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S.K. Pandey, G. Neilson, E.J. Milverton, A.J. Maloof; Selective Targeting of Lens Epithelial Cells During Human Cataract Surgery Using Sealed–Capsule Irrigation With Distilled Water . Invest. Ophthalmol. Vis. Sci. 2004;45(13):318.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Postoperative proliferation of lens epithelial cells in the capsular bag remains the most common complication of cataract surgery. Intraocular infusion of anti–metabolites or hypo–osmotic agents are not preferred in human cataract surgery due to potential toxicity to corneal endothelium and other tissues. Selective delivery of pharmacologic/hypo–osmotic agents into the capsular bag is now possible using a Sealed Capsule Irrigation (SCI) device, manufactured from biomedical grade soft silicone. This device allows the surgeon to reseal the capsular bag intraoperatively. We evaluated efficacy of distilled water for intraoperative irrigation of the internal capsular bag during cataract–intraocular lens (IOL) surgery using SCI. Methods: A total of 9 eyes underwent cataract–IOL surgery using SCI with distilled water and hydrophobic acrylic lenses (Group AA). Another 9 eyes underwent cataract–IOL surgery using SCI with distilled water and silicone lenses (Group AS). A control group of 18 eyes, underwent cataract surgery with implantation of silicone or hydrophobic acrylic lenses, without SCI (Group BA and BS). All eyes in the Groups AA, AS, underwent internal irrigation of the capsular bag using distilled water for 90 seconds using the SCI device (Perfect Capsule,TM Milvella Pty. Ltd., Sydney, Australia). Fluorescein sodium (0.01%) was used to identify the leakage into the anterior chamber prior to the SCI procedure. Slit lamp biomicroscopic examination was performed at 1 day, 1 week, 3 and 6 months to evaluate anterior capsule opacification (ACO), capsular folds/wrinkling, capsular phimosis, and posterior capsule opacification (PCO) (area/severity). Results: Intraoperatively, there was no visible leakage of fluorescein sodium into the anterior chamber during SCI in all eyes in Group AA and AS, indicative of effective seal provided by the SCI device. Follow–up examination at 6 months demonstrated a significant reduction in ACO in all eyes, which had undergone SCI with distilled water treatment (Group AA and AS) in comparison to control (Group BA and BS). In addition, the degree of capsular phimosis was significantly reduced in group AA and AS, compared to control groups BA and BS. Conclusions: SCI of the capsular bag using distilled water may cause swelling and lyses of lens epithelial cells as indicated by significantly less ACO after 6 months. SCI may allow the isolated safe delivery of other pharmacological agents into the capsular bag during cataract surgery.
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