Intercapsular cataract surgery with lens epithelial cell removal. Part IV: Capsular fibrosis induced by poly(methyl methacrylate).

Characteristic lens epithelial cell behavior in the pseudophakic eye was examined by comparing 30 eyes that had extracapsular cataract surgery by the intercapsular technique and posterior chamber intraocular lens (IOL) implantation with lens epithelial cell removal but without anterior capsule capsulectomy and nine aphakic eyes that had the same procedure but without posterior chamber lens implantation over a mean follow-up period of 30 and 23 months, respectively. Fibrous anterior capsule opacification was observed in 83% of the pseudophakic eyes in the area of contact with the IOL, while the region beyond the margin of the IOL remained transparent. Fibrous anterior capsular opacification was not noted in the aphakic eyes. This suggests that the IOL material, poly(methyl methacrylate), stimulates lens epithelial cells to undergo fibrous metaplasia and to produce collagen fibers. Various cytokines such as IL-1 and TGF-beta synthesized by lens epithelial cells may play a crucial role as mediators in the process. We recommend that this effect be considered as a parameter of biocompatibility in developing and evaluating new biomaterials.