The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 9, Risk factors for posterior capsule opacification

Donachie, Paul H. J.; Barnes, Beth; Olaitan, Martina; Sparrow, J M

doi:10.1038/s41433-022-02204-1

Cited by 22 publications

(30 citation statements)

References 13 publications

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“…Based on the findings from various in vivo and in vitro investigations in animals as well as in humans that NSAIDs can lessen the formation of PCO following cataract surgery [12,13], some new non-invasive clinical approaches to reduce after-cataract formation in humans are potentially important because complications from YAG capsulotomy after cataract surgery may result in significant loss of vision from cystoid macular edema, retinal breaks, and detachments with possible IOL damage or subluxation in some cases [1][2][3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Cataract surgery is the most common surgical procedure in the world and the most frequent long-term postoperative complication is posterior capsule opacification (PCO) which reaches 50% in many investigations, many of which require Nd:YAG laser capsulotomy [1]. Although modified surgical techniques including cortical cleanup with improvements in intraocular lens (IOL) design, size, shape, and chemical composition have been developed to reduce PCO formation, this problem is by no means resolved and aftercataract formation still develops as a result of re-proliferation, migration, and metaplasia of residual lens epithelial cells (LECs) from the anterior subcapsular epithelium and the remnants of lenticular fibers, which transform into fibroblasts and myofibroblasts along the posterior lens capsule [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Rate of Posterior Capsule Opacification Following Combined Treatment With Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone: A Two-Year, Randomized Clinical Investigation

Evereklioğlu¹,

Arda²,

Şener³

et al. 2023

Cureus

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Background and aimThe use of non-steroidal anti-inflammatory drugs in animals decreases the incidence of posterior capsular opacification (PCO) following cataract surgery. We evaluated the rate of PCO in patients with cataract surgery and foldable "in the bag" posterior chamber intraocular lens (PC-IOL) implantation treated with combined dexamethasone 0.1% plus ketorolac tromethamine 0.5% versus dexamethasone 0.1% alone. Materials and methodsA total of 114 eyes of 101 patients underwent uneventful corneal small-incision phacoemulsification with primary implantation of a foldable acrylic PC-IOL (AcrySof ® , Alcon, Fort Worth, USA). Postoperatively for four weeks, group 1 eyes were treated with dexamethasone 0.1% plus ketorolac tromethamine 0.5% ophthalmic solutions four times daily for each whereas group 2 eyes were treated with dexamethasone 0.1% alone. Other regiments were the same for each group. Patients were evaluated between one-and fouryear following surgery. The frequency and timing of severe PCO following surgery that needed Nd:YAG laser posterior capsulotomy were recorded and evaluated. ResultsThe mean (SEM) age of group 1 (n = 54) and group 2 (n = 60) at operation was similar (62.8 ± 2.2 vs. 60.6 ± 1.7 years, respectively). Eighty-eight patients had unilateral cataract and 13 cases had bilateral disease. Overall, the mean follow-up duration was 24.7 months postoperatively (range, 15-48). Clinically significant PCO that finally needed Nd:YAG laser application developed in two eyes (3.7%) in group 1 and in four eyes (6.6%) in group 2, and the difference was not statistically significant (p>0.05). The mean month at capsulotomy was 26.5 in group 1 and 24.3 months in group 2 eyes (p>0.05). ConclusionsTopical instillation of ketorolac ophthalmic solution in the immediate period after phacoemulsification and PC-IOL implantation did not seem to influence the incidence of PCO formation two years after cataract surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the Rate of Posterior Capsule Opacification Following Combined Treatment With Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone: A Two-Year, Randomized Clinical Investigation

Evereklioğlu¹,

Arda²,

Şener³

et al. 2023

Cureus

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“…Weaknesses include the lack of baseline ethnicity data and the absence of a direct comparator group. The missing ethnicity data were primarily due to under‐reporting on the local electronic record database (fewer than half of patients had ethnicity data recorded), which is a widespread issue even with national ophthalmology database reports 43 . Inferring from prospective studies using population‐representative datasets of the Liverpool and Aintree region, as well as national census figures, the ethnicity demographics of our cohort is likely to be between 92% and 94% Caucasian 44,45 .…”

