Impact of Age-Related Changes in Lens Shape on the Increased Risk of Posterior Capsule Opacification Observed in...

Posterior capsule opacification (PCO) rates are higher in young cataract patients compared to adults, a phenomenon attributed to a higher proliferative potential of young lens epithelial cells (LECs). This study investigates the hypothesis that implanting standard (adult-sized) intraocular lenses (IOLs) in pediatric patients, whose lenses are smaller and more spherical, results in a low contact between the IOL and the posterior lens capsule (PLC), thus contributing to elevated pediatric PCO rates.

Simulated PLCs (sPLC) modeling the size and curvatures of human lenses of eight-year-old (8y-sPLC), 25-year-old (25y-sPLC), and 65-year-old (65y-sPLC) individuals were fabricated. The physical interactions between standard IOL and the sPLCs were quantified using optical coherence tomography (OCT) and adhesion force testing. Furthermore, the influence of age-dependent lens shape on young and adult primary mouse LEC responses (infiltration, proliferation, and epithelial-mesenchymal transdifferentiation [EMT]) was investigated.

The 8y-sPLC exhibited the least contact with IOLs, followed by 25y-sPLC and 65y-sPLC. Consequently, despite an inherent difference in cell activity, both young and adult LECs exhibited higher responses at the IOL-8y-sPLC interface compared to the 25y- and 65y-sPLC interfaces. Regression analyses confirmed that low IOL-PLC contact, observed only with 8y-sPLC, accompanied by higher cell responses from both young and adult LECs.

The findings suggest that the mismatch in size and curvature between pediatric PLCs and standard IOLs may be a key factor contributing to higher PCO rates observed in young cataract patients.

Our findings provide foundational knowledge for designing age-specific IOLs that optimize IOL-PLC contact, potentially reducing pediatric PCO incidence.