PURPOSE-To evaluate efficacy of a neodymium:YAG (Nd:YAG) laser photolysis system in removing lens epithelial cells (LECs) and characterize the effect of the laser on laminin and fibronectin involved in LEC adhesion and migration.METHODS-Cadaver eyes were evaluated using the Miyake technique. The lenses were removed with phacoemulsification. The modified Nd:YAG laser was used to clean the LECs from the capsule. Only the fornix was cleaned in some eyes and the anterior subcapsular area in other eyes. Some areas were not treated and acted as controls. Standard irrigation/aspiration (I/A) removal of LECs was performed in additional eyes. The eyes were analyzed using light microscopy and immunohistochemical staining.RESULTS-Histopathologic evaluation showed that the laser removed the LECs from the anterior lens capsule and from the fornix. Immunohistochemical staining showed fibronectin and laminin staining in the untreated areas that was absent in the treated areas. Standard I/A removal of the LECs showed absence of cells but persistent laminin and fibronectin. Electron microscopy showed epithelial cells in untreated areas with an absence of the LECs and debris in treated areas.
CONCLUSIONS-The laser photolysis system removed LECs from the anterior lens capsule and capsule fornix. Along with the cells, laminin, fibronectin, and cell debris remained in the untreated areas but were removed by the treatment. This treatment may be useful in preventing posterior capsule opacification.Financial Disclosure-No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.Cataract surgery with intraocular lens (IOL) implantation has evolved into a highly successful procedure; however, opacification of the capsular bag, including posterior capsule opacification (PCO), remains the most common complication of modern cataract surgery. The incidence of PCO ranges from 10% to 30% in the first several years after cataract surgery. In 1998, Schaumberg et al. 1 published a metaanalysis of the published literature on PCO; they found the postoperative incidence of PCO to be 11.8% at 1 year, 20.7% at 3 years, and 28.5% at 5 years.
We describe a technique that uses a neodymium:YAG (Nd:YAG) laser photolysis system to prevent lens capsule opacification. The photolysis instrument consists of a 1064 nm Nd:YAG laser transmitted along a fiber-optic cable into a handpiece containing an angulated titanium plate that the laser beam strikes, creating plasma and a shockwave that exits the handpiece through an aperture. Under direct visualization, the shockwave is aimed at the inner surface of the anterior capsule, where it removes LECs and proteoglycan attachment molecules; the shockwave probably extends to the capsule fornix, destroying germinal epithelial cells. We report preliminary results in 12 eyes followed for approximately 2.5 years in which the treated nasal anterior capsule remained clear or with only slight opacity and the untreated temporal capsule developed moderate to severe opacification.
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