University of Utah researchers highlight deficiencies of current methods of cortical cleanup

San Francisco-Current methods used to evacuate the capsule of lens epithelial cells and other lens material are not sufficient to prevent late complications of Soemmerring’s Ring formation, posterior capsule opacification (PCO), and unwanted fibrosis after pediatric cataract surgery, said Brian Zaugg, BS.

Zaugg reported the findings from a study conducted at the University of Utah, Salt Lake City, using 500 cadaver eyes from the David J. Apple Center databank. The specimens were post-extracapsular cataract extraction and IOL insertion and were examined and photographed using the Miyake-Apple technique. The eyes were evaluated with special reference to identifying PCO and postoperative fibrosis proliferation of lens epithelial cells.

Two levels of intracapsular lens epithelial cell activity were identified through examination of the capsular bag. While 40% of cells were quiescent and appeared no longer capable of causing problematic proliferation, 60% of cells were viable and mitotic. In addition, there were no eyes where complete cortical cleanup was achieved.

The researchers also concluded that a Soemmerring’s Ring occurs in 100% of cases 5 to 7 years after surgery and that all IOL models are susceptible to a breakout of cells from the Soemmerring’s Ring that leads to PCO.

“This study identifies an important problem and even suggests that a paradigm shift needs to be made in the surgical procedure,” Zaugg said. “We recommend that the search for a better means of removing lens material using pharmacologic or other approaches must continue.”