Specular microscopy of the anterior lens capsule after endocapsular lens implantation

Abstract

Endocapsular phacoemulsification and complete in-the-bag intraocular lens (IOL) fixation was performed on 77 eyes. Specular microscopy of the anterior lens capsule was performed postoperatively, and the process of anterior capsule opacification after endocapsular cataract surgery was classified. Lens epithelial cells on the inner surface of the anterior lens capsule, facing the optical portion of the IOL, underwent a diffuse fibrosis. In more peripheral areas, where the anterior and posterior capsules were tightly adherent, the regularly proliferating lens epithelial cells retained their polygonal shape. These findings suggest the possibility of retaining the transparency of the anterior lens capsule postoperatively by refilling the capsular bag to apply internal pressure.

Long-term Study of Posterior Capsular Opacification Prevention With Endocapsular Equator Rings in Humans

“…In rabbit eyes, in which extensive postoperative capsular opacification usually occurs, the Ering prohibited PCO without preoperative and postoperative local or general medication. 6 In electron microscopic 14,16,37 and immunohistochemical observations, including the in situ hybridization technique, the postoperative changes under the anterior capsule and equator were the same as during normal wound healing. 38 Fagerholm et al 39 reported the same concept earlier.…”

“…4,14 Because Kleinmann et al 15 reported that the capsular bag can survive anatomically without the LECs, this seems to be a rational approach, but all trials failed. During actual clinical surgery, it is almost impossible to remove all LECs superiorly, and if any LECs remain, they transform into fibroblastlike cells, 16 anterior capsular opacification occurs, and the subsequent PCO cannot be prevented. In addition, there is no chemical procedure to remove all LECs completely and safely.…”

“…However, when the PMMA IOL was inserted between these capsules, the LECs became mobile and both capsules were opacified. 16 When the dual-optic accommodative IOL was placed in the almost retained capsular bag and the anterior and posterior capsules were pressed tightly from inside using PMMA optics, both capsules maintained their transparency but could not prevent massive proliferation from the compressionfree equatorial area. 23 To obtain more ideal compression from inside over a wide area, a silicone endocapsular balloon was inserted into the almost completely retained capsular bag and inflated.…”

Age-Related Changes of Human Lens Epithelial Cells in vivo

“…However, using a slitlamp and a conventional specular microscope, in vivo LECs have only been observed on the surface of an intraocular lens and near the rim of the anterior capsular opening after cataract surgery [12][13][14]. The specular images of LECs in the crystalline lens in vivo were not well visualized when they were compared with those of corneal endothelial cells [15][16][17][18][19][20].…”