Interventions for preventing posterior capsule opacification

Findl, Oliver; Buehl, Wolf; Bauer, Péter; Sycha, Thomas

doi:10.1002/14651858.cd003738.pub3

Cited by 112 publications

(71 citation statements)

References 110 publications

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“…Few studies evaluated the choice of post-operative anti-inflammatory treatment, but, in those that did, there was little evidence of an effect on PCO development. 144 …”

Section: Overview Of Capsulotomymentioning

confidence: 99%

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

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BackgroundNHS expenditure has stagnated since the economic crisis of 2007, resulting in financial pressures. One response is for policy-makers to regulate use of existing health-care technologies and disinvest from inefficiently used health technologies. A key challenge to disinvestment is to identify existing health technologies with uncertain cost-effectiveness.ObjectivesWe aimed to explore if geographical variation in procedure rates is a marker of clinical uncertainty and might be used by local commissioners to identify procedures that are potential candidates for disinvestment. We also explore obstacles and solutions to local commissioners achieving disinvestment, and patient and clinician perspectives on regulating access to procedures.MethodsWe used Hospital Episode Statistics to measure geographical variation in procedure rates from 2007/8 to 2011/12. Expected procedure numbers for each primary care trust (PCT) were calculated adjusting for proxies of need. Random effects Poisson regression quantified the residual inter-PCT procedure rate variability. We benchmarked local procedure rates in two PCTs against national rates. We conducted rapid systematic reviews of two high-use procedures selected by the PCTs [carpal tunnel release (CTR) and laser capsulotomy], searching bibliographical databases to identify systematic reviews and randomised controlled trials (RCTs). We conducted non-participant overt observations of commissioning meetings and semistructured interviews with stakeholders about disinvestment in general and with clinicians and patients about one disinvestment case study. Transcripts were analysed thematically using constant comparison methods derived from grounded theory.ResultsThere was large inter-PCT variability in procedure rates for many common NHS procedures. Variation in procedure rates was highest where the diffusion or discontinuance was rapidly evolving and where substitute procedures were available, suggesting that variation is a proxy for clinical uncertainty about appropriate use. In both PCTs we identified procedures where high local use might represent an opportunity for disinvestment. However, there were barriers to achieving disinvestment in both procedure case studies. RCTs comparing CTR with conservative care indicated that surgery was clinically effective and cost-effective on average but provided limited evidence on patient subgroups to inform commissioning criteria and achieve savings. We found no RCTs of laser capsulotomy. The apparently high rate of capsulotomy was probably due to the coding inaccuracy; some savings might be achieved by greater use of outpatient procedures. Commissioning meetings were dominated by new funding requests. Benchmarking did not appear to be routinely carried out because of capacity issues and concerns about data reliability. Perceived barriers to disinvestment included lack of collaboration, central support and tools for disinvestment. Clinicians felt threshold criteria had little impact on their practice and that prior approval systems would not be cost-effective. Most patients were unaware of rationing.ConclusionsPolicy-makers could use geographical variation as a starting point to identify procedures where health technology reassessment or RCTs might be needed to inform policy. Commissioners can use benchmarking to identify procedures with high local use, possibly indicating overtreatment. However, coding inconsistency and limited evidence are major barriers to achieving disinvestment through benchmarking. Increased central support for commissioners to tackle disinvestment is needed, including tools, accurate data and relevant evidence. Early engagement with patients and clinicians is essential for successful local disinvestment.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Few studies evaluated the choice of post-operative anti-inflammatory treatment, but, in those that did, there was little evidence of an effect on PCO development. 144 …”

Section: Overview Of Capsulotomymentioning

confidence: 99%

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

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“…(Cheng, Wei et al 2007;Li, Chen et al 2008;Findl, Buehl et al 2010) The neodymium:YAG capsulotomy rate for acrylic and silicone IOLs was comparable. (Cheng, Wei et al 2007;Li, Chen et al 2008;Findl, Buehl et al 2010) In addition, sharp-edged acrylic and sharp-edged silicone IOLs were significantly more effective than round-edged IOLs in the prevention of PCO and neodymium:YAG capsulotomy. (Cheng, Wei et al 2007;Findl, Buehl et al 2010) Currently available toric IOLs all have a sharp-edged design (Acrysof toric, Rayner toric, Acri.Comfort toric and MicroSil toric), or an almost sharp-edged design (STAAR toric).…”

