags and in vivo animal models have used a Bag-in-the-lens implantation technique to limit LEC proliferation. Neodymium:YAG laser capsulotomy almost always disrupts the anterior vitreous face, and the capsulotomy itself increases the complexity and the risks of an IOL exchange, surgeons say. Comparison of Nd : YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, or acrylic intra-ocular lenses in four European countries. The response of the LECs in the lens capsular bag is executed by the autocrine or paracrine systems (57). Moreno-Montanes J, Alvarez A, Maldonado MJ. The various anti-proliferative agents tested in vitro are 5-fluorouracil, mitomycin C (119), duanomycin (120), FGF receptor-1 antagonist SU5402 (58), octreotide (121), colchicines (122) and doxorubicin (123). It can and should be learned by all cataract surgeons, he declares. Nishi O, Nishi K, Menapace R, Akura J. Capsular bending ring to prevent posterior capsule opacification: 2 year follow-up. He found the conventionally cited 1 to 2 percent RD rate overstates the truth the rate is substantially lower, between 0.5 and 1 percent.1. However, some sub-populations are at more riskspecifically men with high myopia in their 50s and early 60s, says Douglas Koch, MD, professor and chair at the Cullen Eye Institute, Baylor College of Medicine in Dallas. Unfortunately, in our tertiary care center we frequently see patient referrals after a YAG was performed for IOL-related symptoms, but we end up having to perform an IOL exchange, which can be very difficult due to the open bag, Dr. Mamalis says. This may cause you to have blurry or hazy vision, or to see a lot of glare from lights. Posterior capsular opacification, referred to as secondary cataract or after cataract, develops over the clear posterior capsule a few months to a few years after an uneventful cataract surgery (Figure (Figure2A,2A, ,2B,2B, ,2C).2C). Posterior capsule striae. Yag capsulotomy is the only way to correct cloudy vision as a result of scar tissue buildup (PCO) after cataract surgery. Better cortical cleanup, square-edged IOLs and laser-generated capsulotomies have been touted as keys to preventing PCO. That said, there are accommodative IOLs showing good response up to two years postoperatively, but longer follow-up is needed, Dr. Koch notes. Its a life-changing event for the patient who develops one., Michael Snyder, MD, associate professor of ophthalmology at the University of Cincinnati, is somewhat skeptical that the YAG causes most RDs after capsulotomy. Baumeister M, Neidhardt B, Strobel J, Kohnen T. Tilt and decentration of three-piece foldable high-refractive silicone and hydrophobic acrylic intraocular lenses with 6-mm optics in an intra-individual comparison. The medical term for this common complication is known as posterior capsule opacification (PCO). Tan DT, Chee SP. Topical instillation of diclofenac in the immediate post-operative period did not seem to influence the formation of PCO (118). I am 99% sure they were not there from initial surgery up until YAG. I. Immunoelectron microscopic localization and biochemical studies. The ophthalmologists at South Florida Vision Associates can treat your PCO and restore your vision with a quick and easy outpatient procedure: a Yag laser capsulotomy. So why are some experts rethinking the risk/benefit ratio of Neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification after phacoemulsification and intraocular lens implantation? Dr. Menapace also recommends thorough removal of cortical material from the capsular equator while keeping the anterior lens epithelial layer on the posterior side of the anterior capsular rim intact.. Part-3: intraocular lens optic barrier effect as a second line of defense. They have a homogenously granular cytoplasm with pyknotic or no nuclei and do not express SMA (69). Examples include dysphotopsias related to multifocal IOLs or lenses in general. The overlap of the anterior capsule rim over the IOL optic leads to the EMT of the LECs, resulting in ACO. Epidemiological studies have emphasized a relationship between sunlight, particularly long wavelength UV (300-400 nm) and UV B (290-320 nm), and the formation of cataracts (2, 3). Most surgeons agree, however, that early or later onset is correlated with IOL type, length of follow-up, and whether the cataract surgery was performed in a developing country. Ocular Surgery News Europe Edition | Despite advances that have increased the success and safety of cataract surgery in recent years, posterior capsule opacification remains a common complication. Nishi O, Nishi K, Akaishi T, Shirasawa E. Detection of cell adhesion molecules in lens epithelial cells of human cataracts. In a small percentage of frustrated patients, however, the floaters persist. The size of this continuous capsulorhexis opening has not shown any correlation with the degree or severity of PCO (92). Hanson RJ, Rubinstein A, Sarangapani S, Benjamin L, et al. Tetz M, Wildeck A. Koraszewska-Matuszewska B, Samochowiec-Donocik E, Pieczara E, Filipek E. Heparin-surface-modified PMMA