Anterior capsule opacification - Correlation of pathologic findings with clinical sequelae

Objective: To evaluate the degree of anterior capsule opacification (ACO) i n human eyes obtained postmortem containing various rigid and foldable post erior chamber intraocular lens (PC-IOL) designs and compare the findings wi th clinical sequelae of capsular shrinkage. Design: Comparative autopsy tissue study with clinicopathologic correlation s. Materials. Three hundred formalin-fixed human eyes containing the following PC-IOL styles were analyzed: (1) one-piece polymethyl methacrylate (PMMA) optic-PMMA haptic (n = 50), one-piece silicone-plate IOL, with large (2) or small (3) fixation holes (n = 35), (4) three-piece PMMA optic-Prolene hapt ic (n = 50), (5) three-piece acrylic optic-PMMA haptic (n = 55), three-piec e silicone optic with PMMA (6) or polyimide (7) haptics (n = 30), and (8) t hree-piece silicone optic-Prolene haptic (n = 80) lenses. Testing. The eyes were sectioned in the equatorial plane for gross examinat ion of the capsular bag from a posterior view. The cornea and iris were the n excised for evaluation from an anterior view. Main Outcome Measures: ACO was scored in each eye from 0 to IV, according t o the degree/area of capsule opacification. Capsulorrhexis size and IOL dec entration were measured with calipers. Results. The overall differences among the IOL groups regarding the three p arameters were significant (ACO score: P < 0.001; capsulorrhexis diameter: P = 0.036; IOL decentration: P = 0.012). Mean ACO scores were highest with the large- and small-hole one-piece silicone-plate lenses (2.543 +/- 0.950) and lowest with the three-piece acrylic optic-PMMA haptic lenses (0.600 +/ - 0.710). Of 10 cases of capsulorrhexis phimosis observed in the study, 7 c ases were associated with three-piece silicone optic-Prolene haptic lenses, which also presented the highest mean decentration (0.375 +/- 0.601 mm). Conclusions: Our results confirm previous histopathologic observations that the rate of ACO is the lowest with acrylic lenses and higher with plate-ha ptic silicone IOLs. Nevertheless, clinical sequelae of capsular shrinkage a re also very important with three-piece silicone optic-Prolene haptic desig ns. Thus, IOL material and design are significant factors in the developmen t of ACO, but they ultimately also influence the clinical presentation of c apsular shrinkage.