Section: Posterior Capsule Opacificationmentioning

confidence: 93%

“…Two metaanalyses and one Cochrane systematic review have been published concerning the PCO and neodymium:YAG capsulotomy rates of different IOL biomaterials and optic edge designs. (Cheng, Wei et al 2007;Li, Chen et al 2008;Findl, Buehl et al 2010) Silicone IOLs were associated with lower PCO rates than acrylic IOLs, but this difference did not reach statistical significance in the Cochrance systematic review. (Cheng, Wei et al 2007;Li, Chen et al 2008;Findl, Buehl et al 2010) The neodymium:YAG capsulotomy rate for acrylic and silicone IOLs was comparable.…”

Section: Posterior Capsule Opacificationmentioning

confidence: 99%

“…(Cheng, Wei et al 2007;Li, Chen et al 2008;Findl, Buehl et al 2010) Silicone IOLs were associated with lower PCO rates than acrylic IOLs, but this difference did not reach statistical significance in the Cochrance systematic review. (Cheng, Wei et al 2007;Li, Chen et al 2008;Findl, Buehl et al 2010) The neodymium:YAG capsulotomy rate for acrylic and silicone IOLs was comparable. (Cheng, Wei et al 2007;Li, Chen et al 2008;Findl, Buehl et al 2010) In addition, sharp-edged acrylic and sharp-edged silicone IOLs were significantly more effective than round-edged IOLs in the prevention of PCO and neodymium:YAG capsulotomy.…”

Section: Posterior Capsule Opacificationmentioning

confidence: 99%

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Toric Intraocular Lenses in Cataract Surgery

Visser¹

2012

Astigmatism - Optics, Physiology and Management

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“…After cataract surgery, the incidence of 1 ~ 5 PCO D was 50 % ~ 11 %, and the incidence rate was 100 % (1). The study showed that the proliferation, migration and epithelial mesenchymal transition (EMT) of lens epithelial cells (LEC) after cataract surgery were the main reasons for the formation of PCO (2). Transforming growth factor (TGF) can induce the occurrence of EMT.…”

Section: Introductionmentioning

confidence: 99%

The significance of Akt/NF-κb signaling pathway in the posterior cataract animal model

Shao¹,

Zhu²,

Huo³

et al. 2017

BLL

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OBJECTIVE: To establish SD rat posterior capsular opacifi cation (posterior capsular opacifi cation-PCO) animal model, and to detect the expression of Akt/NF-kb signaling pathway in the PCO model. METHODS: 30 healthy SD rats were randomly divided into control group (0d) and the experimental groups (7d and 14 d), there were 10 rats at all time points. All rats (right eye) were treated with the lens capsule, and the infl ammatory reaction of the anterior segment of the eye and the occurrence of PCO at different time points were observed under the microscope. The TGF-β concentration of humor aquosus was measured at the different time points by ELISA method. Eyeballs were removed after the rats were killed. RT-PCR method was used to detect the gene expression levels of Akt and NF-κb and Westen Blot method to detect the protein expression of Akt, p-Akt, NF-κb and p-NF-κb. RESULTS: TGF-β concentration, Akt and NF-κb gene expression, and Akt, p-Akt, NF-κb and p-NF-κb protein expression in humor aquosus, increased with the time and the time-dependence was signifi cant. CONCLUSION: Akt/NF-κb signaling pathway may be closely related to the occurrence and development of PCO, which may be related to the role of protein phosphorylation (Fig. 5, Ref. 20). Text in PDF www.elis.sk.

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Interventions for preventing posterior capsule opacification

Cited by 112 publications

References 110 publications

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Toric Intraocular Lenses in Cataract Surgery

The significance of Akt/NF-κb signaling pathway in the posterior cataract animal model

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