Non‐surgical strategies for PCO prevention

Purpose Surgical approaches and IOL design have gone some way to reduce the rate of PCO progression. Despite these efforts PCO remains a common and important problem which diminishes the visual quality of patients and is a major financial burden on healthcare providers. If we are to effectively respond to the problem of PCO then a biological solution has to be adopted to reduce/prevent formation of light scattering changes. Methods Methods have been employed to investigate PCO development, which include in vitro cell culture and capsular bag models; in vivo animal models and post‐mortem analysis. These have greatly aided our understanding of PCO. Results A number of basic approaches have been identified to prevent PCO. 1) To kill the entire lens epithelial population. This will require a pharmacological agent, therefore delivery of this drug needs to be localised to the target cells, but have limited access to non‐target cells; closed capsular bag systems such as perfect capsule provides opportunity to achieve this aim. 2) Maintenance of a cell monolayer on the posterior capsule. In particular the role of TGFβ has been investigated, which is known to cause matrix deformation. Disruption of TGFβ signalling pathways can suppress matrix deformation and thus reduce light scatter. 3) Recreation of a lens is the ultimate solution. While it has been shown that lens fibre differentiation can be promoted in animal systems, perfect formation of the lens is not achieved and the protein density is typically low relative to the native lens. Conclusion Strategies to prevent PCO are being actively developed, which will are greatly aided by improved drug delivery systems. The development of biological/pharmacological approaches in concert with improved surgical methods and IOL designs should yield benefit to patients.Commercial interest