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[Prevention of secondary cataract by intracapsular administration of the antimitotic daunomycin]
C Hartmann1, P Wiedemann, K Gothe
1Clinique Ophtalmologique de l'université de Cologne.
Abstract:
Pharmacological inhibition of capsule opacification e.g. using antimitotics such as daunomycin is a promising concept. Our own in vitro studies on cultured porcine lens epithelial cells have shown, that daunomycin penetrates the cells within at least 5 minutes. It possesses a low acute cytotoxicity and significantly inhibits epithelial cell proliferation at dose dependent concentrations ranging from 2.5 to 7.5 mg/l. In addition, in vitro studies on isolated pig corneas showed almost no corneal endothelial toxicity. After 10 resp. 30 min. exposure to 7.5 mg/l daunomycin, there was only 4.8 +/- 1.6 resp. 6.1 +/- 1.5% endothelial damage that dit not significantly differ from BSS serving as control. Encouraged by our clinical experience of good anterior segment tolerance of 7.5 mg/l daunomycin when used during vitrectomy in PVR, we started a prospective clinical trial to assess the effect to daunomycin on capsular opacification after ECCE with endo-capsular IOL implantation using the envelope technique. After agreement of the medical ethic commission we chose 6 patients with a mean age of 78 (72-83), no other ocular or general diseases and bilateral cataract of identical morphology and density. After written consent of the patients their first eye was operated using BSS as control. At least 4 weeks later the second eye was operated and received 0.5 ml of daunomycin (7.5 mg/l) applied during 5 minutes into the cleaned capsular bag, leaving the anterior capsular flap and a Healon filled anterior chamber to protect the surrounding intraocular structures. Mean postoperative control time actually is 12 (6-17) months for the controls and 10 (5-14) months for the eyes treated with daunomycin.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Daunomycin effectively inhibits lens epithelial cell proliferation, showing low toxicity in vitro and in clinical trials for preventing capsular opacification after cataract surgery. This antimitotic agent offers a promising approach to enhance outcomes in extracapsular cataract extraction with intraocular lens implantation.
Area of Science:
- Ophthalmology
- Pharmacology
- Cell Biology
Background:
- Capsular opacification is a common complication after cataract surgery.
- Pharmacological inhibition using antimitotics like daunomycin is a potential preventive strategy.
- Previous in vitro studies demonstrated daunomycin's efficacy and safety profile.
Purpose of the Study:
- To evaluate the effect of daunomycin on preventing capsular opacification.
- To assess the safety and efficacy of daunomycin in patients undergoing cataract surgery.
Main Methods:
- Prospective clinical trial involving 6 patients with bilateral cataracts.
- One eye served as control (BSS), the other received 0.5 ml of 7.5 mg/l daunomycin in the capsular bag post-ECCE.
- Postoperative follow-up ranged from 5 to 17 months.
Main Results:
- In vitro studies showed daunomycin inhibits epithelial cell proliferation at 2.5-7.5 mg/l with low cytotoxicity.
- In vitro studies on pig corneas indicated minimal endothelial damage (<7%) after daunomycin exposure.
- Clinical trial data on daunomycin's effect on capsular opacification is being collected.
Conclusions:
- Daunomycin demonstrates promising in vitro efficacy and safety for preventing capsular opacification.
- Further clinical evaluation is warranted to confirm its therapeutic potential in cataract surgery patients.