5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes

Ursell, Paul G.; Dhariwal, Mukesh; O'Boyle, D.; Khan, Javeed; Venerus, Alessandra

doi:10.1038/s41433-019-0630-9

Cited by 81 publications

(76 citation statements)

References 25 publications

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“…Fibrosis often is the result of an aberrant wound healing response characterized by myofibroblast persistence and the excessive production of extracellular matrix proteins like collagen I leading to the loss of tissue structure and function 66,67 . In the lens, the fibrotic disease PCO is a major complication of cataract surgery and is health burden with no effective treatment strategies 68,69 . Our finding that lens resident immune cells serve as myofibroblast progenitors strongly suggests that these cells are mediators of PCO.…”

Section: Discussionmentioning

confidence: 94%

Resident immune cells of the avascular lens: Mediators of the injury and fibrotic response of the lens

et al. 2021

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Tissues typically harbor subpopulations of resident immune cells that function as rapid responders to injury and whose activation leads to induction of an adaptive immune response, playing important roles in repair and protection. Since the lens is an avascular tissue, it was presumed that it was absent of resident immune cells. Our studies now show that resident immune cells are a shared feature of the human, mouse, and chicken lens epithelium. These resident immune cells function as immediate responders to injury and rapidly populate the wound edge following mock cataract surgery to function as leader cells. Many of these resident immune cells also express MHCII providing them with antigen presenting ability to engage an adaptive immune response. We provide evidence that during development immune cells migrate on the ciliary zonules and localize among the equatorial epithelial cells of the lens adjacent to where the ciliary zonules associate with the lens capsule. These findings suggest that the vasculature‐rich ciliary body is a source of lens resident immune cells. We identified a major role for these cells as rapid responders to wounding, quickly populating each wound were they can function as leaders of lens tissue repair. Our findings also show that lens resident immune cells are progenitors of myofibroblasts, which characteristically appear in response to lens cataract surgery injury, and therefore, are likely agents of lens pathologies to impair vision like fibrosis.

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Section: Discussionmentioning

confidence: 94%

Resident immune cells of the avascular lens: Mediators of the injury and fibrotic response of the lens

et al. 2021

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“…Several studies demonstrated that IOL material and design can have a significant effect on posterior capsule opacification (PCO) and neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates. [9][10][11][12] AcrySof IOLs were reported to have lower Nd:YAG capsulotomy rates compared with round-edged silicone IOLs (P=0.001). 9 A meta-analysis of randomized controlled trials reported that PCO rates were significantly lower for hydrophobic acrylic versus hydrophilic acrylic IOLs at 1and 2-year follow-up (P=0.0002 and P<0.00001, respectively).…”

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confidence: 99%

Effectiveness and Safety of the Clareon Monofocal Intraocular Lens: Outcomes from a 12-Month Single-Arm Clinical Study in a Large Sample

Lehmann¹,

Maxwell²,

Lubeck³

et al. 2021

OPTH

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This study assessed effectiveness and safety of the novel Clareon intraocular lens (IOL; model SY60CL; Alcon Vision LLC). Patients and Methods: This was a prospective, single-arm, unmasked clinical trial at 16 investigative clinical sites in the United States. Included were adults ≥22 years who required cataract extraction by phacoemulsification. Following phacoemulsification, 350 subjects received SY60CL IOL unilaterally; 342 completed the study. Monocular best corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) were evaluated. The primary effectiveness endpoint was the percentage of subjects with CDVA ≤0.3 logMAR at month 12. Safety was assessed by monitoring adverse events (AEs). Visual acuity and safety outcomes were compared with historical safety and performance endpoint (SPE) rates. Results: At 12 months post-implantation, 99.7% of subjects receiving the SY60CL IOL achieved monocular CDVA ≤0.3 logMAR (primary effectiveness endpoint; 1-sided 95% upper confidence limit >SPE rate); 99.7% and 86.8% of subjects achieved monocular CDVA of ≤0.34 (20/40 Snellen or better) and ≤0.04 logMAR (20/20 Snellen or better), respectively. At 12 months, >95% of subjects achieved mean monocular UDVA ≤0.3 logMAR; 97.1% and 57.6% of subjects achieved monocular CDVA of ≤0.34 and ≤0.04 logMAR, respectively. Mean monocular CDVA and UDVA were −0.05 and 0.04 logMAR, respectively. AEs were within SPE limits. The most common nonserious ocular AE was posterior capsule opacification (5.4%). Serious AEs were <1%, and no serious ocular AEs were assessed as related to the device. There were no observations for IOL glistenings at 12 months. Conclusion: Results of this study supported effectiveness and safety of the SY60CL IOL. Visual acuity outcomes with the SY60CL IOL exceeded the SPE rates for monocular CDVA and AEs were within the limit of historic SPE rates. (Model number SY60WF is the Clareon lens approved by the FDA.

