Anterior capsule opacification and lens epithelial outgrowth on the intraocular lens surface arter curettage

Purpose: To evaluate the long-term difference in lens epithelial cell (LEC) outgrowth on the anterior surface of a hydrogel intraocular lens (IOL) aft er curettage of the entire or one half of the circumference of the anterior capsule, Setting: Department of Ophthalmology, University of Vienna, Austria. Methods: Forty eyes with senile cataract only were randomly assigned to Gro up A, which had curettage of the entire anterior capsule, or Group B, which had curettage of the nasal half of the anterior capsule. Rentsch capsule c urettes (Geuder) were used, a straight one for the nasal half and a bent mo del for the temporal half. One surgeon performed all standardized procedure s with a temporal clear corneal incision, phacoemulsification, and in-the-b ag implantation of a hydrogel IOL. Two years after surgery, the anterior su rface of the IOL was examined by specular microscopy in a double-blinded fa shion, and LEC outgrowth was graded semiquantitatively. Anterior capsule op acification (ACO) was also graded semiquantitatively. Results: In Group A, grade 2 ACO was observed in 53% of patients and grade 1 ACO in 47%. Similar results were achieved in Group B (59% and 41%, respec tively). Two years after IOL implantation, the typically circumferential mo nolayer outgrowth of LECs on the hydrogel IOL surface was present in 80% in Group A and 60% in Group B, The ongrowth was less dense in the other IOLs; however, no significant differences between the groups were observed. Conclusions. Mechanical removal of residual LECs with a Rentsch capsule cur ette from the entire or from one half of the anterior capsule did not reduc e LEC outgrowth 2 years after IOL implantation. Furthermore, the ACO grade was not significantly different. Lens epithelial cell proliferation in the germinative region and consecutive migration might be the cause of this out growth. (C) 2001 ASCRS and ESCRS.