An Optical Section-Assisted In Vivo Rabbit Model for Capsular Bend and Posterior Capsule Opacification Investigation
Identifieur interne : 000165 ( Pmc/Checkpoint ); précédent : 000164; suivant : 000166An Optical Section-Assisted In Vivo Rabbit Model for Capsular Bend and Posterior Capsule Opacification Investigation
Auteurs : Pingjun Chang ; Lei Lin ; Qian Zheng ; Fang Yu ; Xiaoyu Yu ; Yinying Zhao ; Xixia Ding ; Weigen Zhu ; Jin Li ; Yun-E ZhaoSource :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
To establish an optical section-assisted in vivo rabbit model for capsular bend and posterior capsule opacification (PCO) investigation.
A total of 10 rabbits underwent phacoemulsification surgery and intraocular lens (IOL) implantation. On the basis of the relationship between the anterior capsule and IOL, the rabbits were divided into complete overlap and incomplete overlap groups, in which six and four rabbits were included, respectively. The capsular bend optical sections were assessed using ultra-long scan depth optical coherence tomography (UL-OCT), and posterior capsule opacification was evaluated with slit lamp on postoperative day 3, 7, 14, and 28. In addition, histopathological section was used to verify the accuracy of capsular bend type captured by OCT in three rabbits.
Based on the special animal model, six capsular bend types were observed, namely, anterior (A), middle (M), posterior (P), detachment (D), funnel (Fun) and furcate adhesion (Fur). On day 3, capsular bend began to form. On 14 days, the capsular bends were comprised of A, M and D types, which were almost maintained until day 28. Histopathological section findings were consistent with optical sectioning results. In the incomplete and complete groups, the earliest PCO within the optical zone were on day 7 and 28, respectively. The incomplete group exhibited higher incidence and faster PCO on day 7 (p = 0.038) and 14 (p = 0.002).
This animal model not only mimics capsular bend evolution and PCO processes but also produces OCT optical section images equivalent to and more repeatable than histopathology, thereby providing a promising method for the further investigations of PCO.
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DOI: 10.1371/journal.pone.0148553
PubMed: 26840405
PubMed Central: 4739694
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">An Optical Section-Assisted <italic>In Vivo</italic> Rabbit Model for Capsular Bend and Posterior Capsule Opacification Investigation</title><author><name sortKey="Chang, Pingjun" sort="Chang, Pingjun" uniqKey="Chang P" first="Pingjun" last="Chang">Pingjun Chang</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Lin, Lei" sort="Lin, Lei" uniqKey="Lin L" first="Lei" last="Lin">Lei Lin</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zheng, Qian" sort="Zheng, Qian" uniqKey="Zheng Q" first="Qian" last="Zheng">Qian Zheng</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Yu, Fang" sort="Yu, Fang" uniqKey="Yu F" first="Fang" last="Yu">Fang Yu</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Yu, Xiaoyu" sort="Yu, Xiaoyu" uniqKey="Yu X" first="Xiaoyu" last="Yu">Xiaoyu Yu</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zhao, Yinying" sort="Zhao, Yinying" uniqKey="Zhao Y" first="Yinying" last="Zhao">Yinying Zhao</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Ding, Xixia" sort="Ding, Xixia" uniqKey="Ding X" first="Xixia" last="Ding">Xixia Ding</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zhu, Weigen" sort="Zhu, Weigen" uniqKey="Zhu W" first="Weigen" last="Zhu">Weigen Zhu</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Li, Jin" sort="Li, Jin" uniqKey="Li J" first="Jin" last="Li">Jin Li</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zhao, Yun E" sort="Zhao, Yun E" uniqKey="Zhao Y" first="Yun-E" last="Zhao">Yun-E Zhao</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26840405</idno><idno type="pmc">4739694</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739694</idno><idno type="RBID">PMC:4739694</idno><idno type="doi">10.1371/journal.pone.0148553</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000546</idno><idno type="wicri:Area/Pmc/Curation">000546</idno><idno type="wicri:Area/Pmc/Checkpoint">000165</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">An Optical Section-Assisted <italic>In Vivo</italic> Rabbit Model for Capsular Bend and Posterior Capsule Opacification Investigation</title><author><name sortKey="Chang, Pingjun" sort="Chang, Pingjun" uniqKey="Chang P" first="Pingjun" last="Chang">Pingjun Chang</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Lin, Lei" sort="Lin, Lei" uniqKey="Lin L" first="Lei" last="Lin">Lei Lin</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zheng, Qian" sort="Zheng, Qian" uniqKey="Zheng Q" first="Qian" last="Zheng">Qian Zheng</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Yu, Fang" sort="Yu, Fang" uniqKey="Yu F" first="Fang" last="Yu">Fang Yu</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Yu, Xiaoyu" sort="Yu, Xiaoyu" uniqKey="Yu X" first="Xiaoyu" last="Yu">Xiaoyu