Low-intensity ultraviolet A irradiation of the lens capsule to remove lens epithelial cells during cataract surgery. Effectiveness and safety

PURPOSE: To assess the effectiveness and safety of low-intensity ultraviolet A (UVA) irradiation in removing lens epithelial cells (LECs) during cataract surgery and compare them with those of mechanical polishing and no treatment. SETTING: Eyecove Ophthalmology Clinics, Pune, India. METHODS: This prospective randomized double-masked study consisted of preoperative screening of 36 patients, of which 30 met the inclusion criteria and were recruited. The patients had routine cataract surgery. A bean-shaped capsulorhexis was performed. After the nucleus and cortex were removed, the capsular bag was irradiated from inside with low-intensity UVA in 1 group. A second group had mechanical polishing, and a third group was not treated. A small flap of the anterior capsule was removed in each patient. The flap was stained and mounted in a Fuchs-Rosenthal chamber. For estimation of effectiveness, the area of capsule covered with epithelial cells was estimated by examination under a light microscope. One day postoperatively, an examination was performed to assess the safety of each technique. RESULTS: The area of the capsule from which the LECs were removed was significantly larger in the UVA-irradiation group than in the mechanical-polishing group (P = .001) and the no-treatment group (P = .001). There was no significant difference between the mechanical-polishing and no-treatment groups (P>.05). The area of the capsule flap that was covered with LECs was significantly less in the UVA-irradiation group than in the mechanical-polishing group (P = .017) and the no-treatment group (P = .001). The mechanical-polishing group and no-treatment group were not significantly different from each other (P>.05). Corneal edema was significantly less in the UVA-irradiation group than in the mechanical-polishing group (P<.001) and no-treatment group (P = .012). No patient in the UVA-irradiation group had postoperative lid edema; 8 patients in each of the other 2 groups had lid edema. The difference was statistically significant (P<.0001). Pupil size was significantly larger in the UVA-irradiation group than in the mechanical-polishing group and no-treatment group; the difference was significant (both P = .0001). There was no significant difference in pupil size in the mechanical-polishing group and no-treatment group. No significant difference was observed between the 3 groups in visual acuity, conjunctival edema, anterior chamber flare, and intraocular pressure. CONCLUSION: Ultraviolet A irradiation of the capsular bag was effective and safe in removing LECs from the anterior capsule during cataract surgery.