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| |  ARVO: Sealed Capsule Irrigation Devices May Aid Cataract Surgery By Mike Fillon FORT LAUDERDALE, FL -- April 28, 2004 -- Opacification of the posterior capsule (PCO), caused by the proliferation of lens epithelial cells in the capsular bag, is still the most common complication of cataract surgery. A new study shows selective delivery of pharmacological agents using sealed capsule irrigation devices may allow surgeons to reseal the capsular bag without damaging collateral ocular structures owing to leakage into the anterior chamber. Results of the study were reported here on April 25th in a poster presentation at the Association for Research in Vision and Ophthalmology Annual Meeting. Reducing or eliminating PCO relies on removing cells from the anterior and equatorial regions of the capsular bag after cataract surgery. Several pharmacological methods have been attempted to eliminate lens epithelial cells with varying results. This new concept in irrigation of the lens capsule following lens surgery called sealed capsule irrigation was developed by 1 of the researchers involved in this study; Anthony J. Maloof, MBBS, MbiomedE from the ophthalmology and visual sciences department, Sydney Hospital and Sydney Eye Hospital in Sydney, Australia. The irrigation device is made from biomedical grade soft silicone and allows the surgeon to reseal the capsular bag. The device consists of a rounded plate containing a suction ring that abuts the anterior capsule, and an extension arm that passes through a phacoemulsification wound. The extension arm has a vacuum channel that supplies suction to the suction ring, and a combined irrigation and outflow channel. Because the device is short, it folds easily and can be inserted through a 3.2 to 3.5 mm incision using Kelman-McPherson forceps. For the study, all surgeries were performed under topical anesthesia at the Intraocular Implant Unit of the Sydney Eye Hospital. A total of 9 eyes underwent cataract surgery with implantation of 1- or 3-piece hydrophobic acrylic lenses using sealed capsule irrigation with distilled water (group AA). Another 9 eyes underwent cataract surgery with implantation of silicone lenses using sealed capsule irrigation with distilled water (Group AS). A control group of 18 eyes underwent cataract surgery with implantation of hydrophobic acrylic lenses, or silicone intraocular lens designs, but without irrigation (Group BA and BS). All eyes in groups AA and AS underwent internal irrigation of the capsular bag using 20 cc of distilled water for 90 seconds using the sealed capsule device. The researchers noted there was no leakage of the 0.01% fluorescein sodium or 0.01% trypan blue dyes into the chamber, confirming the closed chamber irrigation of the capsular bags. Slit lamp biomicroscopic examination was performed at 1 day, 1 week, and 3 and 6 months to evaluate anterior capsule opacification, capsular folds/wrinkling, capsular phimosis, and the area and severity of PCO. The 6-month follow-up examination showed a reduction in anterior capsule opacification in all eyes in groups AA and AS in comparison to the control groups. After 1-year follow-up, the degree of anterior capsule fibrosis and capsular phimosis was reduced in the AA and AS groups compared with the control groups. However, the PCO was not seen in the majority of the control and treatment eyes at the 1-year follow-up. According to the researchers, the definitive agent to be used with sealed capsular irrigation is currently being investigated.
[Presentation title: Selective Targeting of Lens Epithelial Cells During Human Cataract Surgery Using Sealed-Capsule Irrigation With Distilled Water. Abstract B291]
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