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Subspecialties Cataract

PCO Secrets

At a Glance

  • Posterior capsule opacification (PCO) occurs as a result of natural post-surgical wound healing in the eye, and can lead to patients losing some of their vision months or years after undergoing cataract surgery
  • The new in vitro capsular bag model, developed by University of East Anglia scientists and West Norwich Hospital ophthalmologists, benefits from spatial organization and cell types found in real-life patients
  • Researchers are working on improving the human model, replicating regenerative features of PCO and examining a range of IOLs to determine the best outcomes for patients.

At nearly 30 million operations per annum, cataract removal and intra-ocular lens (IOL) implantation is the most common surgical procedure in the world. There are good reasons for this: cataract surgery is phenomenally effective at restoring sight to patients. But imagine how frustrating it would be for an IOL recipient to find their sight disappearing all over again.  Unfortunately, this is precisely what happens to those patients who experience posterior capsule opacification (PCO). After two or three years, their decline in vision is such that they need yet another procedure – laser-removal of light scattering areas. This is not only inconvenient, but also associated with a degree of risk. Obviously, patients and surgeons alike want to avoid this situation.

Developing rational approaches to inhibit or avoid PCO, however, requires some understanding of the processes at work. What causes PCO? In brief, it is the consequence of a natural wound-healing mechanism in the eye, which itself is a response to the trauma of cataract surgery. A key aspect of post-surgical wound-healing in the eye is stimulation of lens epithelial cells to proliferation and migrate. Some of these cells invade previously cell-free areas of the lens capsular bag and can grow over the IOL, which interferes with the passage of light to the retina. Consequently, many patients start to lose their vision within months or years of having cataract surgery. We know that much about PCO – but we still have a lot of questions to answer. What molecular pathways are involved, and how might we modulate them? Which IOLs are inherently less susceptible to PCO and why – and can we build on this to design IOLs that can better prevent PCO?

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Michael Wormstone


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