intraocular lenses in children in early and late follow-up. Posterior capsulotomy (or YAG laser capsulotomy) is laser surgery you might need sometime after cataract surgery. Barman SA, Hollick EJ, Boyce JF, Spalton DJ, et al. Using a wave-length of 800 nm, the anterior and posterior capsules, area of growth of the LECs, ECM production, and IOL can be clearly visualized. Acta Ophthalmol. What is posterior capsular opacification (PCO)? - All About Vision Thompson AM, Sachdev N, Wong T, Riley AF, et al. Nebe B, Kunz F, Peters A, Rychly J, et al. The risk of causing retinal detachment is the first factor cataract surgeons cite when. In some cases, a thin layer of scar tissue forms on a membrane called the posterior capsule, which is located behind your new lens. The uneven illumination and low resolution of the images obtained with a slit lamp has led to the increasing use of digital images. 7. Whether laser-assisted capsulorhexis is worth the expense and time continues to be debated, and proponents for the Zepto, femtosecond laser or manual continuous circular capsulorhexis cite both research and personal experience to support their individual preferences.8-12, Despite a relatively safe track record, timing and circumstances are critical factors when performing a YAG laser capsulotomy. European PCO Study Group. The LECs have the ability to undergo both normal and abnormal differentiation. Learn about the latest developments in the fields of optometry and ophthalmology, along with updates about our practice. PCO still a major hurdle in successful cataract surgery - Healio Continuous Curvilinear Capsulorhexis. An in vitro experiment of human capsules with a central hole of 5 mm (PCCC) placed in a culture showed that even in the absence of the posterior capsule, their natural substrate, LECs that remain after cataract extraction have the potential to proliferate and form a monolayer of LECs on a basal lamina of vitreous origin. 1. Hydrodissection Combined with Rotation. Mastropasqua L, Toto L, Calienno R, Mattei PA, Mastropasqua A, Vecchiarino L, Di Iorio D. Scanning electron microscopy evaluation of capsulorhexis in femtosecond laserassisted cataract surgery. At $1.1 billion annually, cataract surgery with IOL tops Medicare payments for ambulatory surgery procedures; complex cataract surgery comes in at number five ($96 million); and YAG capsulotomys $65 million cost puts the procedure at number 10, according to Beckers ASC Review.5, Most experts agree that meticulous surgery is the first, best way to prevent PCO, but techniques differ. But it depends on how long patients liveeventually they all might develop PCO, he says. PCO Secrets: Out of the Bag - The Ophthalmologist Posterior capsule opacification (secondary cataract). Methods of quantifying posterior capsule opacification. The .gov means its official. Cataract surgeons have banked on its efficacy and reliability for decades. All rights reserved. In this technique, anterior and posterior capsule flaps of similar sizes are inserted in a flange of the IOL. Nishi O, Nishi K, Wada K, Ohmoto Y, et al. From the lens capsule to the center of the lens, these concentric layers of lens fibers are identified broadly as cortex and nucleus. Reproduction in whole or in part without permission is prohibited. Vasavada AR, Chauhan H, Shah G. Incidence of posterior capsular plaque in cataract surgery. Relationship between anterior capsule contraction and posterior capsule opacification after cataract surgery in patients with diabetes mellitus. Effect of trypan blue staining on the density and viability of lens epithelial cells in white cataract. Ewe SY, Abell RG, Vote BJ. JCRS 2013;39:10:15811586. PCO reduces visual acuity when the central area (inside the pupillary aperture) is involved (25). We try to determine how to control this amount so that we get just the right amount of capsule fibrosis to hold onto the lens, but not so much that PCO occurs, says William Barlow Jr., MD, assistant professor at the Moran Eye Center. He recommends holding off a minimum of three months before doing a YAG laser in patients with side effects such as blurry vision, glare and halos. ), Ophthalmology Locations (cataracts, glaucoma, macular degeneration, etc. Gly-Arg-Gly-Asp-Ser-Pro (GRGDSP) RGD peptide inhibited cell attachment, and migration on laminin and fibronectin that have Arg-Gly-Asp (RGD) peptide sequences (38). A YAG laser posterior capsulotomy wont improve positive dysphotopsias. If this happens, the capsule becomes diaphanous and floppy, unable to support the IOL, and subsequently dislocates. Chang DF, Mamalis N, Werner L. Precision pulse capsulotomy: Preclinical safety and performance of a new capsulotomy technology. It is fierce, not only in its appearance but also in its impact on the development of amblyopia. Dr. Menapace says the reality may be even bleaker for patients in the developing parts of the world where cheap one-piece hydrophilic IOLs with broader haptic-optic junctions are often used. His evaluation of two hydrophilic, small-incision IOLs showed early and high PCO