title: Anterior capsule opacification: correlation of pathologic findings with clinical sequelae.
abstract: OBJECTIVE
  To evaluate the degree of anterior capsule opacification (ACO) in human eyes obtained postmortem containing various rigid and foldable posterior chamber intraocular lens (PC-IOL) designs and compare the findings with clinical sequelae of capsular shrinkage.
  
  
  METHODS
  Comparative autopsy tissue study with clinicopathologic correlations.
  
  
  METHODS
  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 haptic (n = 50), (5) three-piece acrylic optic-PMMA haptic (n = 55), three-piece silicone optic with PMMA (6) or polyimide (7) haptics (n = 30), and (8) three-piece silicone optic-Prolene haptic (n = 80) lenses.
  
  
  METHODS
  The eyes were sectioned in the equatorial plane for gross examination of the capsular bag from a posterior view. The cornea and iris were then excised for evaluation from an anterior view.
  
  
  METHODS
  ACO was scored in each eye from 0 to IV, according to the degree/area of capsule opacification. Capsulorrhexis size and IOL decentration were measured with calipers.
  
  
  RESULTS
  The overall differences among the IOL groups regarding the three parameters 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 cases 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-haptic silicone IOLs. Nevertheless, clinical sequelae of capsular shrinkage are also very important with three-piece silicone optic-Prolene haptic designs. Thus, IOL material and design are significant factors in the development of ACO, but they ultimately also influence the clinical presentation of capsular shrinkage.
authors.affiliation: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA.
authors.forename: L
authors.initials: L
authors.lastname: Werner
authors.forename: S K
authors.initials: SK
authors.lastname: Pandey
authors.forename: D J
authors.initials: DJ
authors.lastname: Apple
authors.forename: M
authors.initials: M
authors.lastname: Escobar-Gomez
authors.forename: L
authors.initials: L
authors.lastname: McLendon
authors.forename: T A
authors.initials: TA
authors.lastname: Macky
mesh_terms: D000180:Acrylic Resins; D000869:Anterior Eye Segment / Q000473:pathology; D002386:Cataract / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000473:pathology*; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular / Q000009:adverse effects; D011183:Postoperative Complications / Q000473:pathology*; D011474:Prosthesis Design; D012826:Silicone Elastomers
chemical_list: D000180:Acrylic Resins; D012826:Silicone Elastomers