Yu</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zhao, Yinying" sort="Zhao, Yinying" uniqKey="Zhao Y" first="Yinying" last="Zhao">Yinying Zhao</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Ding, Xixia" sort="Ding, Xixia" uniqKey="Ding X" first="Xixia" last="Ding">Xixia Ding</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zhu, Weigen" sort="Zhu, Weigen" uniqKey="Zhu W" first="Weigen" last="Zhu">Weigen Zhu</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Li, Jin" sort="Li, Jin" uniqKey="Li J" first="Jin" last="Li">Jin Li</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author><author><name sortKey="Zhao, Yun E" sort="Zhao, Yun E" uniqKey="Zhao Y" first="Yun-E" last="Zhao">Yun-E Zhao</name><affiliation><nlm:aff id="aff001"></nlm:aff></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Purpose</title><p>To establish an optical section-assisted in vivo rabbit model for capsular bend and posterior capsule opacification (PCO) investigation.</p></sec><sec id="sec002"><title>Methods</title><p>A total of 10 rabbits underwent phacoemulsification surgery and intraocular lens (IOL) implantation. On the basis of the relationship between the anterior capsule and IOL, the rabbits were divided into complete overlap and incomplete overlap groups, in which six and four rabbits were included, respectively. The capsular bend optical sections were assessed using ultra-long scan depth optical coherence tomography (UL-OCT), and posterior capsule opacification was evaluated with slit lamp on postoperative day 3, 7, 14, and 28. In addition, histopathological section was used to verify the accuracy of capsular bend type captured by OCT in three rabbits.</p></sec><sec id="sec003"><title>Results</title><p>Based on the special animal model, six capsular bend types were observed, namely, anterior (A), middle (M), posterior (P), detachment (D), funnel (Fun) and furcate adhesion (Fur). On day 3, capsular bend began to form. On 14 days, the capsular bends were comprised of A, M and D types, which were almost maintained until day 28. Histopathological section findings were consistent with optical sectioning results. In the incomplete and complete groups, the earliest PCO within the optical zone were on day 7 and 28, respectively. The incomplete group exhibited higher incidence and faster PCO on day 7 (p = 0.038) and 14 (p = 0.002).</p></sec><sec id="sec004"><title>Conclusions</title><p>This animal model not only mimics capsular bend evolution and PCO processes but also produces OCT optical section images equivalent to and more repeatable than histopathology, thereby providing a promising method for the further investigations of PCO.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Knight Nanan, D" uniqKey="Knight Nanan D">D Knight-Nanan</name></author><author><name sortKey="O Keefe, M" uniqKey="O Keefe M">M O'Keefe</name></author><author><name sortKey="Bowell, R" uniqKey="Bowell R">R Bowell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sacu, S" uniqKey="Sacu S">S Sacu</name></author><author><name sortKey="Findl, O" uniqKey="Findl O">O Findl</name></author><author><name sortKey="Menapace, R" uniqKey="Menapace R">R 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26840405</article-id><article-id pub-id-type="pmc">4739694</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0148553</article-id><article-id pub-id-type="publisher-id">PONE-D-15-16114</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Research and Analysis Methods</subject><subj-group><subject>Model Organisms</subject><subj-group><subject>Animal Models</subject><subj-group><subject>Rabbits</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Animals</subject><subj-group><subject>Vertebrates</subject><subj-group><subject>Mammals</subject><subj-group><subject>Rabbits</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Research and Analysis Methods</subject><subj-group><subject>Model Organisms</subject><subj-group><subject>Animal Models</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Evolutionary Biology</subject><subj-group><subject>Organismal Evolution</subject><subj-group><subject>Animal Evolution</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Surgical and Invasive Medical Procedures</subject><subj-group><subject>Ophthalmic Procedures</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Surgical and Invasive Medical Procedures</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Physical Sciences</subject><subj-group><subject>Materials Science</subject><subj-group><subject>Material Properties</subject><subj-group><subject>Optical Properties</subject><subj-group><subject>Opacity</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Ocular Anatomy</subject><subj-group><subject>Lens (Anatomy)</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Ocular Anatomy</subject><subj-group><subject>Lens (Anatomy)</subject></subj-group></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>An Optical Section-Assisted <italic>In Vivo</italic> Rabbit Model for Capsular Bend and Posterior Capsule Opacification Investigation</article-title><alt-title alt-title-type="running-head">Rabbit Model for Capsular Bend and PCO