rates resulting in YAG laser rates of up to 49 percent.2, Not all ophthalmologists agree on YAG laser capsulotomys overall safety record. Aslam TM, Patton N, Graham J. Peng Q, Apple DJ, Visessook N, et al. Association between intensity of posterior capsule opacification and contrast sensitivity. Post-operative capsular opacification is a multifactorial physiological consequence of cataract surgery. Different methodologies have been used in experimental and clinical studies. Meacock WR, Spalton DJ, Hollick EJ, Boyce JF, et al. Koh HJ, Kang SJ, Lim SJ, Chu YK, et al. Ebihara Y, Kato S, Oshika T, Yoshizaki M, et al. Visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses in children with traumatic cataracts. It has been observed to be the lowest with acrylic IOLs (10). Now were saying maybe theres benefit to retaining some LECs to maintain the bag and keep it healthy.. An animal model. Graefes Arch Clin Exp Ophthalmol 2008;246:6:787-801. Buehl W, Sacu S, Findl O. A number of pharmacological agents have been proposed to prevent PCO, and most of these have been tested in vitro. Among them is Eric Donnenfeld, MD, clinical professor of ophthalmology at New York University. Posterior capsule opacification (PCO), often referred to as "secondary cataract," is the most common postoperative complication of cataract extraction. 5 year incidence of YAG capsulotomy and PCO after cataract surgery with Curr Opinion Ophthalmol 2018;29:1:54-60. A histological examination of the fibrous PCO shows extracellular matrix (ECM) accumulation and the presence of elongated fibroblast cells positive to vimentin and alpha-smooth muscle actin (17). The development of PCO is faster in rabbits and has been found to be suitable for studies to explain human PCO development (32). Cataract surgery is a common procedure that treats cataracts, or cloudy patches that form on your eye's natural lens. Pharmacologic prevention of posterior capsule opacification: Malecaze F, Decha A, Serre B, Penary M, et al. Part II: enhancement of cortical cleanup by focusing on hydrodissection. A digital quantification of the cell migration onto the posterior capsule and capsule contraction can also be done in these models (39). Polishing (scraping) the Anterior Capsule. I would very much recommend looking hard at the patients symptoms prior to considering a YAG laser.. Krishnamachary M, Rathi V, Gupta S. Management of traumatic cataract in children. About one-third develop PCO after five years. Alio JL, Chipont E, BenEzra D, Fakhry MA International Ocular Inflammation Society, Study Group of Uveitic Cataract Surgery. Bag-in-the-lens implantation. Volk T, Geiger B. A-CAM: a 135-kD receptor of intercellular adherens junctions. Bethesda, MD 20894, Web Policies New research is focusing on ways to modulate the LECs so that they dont fibrose and dont cause capsule opacity, yet still keep the capsule elastic. Auffarth GU, Brezin A, Caporossi A, Lafuma A, et al. Indian J Ophthalmol 2017;65:12:14111414. Plaques are frequently associated with white mature cataract (4). The findings suggest that RD risk is highest in the first five months post-procedure. Zaczek A, Laurell CG, Zetterstrom C. Posterior capsule opacification after phacoemulsification in patients with postoperative steroidal and nonsteroidal treatment. Aspiration of LECs from the anterior capsule during cataract surgery has shown to reduce the capsulorhexis aperture contraction 3 months after cataract surgery (15). A histopathological examination reveals that IOLs with a rounded edge show a capsular bend and complex folds in the posterior capsule that are not as sharp as that of a square-edged optic (107). Cortina P, Gomez-Lechon MJ, Navea A, Menezo JL, et al. Van Tenten Y, Schuitmaker HJ, De Groot V, Willekens B, et al. Lois N, Taylor J, McKinnon AD, Smith GC, et al. The concern for capsule-fixated accommodating IOLs is that IOL movement in the capsule will diminish with LEC proliferation, reducing or possibly eliminating the accommodative IOL power change. Inhibitory effects of Arg-Gly-Asp (RGD) peptide on cell attachment and migration in a human lens epithelial cell line. Elgohary MA, Hollick EJ, Bender LE, Heatley CJ, et al. When the size of the anterior capsulorhexis is larger than that of the IOL, there is an increased incidence of fibrous PCO since the anterior epithelium remains apposed to the posterior capsule. Central PCO obscuring the visual axis can be treated with either surgical intervention such as posterior capsule scraping or with a non-surgical neodymium:YAG (Nd: YAG) laser capsulotomy. With PMMA, the opacification sets in rapidly in the first few weeks. The incidence of PCO is also high in eyes with uveitis (77). 