Overview of Current and Prospective Applications of the Anterior Lens Capsule in Eye Surgery

This review provides an outcome-oriented, comprehensive summary of published works on the topic of repurposing the anterior lens capsule (ALC) in various subfields of ophthalmic surgery. Covering a broad spectrum of studies ranging from pre-clinical experiments on animal models to blinded prospective clinical trials involving patients.

National Institute of Health (NIH) and COCHRANE libraries were comprehensively searched for published works covering the topic of ALC utilization in corneal, retinal, and glaucoma surgical procedures. Studies covering the topic of ALC use unrelated to ophthalmic surgical trials were excluded. A total of 15 studies were included based on the search criteria. Patient follow-up was limited to 18 months. Primary and secondary post-surgical outcomes were evaluated to assess the surgical effectiveness and complication risk of ALC use compared to alternative surgical techniques.

ALC is a viable ophthalmic tissue for prospective use in ophthalmic surgery. Despite the limited number of studies conducted on the topic, the results presented have shown promise. Three studies demonstrated superior post-surgical outcomes in ALC-utilizing procedures compared to other ophthalmologic interventions. Remaining studies included in this review have demonstrated potential equivalence of outcomes after ALC-utilizing surgeries to established surgical methods without presenting new limitations and complications.

ALC is an abundant, routinely discarded tissue during cataract surgery. It possesses unique properties of acellularity, optical transparency, and immunologic nativity to the human eye, which enables it to be an excellent donor tissue for ophthalmic surgeries ranging from corneal defect management to prolonging the longevity of anti-glaucoma filtering blebs. The use of ALC autografts in ophthalmic surgery allows for augmentation of standard procedures in phakic patients, delivering satisfactory outcomes and potentially reducing costs. Further research into ALC collection, processing, and long-term storage is needed to enable ALC allograft use in pseudophakic and aphakic patients.