Investigation</alt-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Chang</surname><given-names>Pingjun</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Lin</surname><given-names>Lei</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Zheng</surname><given-names>Qian</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Yu</surname><given-names>Fang</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Yu</surname><given-names>Xiaoyu</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Zhao</surname><given-names>Yinying</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Ding</surname><given-names>Xixia</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Zhu</surname><given-names>Weigen</given-names></name><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Jin</given-names></name><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref><xref ref-type="corresp" rid="cor001">*</xref><xref ref-type="aff" rid="aff001"></xref></contrib><contrib contrib-type="author"><name><surname>Zhao</surname><given-names>Yun-e</given-names></name><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref><xref ref-type="corresp" rid="cor001">*</xref><xref ref-type="aff" rid="aff001"></xref></contrib></contrib-group><aff id="aff001"><addr-line>School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Bhattacharya</surname><given-names>Sanjoy</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Bascom Palmer Eye Institute, University of Miami School of Medicine;, UNITED STATES</addr-line></aff><author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: PJC YEZ JL. Performed the experiments: PJC LL QZ FY XYY WGZ. Analyzed the data: LL PJC FY YEZ JL. Contributed reagents/materials/analysis tools: LL WGZ QZ. Wrote the paper: LL PJC YYZ XXD JL YEZ.</p></fn><fn fn-type="other" id="econtrib001"><p>‡ These authors also contributed equally to this work.</p></fn><corresp id="cor001">* E-mail: <email>zye@mail.eye.ac.cn</email>; <email>zyehzeye@126.com</email> (YEZ); <email>lijingerry@163.com</email> (JL)</corresp></author-notes><pub-date pub-type="epub"><day>3</day><month>2</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>11</volume><issue>2</issue><elocation-id>e0148553</elocation-id><history><date date-type="received"><day>14</day><month>4</month><year>2015</year></date><date date-type="accepted"><day>20</day><month>1</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Chang et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Chang et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0148553.pdf"></self-uri><abstract><sec id="sec001"><title>Purpose</title><p>To establish an optical section-assisted in vivo rabbit model for capsular bend and posterior capsule opacification (PCO) investigation.</p></sec><sec id="sec002"><title>Methods</title><p>A total of 10 rabbits underwent phacoemulsification surgery and intraocular lens (IOL) implantation. On the basis of the relationship between the anterior capsule and IOL, the rabbits were divided into complete overlap and incomplete overlap groups, in which six and four rabbits were included, respectively. The capsular bend optical sections were assessed using ultra-long scan depth optical coherence tomography (UL-OCT), and posterior capsule opacification was evaluated with slit lamp on postoperative day 3, 7, 14, and 28. In addition, histopathological section was used to verify the accuracy of capsular bend type captured by OCT in three rabbits.</p></sec><sec id="sec003"><title>Results</title><p>Based on the special animal model, six capsular bend types were observed, namely, anterior (A), middle (M), posterior (P), detachment (D), funnel (Fun) and furcate adhesion (Fur). On day 3, capsular bend began to form. On 14 days, the capsular bends were comprised of A, M and D types, which were almost maintained until day 28. Histopathological section findings were consistent with optical sectioning results. In the incomplete and complete groups, the earliest PCO within the optical zone were on day 7 and 28, respectively. The incomplete group exhibited higher incidence and faster PCO on day 7 (p = 0.038) and 14 (p = 0.002).</p></sec><sec id="sec004"><title>Conclusions</title><p>This animal model not only mimics capsular bend evolution and PCO processes but also produces OCT optical section images equivalent to and more repeatable than histopathology, thereby providing a promising method for the further investigations of PCO.</p></sec></abstract><funding-group><funding-statement>This study was supported by National Natural Science Foundation of China (Grant No. 81170869 to YEZ, website: <ext-link ext-link-type="uri" xlink:href="http://www.nsfc.gov.cn/">http://www.nsfc.gov.cn/</ext-link>) and Zhejiang Provincial Natural Science Foundation of China (Grant No. LY13H120005 to JL, website: <ext-link ext-link-type="uri" xlink:href="http://www.zjnsf.gov.cn/">http://www.zjnsf.gov.cn/</ext-link>). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><fig-count count="7"></fig-count><table-count count="2"></table-count><page-count count="11"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the paper and its Supporting Information files.