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G. Sultan, A. Staropoli, C. Blondin, P. Rat, J. Warnet, C. Baudouin; Role of the Packaging in the Cytotoxicity Induced by Two Soft Acrylic Intraocular Lenses on Human Lens Epithelial Cell Line . Invest. Ophthalmol. Vis. Sci. 2003;44(13):206.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: After phacoemulsification, in the anterior chamber, post-operative cases of strong aseptic inflammatory reactions have often been reported. This complication was called TASS (Toxic Anterior Segment Syndrome). It has been suggested that most of these sterile endophthalmitis appear with soft acrylic hydrophilic IOLs. In view of these clinical data, we investigated the role of the IOL packaging (transport liquid, flask cap) in the etiology of TASS. Methods: To release residual chemicals from polymeric biomaterials, ACR6D (Corneal, France) and Istacryl (LCA, France) chlorobutyl flask caps were eluted in DMEM during 24h. The IOL transport solution was diluted in DMEM and compared with a NaCl 0,9% solution. Then, Human Lens Epithelial Cells (SRA 01/04) were treated with the different solutions for 24h. Membrane integrity was assessed using a neutral red test to study cellular viability. Chromatin condensation was evaluated by DNA probes, Hoechst 33342 test and propidium iodide, to characterize apoptosis. These quantitative tests were performed directly in 96 wells microplates using cold light cytofluorometry. Then a qualitative analysis of HLECs treated with the various solutions and stained with phalloidine and propidium iodide, was performed by confocal microscopy. Results: An important necrosis was observed in cells treated with the flask cap elution liquid and the transport liquid. This reaction was characterized by a decrease of both neutral red and Hoechst 33342 / propidium iodide (fluorescence: 70% lower than cellular control for the caps eluted solution, and 30% for the diluted transport liquid solution). Confocal microscopy analysis of cells treated with the various solutions showed a decrease of the cell number, with a cytosqueletal disorganization. Conclusions: These chlorobutyl flask caps appeared to be toxic on HLECs in vitro. They may release chemical particles in the transport solution, which can induce a strong inflammatory reaction in the anterior chamber after phacoemulsification, especially if IOLs are not carefully rinsed before implantation. Other types of packaging, like blisters, as the new one used for the ACR6D, may be more appropriated to intraocular implantation.
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