PCO is the main complication of cataract surgery; no medical treatment is available for its prevention or amelioration. PCO arises from the proliferation, migration, and EMT of residual LECs after cataract surgery. The levels of several cytokines and growth factors, including TGF-β
2, FGF-2, HGF, IL-6, and EGF, increase in the aqueous humor after cataract surgery, and they influence LEC proliferation, migration, and EMT.
29 30 Among these, TGF-β
2 has been shown to play a key role in the etiology of PCO. TGF-β
2 initiates cellular and molecular changes in LECs that are associated with PCO development, including myofibroblast formation, wrinkling of the lens capsule, identification of fibroblast markers, and deposition of ECM.
18 31 32 33 TGF-β
2 has also been shown to inhibit LEC proliferation,
34 35 but this suppressive effect of TGF-β
2 on LEC proliferation is cancelled by other growth factors such as FGF-2,
36 leading to normal LEC proliferation and PCO development. FGF-2 plays a role in PCO development by inducing LEC proliferation, ECM production, multilayering, and plaque formation.
33 HGF has been shown to induce LEC proliferation leading to PCO development.
37 Therefore, because of the differential effect of cytokines and growth factors available to LECs after cataract surgery, we suggest that simultaneous blocking of LEC proliferation, migration, and EMT would be a good strategy to prevent PCO.