Life and death on the posterior capsule

Whilst posterior capsule opacification (PCO) rates had been dramatically reduced in the past few years thanks to IOL design and development there was still a great deal of work to be done in addressing what remains the common complication following implant and cataract surgery, according to Dr David Spalton who delivered the Ridley Medal Lecture at ESCRS in Paris.

Life and death on the posterior capsule was the theme of his talk and he addressed the strides made since Harold Ridley implanted the very first IOL in 1949 from realizing that PCO was not an inevitable result of the procedure, that square edge profiles made a difference in prevention and that resistance was best offered by a 360 degree square edged barrier on the IOL so that lens ephithelial cells could not migrate across the optic-haptic onto the posterior capsule.

Dr Spalton also acknowledged that as the trend towards microincision surgery increased manufacturers were concentrating on developing thinner-edged lenses to insert in a small incision but this was at the expense of incorporating a 360 degree square edged barrier. He predicted that this trend would not be reversible and that the answer to further reduction in PCO rates would emerge from elsewhere. Research to achieve this currently includes isolation of the lens epithelial cells, a means of destroying them completely or removing them by means of an open bag device.