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“…Phacoemulsification cataract removal and intraocular lens insertion is the only therapeutic option to address the visual acuity loss due to cataract. Posterior capsule opacity (PCO) can occur after surgery, which is known as being a multifactorial pathology caused by proliferation of residual lens epithelial cells [8,9]. Although the mechanism is still unclear, it is estimated that PCO can occur in about 10% of cases at 1 year and up to 25% at 5 years after cataract surgery [9].…”

Section: Discussionmentioning

confidence: 99%

“…Posterior capsule opacity (PCO) can occur after surgery, which is known as being a multifactorial pathology caused by proliferation of residual lens epithelial cells [8,9]. Although the mechanism is still unclear, it is estimated that PCO can occur in about 10% of cases at 1 year and up to 25% at 5 years after cataract surgery [9]. Laser capsulotomy is usually preformed in the presence of progressive loss of BCVA.…”

Section: Discussionmentioning

confidence: 99%

Retinal Detachment After Cataract Surgery and Posterior Laser Capsulotomy in a Young Healthy Male Patient: Case Report

Zeppieri¹

2020

SCR

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Background: The onset of cataract formation is normally experienced in senile age. The process of lens opacification can also be influenced by other factors, including systemic diseases, infection, trauma, medication, ultraviolet light exposure, genetic predisposition and environmental sources. Gradual vision loss accompanied by a myopic refractive shift can be caused by nuclear cataract formation, even in young patients. Phacoemulsification cataract removal and intraocular lens insertion surgery is indicated when visual acuity loss and/or myopic anisometropia becomes a problem. Surgical and laser treatments are risk factors in developing retinal detachment, especially in myopic patients. Case Presentation: This is a case of an early onset nuclear cataract in a young male. A 44-year-old man visited the hospital complaining of gradual vision loss in his right eye. History study revealed no systemic or ophthalmic diseases or trauma. The patient underwent phacoemulsification nuclear cataract removal and intraocular lens insertion surgery in his right eye, followed by Nd:YAG laser posterior capsulotomy 3 years later. He underwent phacoemulsification nuclear cataract surgery in his left eye at the age of 48 years, followed by laser capsulotomy treatment 2 years later. At the age 50, a routine eye examination revealed retinal detachment in his right eye. He underwent vitrectomy surgery twice. Conclusion: Nuclear lens opacification is seldom of clinical importance in young healthy adult patients; however, it can be the cause of progressive visual acuity loss, especially in the presence of a myopic refractive shift. Surgery, laser treatment and myopia are all risk factors in retinal detachment. This case shows that thorough and periodic routine eye examinations are a must when dealing with patients with unexpected and atypical signs and symptoms, especially having underwent surgery and laser treatments.

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5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes

Cited by 81 publications

References 25 publications

Resident immune cells of the avascular lens: Mediators of the injury and fibrotic response of the lens

Resident immune cells of the avascular lens: Mediators of the injury and fibrotic response of the lens

Effectiveness and Safety of the Clareon Monofocal Intraocular Lens: Outcomes from a 12-Month Single-Arm Clinical Study in a Large Sample

Retinal Detachment After Cataract Surgery and Posterior Laser Capsulotomy in a Young Healthy Male Patient: Case Report

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