Raise your hand if you’ve ever seen PCO.

Posterior capsule opacification (PCO) is a common complication after cataract surgery.  The NIH agreed and funded a study to try and prevent it.

What causes it?

Even though IOL’s have been used since the 70’s, it remains “exceedingly difficult to remove all of the lens epithelial cells from the anterior capsule during cataract surgery”.  That is when PCO will make an appearance.  If you are a numbers person, roughly 4-12% of patients will develop this.

Why do we care about PCO? 
A few reasons:
–It costs the healthcare system money to remove it ($158 million billed to Medicare in 2003).
–YAG lasers aren’t everywhere!  There can be limited availability in underdeveloped/economically disadvantaged areas.
–There are risks of ocular complications with a YAG (CME, secondary glaucoma, and retinal detachment).

Previous studies suggest that the growth factor TGF-beta becomes highly active in response to surgery-induced injury (i.e. removing a cataract).  When it’s highly active, it can result in PCO.  The research team tested various drugs to try and prevent PCO.  One such drug, multikinase inhibitor rebastinib, is currently in phase I clinical trials for cancer.  They found this drug to be successful in preventing PCO in chick and rat models.

The take home:  PCO is a problem and TGF-beta is partly responsible for it.  Various agents to prevent PCO may eventually be included in IOL’s or in the viscoelastic solution used during cataract surgery to prevent the formation of PCO.