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    Exploring lens regeneration after cataract surgery

    Groundbreaking research harnesses capabilities of endogenous stem cells

    Take-home message: Functional lens regeneration was achieved in infants undergoing surgery for congenital cataract using a novel minimally invasive technique that maintains lens capsule integrity and preserves lens epithelial stem cells.

    Reviewed by Kang Zhang, MD, PhD

    Functional lens regeneration may be moving a step closer to reality from hypothesis.

    In the March 17, 2016, issue of Nature, Kang Zhang, MD, PhD, and colleagues reported results of a clinical trial in which functional lens regeneration was achieved after congenital cataract surgery performed with a novel minimally invasive technique [Lin H, et al. Nature. 2016;531:323-328].

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    Designed to maintain lens capsule integrity and preserve the lens epithelial stem cells (LECs), their surgical strategy involves removal of the lens contents and/or cortical opacities through a small, 1.0 to 1.5 mm, peripheral capsulorhexis using a 0.9 mm phacoemulsification probe.

    After demonstrating in rabbit and macaque models that the surgical technique resulted in functional lens regeneration, the research advanced into a pilot clinical trial co-led by Yizhi Liu, MD, PhD, professor and director, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

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    The randomized study enrolled infants aged 0 to 1 years with bilateral congenital cataract and assigned 12 children to be operated on with the new method and 25 children to undergo conventional cataract surgery. The procedure in the control group involved a 6-mm anterior continuous curvilinear capsulorhexis plus a posterior continuous curvilinear capsulorhexis; an IOL was either implanted primarily or the eyes were left aphakic and children were fitted with glasses or contact lenses for refractive correction.

    After the minimally invasive procedure, the small capsule opening healed within 1 month and a transparent lens structure formed within 3 months. During follow-up to 8 months, the lens attained central thickness comparable to a normal lens while refractive power and accommodative amplitude increased.

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    Achieved visual acuity was comparable in the two surgical groups.

    However, visual axis opacification occurred in only a single eye that underwent the new procedure (4.2%) versus 42 control eyes (84%). Significantly lower rates of other complications also occurred after the new procedure compared with the standard operation, including corneal edema (8.3% versus 30%), anterior chamber inflammation (16.7% versus 74%), ocular hypertension (0% versus 18%), and a need for additional laser surgery (0% versus 84%).

    LECs as stem cells

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