REVIEW article
Front. Ophthalmol.
Sec. Lens and Cataract
Volume 5 - 2025 | doi: 10.3389/fopht.2025.1680042
This article is part of the Research TopicA focus on the past, present and future of lens researchView all 3 articles
Unanswered Questions Regarding the Pathogenesis of Late Onset Posterior Capsular Opacification (PCO)
Provisionally accepted
- 1University of Delaware, Newark, United States
- 2University of Utah, Moran Eye Center, Salt Lake City, Utah, United States
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Abstract Following extracapsular cataract extraction, residual lens epithelial cells (LECs) are induced to express pro-inflammatory genes within hours of surgery, then begin to proliferate while migrating to populate denuded areas of the lens capsule. If these cells reach the optical axis, they scatter light, resulting in visual disturbances that are clinically defined as Posterior capsular opacification (PCO). Historically, PCO occurred at high rates within weeks or months of surgery, but over the past 10-20 years, this "acute onset" PCO has become relatively rare following cataract surgery in adults, due to improved surgical techniques and the ability of square edge intraocular lens (IOL) implants to block residual LECs from reaching the visual axis. Despite this, PCO rates are still substantial by 5-10 years following cataract surgery, apparently due to the ability of these entrapped cells to escape their confinement at capsular bag periphery. This review explores the mechanisms by which cataract surgery elicits acute phenotypic changes to LECs and explores how these changes may set the stage for late-onset PCO.
Keywords: Posterior capsular opacification (PCO), fibrotic PCO, pearl-like PCO, Epithelial-to-mesenchymal transition (EMT), Myofibroblasts, TGFβ, Soemmering's ring, Intraocular lens (IOL)
Received: 05 Aug 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Rakib-Uz-Zaman, Werner and Duncan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Melinda K Duncan, duncanm@udel.edu
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