Role of anterior capsule polishing in residual lens epithelial cell proliferation

PURPOSE: To determine the role of anterior capsule polishing in residual lens epithelial cell (LEC) proliferation. SETTING: Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. METHODS: Phacoemulsification was performed on pairs of human cadaver eyes. One eye of each pair had anterior capsule polishing; the fellow eye did not. Capsular bags with implanted intraocular lenses (IOLs) were incubated in culture. Specimens were observed and photographed under microscopy. For clinical comparison, both eyes of patients who had phacoemulsification and IOL implantation with anterior capsule polishing in 1 eye only were observed for 1 year postoperatively. RESULTS: The study comprised 10 pairs of cadaver eyes and 20 eyes of 10 patients. One day after surgery, large patches of cells remained under the anterior capsule and the equatorial zone in the unpolished cadaver eyes and the anterior capsule was clear in the polished eyes. By 3 days in culture, many patches of dead cells had formed in the unpolished eyes. After 7 days in culture, cell growth was minimal in the unpolished eyes; however, robust cell proliferation was observed in the polished eyes. In the clinical comparison, there was no obvious difference in the mean subjectively assessed fibrotic posterior capsule opacification (PCO) score between polished eyes and unpolished eyes at 1 year. CONCLUSIONS: Anterior capsule polishing, although it removed many LECs, did not decrease residual cell growth and, conversely, enhanced cell proliferation in capsular bag cultures. This might explain why polishing does not reduce PCO in clinical studies.