Sealed capsule irrigation: new device to prevent PCO

Lisbon, Portugal – Sealed capsule irrigation (SCI) using steroids in water is a new technique being studied that may prevent posterior capsular opacification (PCO) after cataract surgery. Gerd Auffarth, MD, PhD, from Heidelberg University Eye Clinic, Heidelberg, Germany, described this approach Saturday at the European Society of Cataract and Refractive Surgeons meeting.

Effective IOL implantation is compromised by the development of PCO, Dr. Auffarth said. Pharmacologic treatments of PCO have been difficult because of lack of effective targeting of PCO and possible toxicity to surrounding tissues, he added. This led Dr. Auffarth and colleagues to focus on SCI, which had been introduced previously by Anthony Maloof, MD. The premise behind SCI is that the capsular bag can be isolated, vacuumed after surgery, and an agent applied safely to the capsular bag.

In a prospective randomized clinical study, Dr. Auffarth and colleagues used steroids in distilled water to influence the epithelial cells osmotically in one eye each of 17 patients; the fellow eye of each patient served as a control. The capsular bags were treated for 2 minutes and the SCI device removed. The patients were followed at 1 day and at 1, 3, and up to 12 months. To use SCI, the capsulorhexis must be smaller than 5 mm, and the pupil must be at least 6 to 7 mm.

“The best-corrected visual acuity was the same between both eyes of the patients. There was also no difference between the endothelial cell counts when the eyes of each patient were compared,” Dr. Auffarth said. “When we evaluated various areas in each eye, there was no difference in PCO development in the eyes at the 3- and 6-month evaluations when SCI was used compared with the control eyes.

“At the 6-month evaluation there was no difference in the treated eyes, but the control eyes began to develop more PCO,” Dr. Auffarth continued. “This trend is expected to continue and the differences to be even greater between the treated and control eyes after 2 and 3 years of follow-up.”

He said that use of more aggressive solutions is being considered, perhaps hyperosmolar solutions, to arrest the development of PCO. This is an area for future study, he added.