6.Menapace R. Posterior capsulorhexis combined with optic buttonholing: An alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? The LEC proliferation is restricted within the space of the remaining lens bag and does not approach the visual axis (101). Rather, coincidence with the natural history of retinal detachment plays a bigger role than stresses induced at the time of capsulotomy, he says. Tan and associates noticed an increased incidence of fibrosis type PCO in cases of ciliary sulcus fixation (89). The influence of posterior capsule opacification on scanning laser polarimetry. An after after-cataract: A curious case of visual axis re-opacification Retinal surgical outcomes are rarely clear cut high myopes may have more problematic retinal detachments, including giant retinal tears--these rates are still low, but [the problem] is not trivial, Dr. Koch notes. Rakic JM, Galand A, Vrensen GF. Explore eye care conditions and treatments in our patient education library, including ophthalmology and optometry issues. Therefore, the targeted delivery of these agents inside the capsular bag is important. FGF: an autocrine regulator of human lens cell growth independent of added stimuli. Mathematical modeling of the forces between an intraocular lens and the capsule. The sustained release of mitomycin C suspended in sodium hyaluronate has shown to reduce PCO in rabbits (124). Association between intensity of posterior capsule opacification and visual acuity. Children display a significantly higher incidence of postoperative PCO and a higher Nd: YAG laser posterior capsulotomy rate (152). Intraocular lens-capsular bag imaging with ultrahigh-resolution optical coherence tomography Pseudophakic human autopsy eyes. Anterior vitreous face behavior with AcrySof in pediatric cataract surgery. Bag-in-the-lens implantation of intraocular lenses. The incidence of retinal detachment was 0.87 percent at five months post Nd:YAG; the rate of retinal tears after Nd:YAG capsulotomy at five months was 0.29 percent. Figures Figures4A4A and and4B4B show an eye before and after Nd: YAG posterior capsulotomy. Grieshaber et al have suggested anterior and posterior vertical capsulotomy, with optic entrapment of the intraocular lens to avoid vitrectomy in infants under the age of 5 years. But it's a concrete example of the change. Early-Onset Posterior Capsule Opacification: Incidence, Severity, and Effect of anterior capsule polishing on posterior capsule opacification and neodymium: YAG capsulotomy rates: three-year randomized trial. The most common risk factor of cataract is aging. Coating the IOL. Tassignon MJ, De Groot V, Vrensen GF. The lens epithelial cells (LECs) line the interior surface of the anterior, pre-equatorial, and equatorial regions of the lens capsule (Figure (Figure1).1). In-the-bag fixation of the optic and the haptic is required to consistently reduce the incidence of central PCO. Nishi O, Nishi K, Sakanishi K. Inhibition of migrating lens epithelial cells at the capsular bend created by the rectangular optic edge of a posterior chamber intraocular lens. The improved resolution can make UHR OCT a powerful tool in anterior segment imaging, to evaluate the capacity of IOL materials and models to induce capsular bag adhesion and to determine the area of origin of PCO after cataract surgery. Opacification involving the central posterior capsule has a significant impact on high and low contrast acuity and low contrast sensitivity. As a library, NLM provides access to scientific literature. Johar K, Vasavada AR, Praveen MR, Nishi O. Culture studies can also detect potential therapeutic targets in the treatment of PCO. Different patient-related factors, ocular and systemic conditions, surgical techniques to remove the residual LECs, and residual cortical fibers and adjuncts influence the development of PCO. HHS Vulnerability Disclosure, Help TGF induces epithelial mesenchymal transition (EMT) of LECs and leads to production of extracellular matrix (60). These LECs are able to close the posterior capsulorrhexis partially or totally in approximately one-third of cases (154). The fusion of the anterior and posterior capsules in front of the IOL limits the proliferation and migration of Elschnig pearls (158). PCO occurs in approximately 20% of patients after cataract surgery. Inhibition of cell proliferation on lens capsules by 4197X-ricin A immunoconjugate. Xia XP, Lu DY, Wang LT. A clinical study of inhibition of secondary cataract with heparin [in Chinese]. Comparison of Scheimpflug images of posterior capsule opacification and histological findings in rabbits and humans. However, it is cautioned that this prevents PCO only if the anterior and posterior capsules have been secured properly in the peripheral groove of the IOL (102). Basic FGF (bFGF) in the aqueous humor of rabbits increases after surgery and stimulates proliferation of LECs (59). The removal of lens fiber mass during cataract surgery seems to alter the local environment, inducing proliferation of LECs (55). The use of intraocular lenses with different biomaterials and edge designs can influence the progression of visually significant PCO. Though many patients dont realize when PCO develops in one eye, unilateral PCO actually reduces binocularity and stereopsis, which could be a factor for the increased incidence of falling and fractures., Finally, the financial burden is significant.
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