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      Research Progress of Drug Prophylaxis for Lens Capsule Opacification after Cataract Surgery

      review-article
      1 , 2 , 3 ,
      Journal of Ophthalmology
      Hindawi

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          Abstract

          Phacoemulsification combined with intraocular lens (IOL) implantation is the international standard operation procedure for cataract and has been generalized worldwide. However, lens capsule opacification, one of the common complications after cataract surgery, impacts the recovery of patients' visual function to a large extent. Lens capsule opacification has two types, anterior capsule opacification (ACO) and posterior capsule opacification (PCO), according to the location. There is not an accepted approach to treat ACO. Nd : YAG laser capsulotomy, the common treatment of PCO, can effectively improve the vision, but may cause a series of complications and is inappropriate for children who are too young to cooperate with this treatment. It is generally known that the responses of lens epithelial cells (LECs) after cataract surgery, including cell proliferation, migration, and epithelial-mesenchymal transition (EMT), play a key role in the pathogenesis of lens capsule opacification. Scholars found that substantial drugs can reduce the occurrence of lens capsule opacification by inhibiting, clearing, or killing LECs, and made great efforts as well as innovations on the exploration of drug species or modes of administration. This article is a systematic interpretation and elaboration about how to prevent lens capsule opacification after cataract surgery via different drugs.

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          Most cited references50

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          Epithelia suspended in collagen gels can lose polarity and express characteristics of migrating mesenchymal cells

          This study of epithelial-mesenchymal transformation and epithelial cell polarity in vitro reveals that environmental conditions can have a profound effect on the epithelial phenotype, cell shape, and polarity as expressed by the presence of apical and basal surfaces. A number of different adult and embryonic epithelia were suspended within native collagen gels. Under these conditions, cells elongate, detach from the explants, and migrate as individual cells within the three-dimensional lattice, a previously unknown property of well-differentiated epithelia. Epithelial cells from adult and embryonic anterior lens were studied in detail. Elongated cells derived from the apical surface develop pseudopodia and filopodia characteristic of migratory cells and acquire a morphology and ultrastructure virtually indistinguishable from that of mesenchymal cells in vivo. It is concluded from these experiments that the three-dimensional collagen gel can promote dissociation, migration, and acquisition of secretory organelles by differentiated epithelial cells, and can abolish the apical-basal cell polarity characteristic of the original epithelium.
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            Experimental models for posterior capsule opacification research.

            Millions of people worldwide are blinded due to cataract formation. At present the only means of treating a cataract is through surgical intervention. A modern cataract operation involves the creation of an opening in the anterior lens capsule to allow access to the fibre cells, which are then removed. This leaves in place a capsular bag that comprises the remaining anterior capsule and the entire posterior capsule. In most cases, an intraocular lens is implanted into the capsular bag during surgery. This procedure initially generates good visual restoration, but unfortunately, residual lens epithelial cells undergo a wound-healing response invoked by surgery, which in time commonly results in a secondary loss of vision. This condition is known as posterior capsule opacification (PCO) and exhibits classical features of fibrosis, including hyperproliferation, migration, matrix deposition, matrix contraction and transdifferentiation into myofibroblasts. These changes alone can cause visual deterioration, but in a significant number of cases, fibre differentiation is also observed, which gives rise to Soemmering's ring and Elschnig's pearl formation. Elucidating the regulatory factors that govern these events is fundamental in the drive to develop future strategies to prevent or delay visual deterioration resulting from PCO. A range of experimental platforms are available for the study of PCO that range from in vivo animal models to in vitro human cell and tissue culture models. In the current review, we will highlight some of the experimental models used in PCO research and provide examples of key findings that have resulted from these approaches.
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              Role of transforming growth factor-beta in transdifferentiation and fibrosis of lens epithelial cells.

              To determine the levels of mRNAs encoding markers of fibrosis in lens epithelial cells (LECs) from patients with anterior polar cataracts and to test whether transforming growth factor (TGF)-beta enhances the expression of mRNAs for mesenchymal markers in LECs. LECs attached to the anterior capsules of patients with nuclear or anterior polar cataracts were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) for the expression of mRNAs encoding pathologic extracellular matrix proteins, a marker of myofibroblast transformation, growth factors, and growth factor receptors, and by western blot analysis for the proteins encoded by these mRNAs. Bovine lens epithelial explants and intact rabbit lenses cultured with or without TGF-beta1 were also subjected to RT-PCR and western blot analysis. The levels of fibronectin, type I collagen, and alpha-smooth muscle actin (SMA) mRNAs were higher in LECs from patients with anterior polar cataracts than in those from patients with nuclear cataracts. Expression of mRNAs for TGF-beta1, TGF-beta2, TGF-beta receptor type II, and connective tissue growth factor (CTGF) was significantly greater in anterior polar type than in nuclear type cataracts. In contrast, expression of mRNAs for epidermal growth factor (EGF), epidermal growth factor receptor (EGFR), fibroblast growth factor (FGF)-2, and FGF receptor-1 was similar in LECs from the two types of cataracts. TGF-beta1 markedly increased the levels of fibronectin, type I collagen, and alpha-SMA mRNA in bovine lens epithelial explants and intact rabbit lenses. This is the first finding showing altered mRNA expression in LECs from anterior polar cataracts. Enhanced expression of TGF-beta and the TGF-beta receptor suggests that TGF-beta derived from LECs may function in an autocrine fashion as the prime mediator of transdifferentiation and pathogenesis in human LECs. Elevated levels of CTGF mRNA suggest that this growth factor may play a role in the increased deposition of extracellular matrix in metaplastic LECs.
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                Author and article information

                Contributors
                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi
                2090-004X
                2090-0058
                2020
                4 July 2020
                : 2020
                : 2181685
                Affiliations
                1Department of Ophthalmology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
                2Graduate School of Dalian Medical University, Dalian Medical University, Dalian 116044, China
                3Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
                Author notes

                Academic Editor: Van C. Lansingh

                Author information
                https://orcid.org/0000-0001-5015-9907
                https://orcid.org/0000-0002-2587-157X
                Article
                10.1155/2020/2181685
                7355348
                6b140f82-f272-4f7f-90cc-bc06430d645b
                Copyright © 2020 Rong-Pei Zhang and Zheng-Gao Xie.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 May 2020
                : 9 June 2020
                Categories
                Review Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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