Posterior Capsular Opacification

Awasthi, Niranjan

doi:10.1001/archophthalmol.2009.3

Cited by 301 publications

(156 citation statements)

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“…Both processes cause vision to degenerate, light becomes scattered and patients suffer from glare from lights at night and reduction in visual acuity (VA). [131][132][133] PCO or 'secondary cataract' is the most common complication of cataract surgery; 134 incidence is reported to be 12%, 21% and 28% at 1, 3 and 5 years respectively. 135 …”

Section: Overview Of Posterior Capsule Opacificationmentioning

confidence: 99%

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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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Section: Overview Of Posterior Capsule Opacificationmentioning

confidence: 99%

“…132,136 Quick pulses of the laser make precise ablations in the posterior capsule and create a small circular opening in the visual axis. The treatment is usually done using topical anaesthesia with non-sedated patients.…”

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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“…Tako spremenjene celice so sposobne odlagati kolagen in obnoviti oz. regenerirati lečna vlakna v prostoru med umetno lečo in zadnjo lečno ovojnico (12). Celice lečnega epitela se razmnožujejo v različnih vzorcih.…”

Section: Razvoj Zamotnitve Zadnje Lečne Ovojniceunclassified

Vloga lečnih epitelnih celic pri razvoju zamotnitve zadnje lečne ovojnice in pri obnovi leče po operaciji prirojene sive mrene

Andjelić¹

2017

SlovMedJour

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Vloga lečnih epitelnih celic pri razvoju zamotnitve zadnje lečne ovojnice in pri obnovi leče po operaciji prirojene sive mreneThe role of lens epithelial cells in the development of the posterior capsule opacification and in the lens regeneration after congenital cataract surgery Sofija andjelic IzvlečekNajpogostejši zaplet po operaciji sive mrene je zamotnitev zadnje lečne ovojnice (angl. posterior capsule opacification, PCO), ki pogosto povzroči poslabšanje vidne funkcije. Vzrok za nastanek PCO je razmnoževanje in selitev lečnih epitelnih celic, ki se med operacijo ne uspejo odstraniti in ostanejo na lečni ovojnici. PCO ima značilnost fibroze, ki se kaže z intenzivnejšim deljenjem, selitvijo, odlaganjem matriksa in spremembo oziroma prehodom v miofibroblaste.Presenetljivo rezultati najnovejših raziskav kažejo, da so lečne epitelne celice pomembne pri obnovi oz. regeneraciji leče pri novem načinu operacije prirojene sive mrene. Pri tem načinu se odstrani le 1-1,5 mm lečne ovojnice bolj lateralno, tako da ostane večji del lečnega epitela nepoškodovan. Nov način operacije se razlikuje od sedanjega, saj se pri njem ohranijo endogene lečne epitelne celice, ki se ne poskušajo odstraniti oz. uničiti. Lečne epitelne celice se tako lahko po operaciji razmnožujejo znotraj lečne ovojnice. Uspeli so doseči funkcionalno obnovo leče pri kuncih in opicah pa tudi pri otrocih s prirojeno očesno mreno. Za obnovo očesne leče je ključnega pomena pluripotentnost leč-nih epitelnih celic, ki imajo naravo zarodnih celic.Ex vivo kulture eksplantov lečnih ovojnic, na katerih so lečne epitelne celice, lahko uporabljamo za testiranje farmakoloških reagentov, s katerimi spodbujamo ali zaviramo rast lečnih epitelnih celic. Funkcionalnost celic in odgovore na farmakološke reagente lahko ovrednotimo z analizo znotraj-in zunajcelične signalizacije kalcija (Ca 2+ ).Spodbujanje rasti lečnih epitelnih celic je pomembno pri obnovi leče pri novem načinu operacije prirojene sive mrene, nasprotno pa je zaviranje rasti lečnih epitelnih celic pomembno pri prepreče-vanju razvoja PCO. Članek opisuje metode analize delovanja lečnih epitelnih celic, ki jih pridobimo pri operacijah sive mrene ter jih izvajamo v laboratoriju na Očesni kliniki UKC v Ljubljani. AbstractPosterior capsule opacification-PCO is the most common complication after cataract surgery. Proliferation and migration of lens epithelial cells that remain in the capsular bag following cataract surgery can lead to the development of PCO, which is the main cause of deterioration of visual function. PCO shows the classic features of fibrosis, including hyperproliferation, migration, deposition of matrix and its shrinkage and transdifferentiation into myofibroblast. Astonishingly, the results of recent research show the importance of lens epithelium for lens regeneration following congenital cataract surgery. New minimally invasive cataract surgery removes only 1-1.5 mm of lens epithelium more laterally, so the major part of the epithelium remains in the

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“…The cataract surgery procedure, through removal of fiber cells, induces an injury response in the adjacent lens epithelium, which responds by re-epithelialization of the posterior area of the lens capsule that had been occupied by the fiber cells. In cataract surgery, as in most wound repair responses, there sometimes occurs an aberrant fibrotic outcome to the wound healing response, associated with the emergence of myofibroblasts, which in the lens is known as Posterior Capsule Opacification [20][21][22] . To generate the cataract surgery wound healing model, a cataract surgery procedure is mimicked in lenses removed from the chick embryo eye to produce a physiological injury.…”

Section: Introductionmentioning

confidence: 99%

Establishment of a Clinically Relevant <em>Ex Vivo</em> Mock Cataract Surgery Model for Investigating Epithelial Wound Repair in a Native Microenvironment

Walker

Bleaken

Wolff

et al. 2015

JoVE

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The major impediment to understanding how an epithelial tissue executes wound repair is the limited availability of models in which it is possible to follow and manipulate the wound response ex vivo in an environment that closely mimics that of epithelial tissue injury in vivo. This issue was addressed by creating a clinically relevant epithelial ex vivo injury-repair model based on cataract surgery. In this culture model, the response of the lens epithelium to wounding can be followed live in the cells' native microenvironment, and the molecular mediators of wound repair easily manipulated during the repair process. To prepare the cultures, lenses are removed from the eye and a small incision is made in the anterior of the lens from which the inner mass of lens fiber cells is removed. This procedure creates a circular wound on the posterior lens capsule, the thick basement membrane that surrounds the lens. This wound area where the fiber cells were attached is located just adjacent to a continuous monolayer of lens epithelial cells that remains linked to the lens capsule during the surgical procedure. The wounded epithelium, the cell type from which fiber cells are derived during development, responds to the injury of fiber cell removal by moving collectively across the wound area, led by a population of vimentin-rich repair cells whose mesenchymal progenitors are endogenous to the lens 1 . These properties are typical of a normal epithelial wound healing response. In this model, as in vivo, wound repair is dependent on signals supplied by the endogenous environment that is uniquely maintained in this ex vivo culture system, providing an ideal opportunity for discovery of the mechanisms that regulate repair of an epithelium following wounding. Video LinkThe video component of this article can be found at

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Posterior Capsular Opacification

Cited by 301 publications

References 117 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

Vloga lečnih epitelnih celic pri razvoju zamotnitve zadnje lečne ovojnice in pri obnovi leče po operaciji prirojene sive mrene

Establishment of a Clinically Relevant <em>Ex Vivo</em> Mock Cataract Surgery Model for Investigating Epithelial Wound Repair in a Native Microenvironment

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