Section: Discussionmentioning

confidence: 99%

Three‐year outcomes of an optometrist‐led virtual clinic for new glaucoma referrals

Karthikeyan¹,

Lee²,

Myneni³

et al. 2023

Ophthalmic Physiologic Optic

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Introduction The purpose of this study was to describe and evaluate the outcomes of an optometrist‐led virtual glaucoma clinic (VGC). Methods New patients referred to the glaucoma service who were consultant triaged as ‘low risk’ were assessed virtually by specialist‐trained optometrists in the VGC and either discharged or monitored for a period of 3 years. Ten percent of virtual case notes were audited by a glaucoma consultant to verify quality and generate learning objectives. Retrospective case‐note review and analysis of all patients seen in the virtual clinic between 2014 and 2016 was undertaken to determine 3‐year outcomes. Results A total of 1710 new patients were seen in the clinic between 1 January 2014 and 31 December 2016. Of these, 1033 (60.4%) patients required no outpatient input in 3 years of follow‐up. Additionally, 320 (18.7%) were discharged at the first visit, and the proportion of glaucoma suspect and ocular hypertension patients who converted to glaucoma was 12.1% and 5.8%, respectively. At 3 years, 95 patients had died, 159 were lost to follow‐up, 576 were discharged and 371 were diagnosed with glaucoma at baseline or during the 3‐year follow‐up. The cumulative discharge proportion from the service at the end of 3 years was 82.6%. No patients required emergency eye treatment or sight‐impairment registration, and of the 12 referred back to the clinic on discharge, only five required ongoing monitoring. Conclusion This optometrist‐led VGC combined two aspects of novel service delivery to reduce the burden of glaucoma monitoring in outpatient departments and consolidate consultant contact to patients requiring more intervention. This model will be of value in units establishing virtual services and looking to expand the role of allied health professionals.

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“…However, advanced IOL designs now physically sequester LCs to the capsular bag periphery, preventing their migration into the optical axis [ 11 ], which greatly reduced the incidence of PCO within a year following surgery. However, longer term, PCO is still of clinical concern as lens derived myofibroblasts persist years or even decades following cataract surgery [ 22 ], and can escape from the capsular bag periphery leading to PCO development at extended times PCS [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

The Immediate Early Response of Lens Epithelial Cells to Lens Injury

Novo

Faranda

Shihan

et al. 2022

Cells

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Cataracts are treated by lens fiber cell removal followed by intraocular lens (IOL) implantation into the lens capsule. While effective, this procedure leaves behind numerous lens epithelial cells (LECs) which undergo a wound healing response that frequently leads to posterior capsular opacification (PCO). In order to elucidate the acute response of LECs to lens fiber cell removal which models cataract surgery (post cataract surgery, PCS), RNA-seq was conducted on LECs derived from wild type mice at 0 and 6 h PCS. This analysis found that LECs upregulate the expression of numerous proinflammatory cytokines and profibrotic regulators by 6 h PCS suggesting rapid priming of pathways leading to inflammation and fibrosis PCS. LECs also highly upregulate the expression of numerous immediate early transcription factors (IETFs) by 6 h PCS and immunolocalization found elevated levels of these proteins by 3 h PCS, and this was preceded by the phosphorylation of ERK1/2 in injured LECs. Egr1 and FosB were among the highest expressed of these factors and qRT-PCR revealed that they also upregulate in explanted mouse lens epithelia suggesting potential roles in the LEC injury response. Analysis of lenses lacking either Egr1 or FosB revealed that both genes may regulate a portion of the acute LEC injury response, although neither gene was essential for expression of either proinflammatory or fibrotic markers at later times PCS suggesting that IETFs may work in concert to mediate the LEC injury response following cataract surgery.

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The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 9, Risk factors for posterior capsule opacification

Cited by 22 publications

References 13 publications

Comparison of the Rate of Posterior Capsule Opacification Following Combined Treatment With Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone: A Two-Year, Randomized Clinical Investigation

Comparison of the Rate of Posterior Capsule Opacification Following Combined Treatment With Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone: A Two-Year, Randomized Clinical Investigation

Three‐year outcomes of an optometrist‐led virtual clinic for new glaucoma referrals

The Immediate Early Response of Lens Epithelial Cells to Lens Injury

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