Lens epithelial cell regression on the posterior capsule with different intraocular lens materials

Posterior capsular opacification (PCO) is caused by proliferation and migration of lens epithelial cells (LECs) across the posterior capsule and is the commonest cause of reduced vision after cataract surgery. The influence of intraocular lens (IOL) material on the process of LEC migration was studied.

90 eyes underwent standardised extracapsular surgery, with capsulorhexis and "in the bag" IOL placement. They were randomised to receive a three piece 6 mm lens of PMMA, silicone, or polyacrylic (AcrySof, Alcon, Fort Worth, TX, USA). On days 7, 30, 90, 180, and years 1 and 2 high resolution digitised retroillumination images were taken of the posterior capsule. The presence of LECs was determined at 90 days and 2 years, and their progression or regression was established by serial examination of images.

LECs were seen in 93% of silicone and 97% of PMMA IOLs at 90 days, compared with 46% of polyacrylic (p < 0.001). At year 2 LECs were present in all patients with silicone or PMMA lenses, whereas 62% of patients with polyacrylic IOLs had LECs (p < 0.001). Of those patients with LECs at day 90 LEC regression occurred in 8% with silicone IOLs and 15% of PMMA cases, compared with 83% of patients with polyacrylic IOLs (p < 0.0001).

The presence of LECs on the posterior capsule was considerably lower with polyacrylic than PMMA or silicone IOLs and LEC regression occurred more frequently. The lower incidence of LECs and the higher rate of regression may explain why PCO formation appears to be reduced with polyacrylic lenses. This has important clinical implications for the prevention of PCO.