title: Prevention of capsule opacification after accommodating lens refilling: pilot study of strategies evaluated in a monkey model.
abstract: OBJECTIVE
  To test 2 strategies to prevent capsule opacification after accommodating lens refilling in a rhesus monkey model.
  
  
  METHODS
  Animal laboratory and laboratory of European university medical centers.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Six rhesus monkeys had refilling of the lens capsular bag. In the first strategy, before it was filled with a silicone polymer, the capsular bag was treated with noncommercial sodium hyaluronate 1.0% containing cytotoxic substances. In the second strategy, the capsular bag was filled with clinically used sodium hyaluronate 1.0% (Healon) after treatment with actinomycin-D. Slitlamp inspection was performed during a follow-up of 40 to 50 weeks. After enucleation, magnetic resonance images were obtained and confocal fluorescence imaging was performed.
  
  
  RESULTS
  Using the first strategy, capsule opacification developed in all eyes. Using the second strategy, 1 monkey did not develop capsule opacification after a 9-month follow-up. In a second monkey, the lens capsule remained clear for 3 months, after which the hyaluronate refill material was exchanged with a silicone polymer and capsule opacification developed. Combining these results with those in a previous study, the difference in opacification between silicone and sodium hyaluronate as refilling materials was statistically significant (P<.01).
  
  
  CONCLUSIONS
  That no capsular bag fibrosis occurred in the presence of hyaluronate suggests that the properties of hyaluronate are the reason that remaining lens epithelial cells do not develop into fibrotic cells. The choice of a suitable lens-refilling material prevents the development of capsule opacification.
  
  
  BACKGROUND
  Mr. Terwee was an employee of Abbott Medical Optics B.V. during the study period. No other author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany. Electronic address: s.a.koopmans@umcg.nl.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Koopmans
authors.affiliation: From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany.
authors.forename: Thom
authors.initials: T
authors.lastname: Terwee
authors.affiliation: From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany.
authors.forename: Alex
authors.initials: A
authors.lastname: Hanssen
authors.affiliation: From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Martin
authors.affiliation: From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany.
authors.forename: Soenke
authors.initials: S
authors.lastname: Langner
authors.affiliation: From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Stachs
authors.affiliation: From the Animal Laboratory of the University of Nijmegen (Hanssen), Nijmegen, and the Department of Ophthalmology (Koopmans) and the Department of Biomaterials (van Kooten), University of Groningen, Abbott Medical Optics b.v. (Terwee), Groningen, the Netherlands; the Department of Radiology (Langner), University of Greifswald, Greifswald, the Department of Biomedical Engineering (Martin), and the Department of Ophthalmology (Stachs), University of Rostock, Rostock, Germany.
authors.forename: Theo G
authors.initials: TG
authors.lastname: van Kooten
mesh_terms: D000065:Accommodation, Ocular; D000818:Animals; D058442:Capsule Opacification / Q000517:prevention & control*; D003609:Dactinomycin / Q000494:pharmacology*; D004195:Disease Models, Animal; D004338:Drug Combinations; D005260:Female; D006820:Hyaluronic Acid / Q000494:pharmacology*; D007903:Lens Capsule, Crystalline / Q000187:drug effects*; D008253:Macaca mulatta; D008279:Magnetic Resonance Imaging; D008297:Male; D019384:Nucleic Acid Synthesis Inhibitors / Q000494:pharmacology*; D010865:Pilot Projects; D012826:Silicone Elastomers / Q000008:administration & dosage*; D055675:Viscosupplements / Q000494:pharmacology*
chemical_list: D004338:Drug Combinations; D019384:Nucleic Acid Synthesis Inhibitors; D012826:Silicone Elastomers; D055675:Viscosupplements; D003609:Dactinomycin; D006820:Hyaluronic Acid