</p></notes></front><body><sec sec-type="intro" id="sec005"><title>Introduction</title><p>Posterior capsule opacification (PCO) results from the migration and proliferation of residual lens epithelial cells (LECs) is the main cause of secondary visual loss following cataract surgery. The incidence of PCO in children is nearly 100%. [<xref rid="pone.0148553.ref001" ref-type="bibr">1</xref>] The capsular bend represents the space configuration among the anterior capsule, posterior capsule, and intraocular lens (IOL). Previous studies [<xref rid="pone.0148553.ref002" ref-type="bibr">2</xref>–<xref rid="pone.0148553.ref006" ref-type="bibr">6</xref>] demonstrated that the capsular bend induced by IOL with a sharp optic edge can prevent PCO.</p><p>However, the underlying mechanism of how sharp edge-designed IOL prevents PCO remains controversial. Nishi et al [<xref rid="pone.0148553.ref003" ref-type="bibr">3</xref>] reported that capsular bends which acted like an mechanical barrier, inhibit LECs proliferation and migration through contact inhibition effect. Nevertheless, Nagamoto et al [<xref rid="pone.0148553.ref007" ref-type="bibr">7</xref>] emphasized that the compression between IOL and capsular bag plays an important role in PCO prevention.</p><p>Nishi et al [<xref rid="pone.0148553.ref003" ref-type="bibr">3</xref>–<xref rid="pone.0148553.ref006" ref-type="bibr">6</xref>] established an animal capsular bend model and concluded by histopathological sections that the LECs created by a sharp optical edge at the capsular bend are significantly inhibited. However, certain limitations are inevitably existed when this method is applied. First, an active observation of the capsular bend evolution is impossible. Second, previous clinical study findings [<xref rid="pone.0148553.ref008" ref-type="bibr">8</xref>] indicated various capsular bend types; however, whether these types playing a crucial role in PCO prevention remains unknown. Previous animal models obviously cannot satisfy the demands of capsular bend study. Thus, the establishment of a new animal model for further research on capsular bends and PCO mechanisms is a worthwhile endeavor.</p><p>On the basis of the transparent characteristics and different optical properties of the cornea, capsule and IOL, ultra-long scan depth optical coherence tomography (UL-OCT) with high axial resolution can capture accurate and clear optical sectioning at the capsular bend. Therefore, an animal model was designed using this optical section method to investigate the configuration of the capsular bend and the PCO incidence after cataract surgery, as well as to evaluate the evolution of the capsular bend–IOL complex. With the purpose to make repeated measurements possible and provide a promising approach for further PCO studies.</p></sec><sec sec-type="materials|methods" id="sec006"><title>Materials and Methods</title><sec id="sec007"><title>2.1 Animal model</title><sec id="sec008"><title>2.1.1 Ethics statements</title><p>A total of 10 three months old Japanese white rabbits (Laboratory Animal Centre of Wenzhou Medical University, Wenzhou, Zhejiang, China) were used in this study. The animal experiments were approved by the Laboratory Animal Ethics Committee of Wenzhou Medical University (File number: wydw2013-0020) and consistent with the ARVO Statement for the Use of Animals in Ophthalmic and Visual Research. The study was performed in strict accordance with standard surgical procedures and all efforts were made to ameliorate animal suffering.</p></sec><sec id="sec009"><title>2.1.2 Surgical procedures</title><p>The surgical procedures were strictly followed. One experienced surgeon (Jin Li) performed all the surgeries under intramuscular anesthesia with 3% pentobarbital sodium (1 mL/kg, Sile Instrumentation Company, Guangzhou, China) combined with compound narcotic Su-Mian-Xin (0.1 mL/kg, Shengda Pharmaceutical Co., Limited, Jilin, China). The following standard phacoemulsification technique was utilized: first, a 2.2-mm clear corneal incision was performed at 11 o’clock in the right eye, and a continuous curvilinear capsulorhexis was created using capsule forceps. After hydrodissection, phacoemulsification and cortex aspiration, an IOL (Alcon, SN60AT, 30D) was implanted into the capsular bag and the haptics of the IOL were perpendicular to the line of inner and outer canthus. The incisions were closed with 10–0 nylon sutures. Levofloxacin (Santen, Japan) and tobramycin dexamethasone (Alcon, USA) eye drop or ointment were used for anti-infection and anti-inflammatory after surgery.</p></sec><sec id="sec010"><title>2.1.3 Intraocular lens</title><p>The IOL used in this study was the sharp edge-designed SN60AT (Alcon, USA) with 30D power. Although the rabbit capsule was larger than the human capsule, the IOL with 13.0 mm haptic length and nice adhesion characteristics was used in this study to reduce the maximum extent of effects among different species.</p></sec></sec><sec id="sec011"><title>2.2 Observation of the capsular bend-IOL complex</title><sec id="sec012"><title>2.2.1 UL-OCT</title><p>The UL-OCT instrument has been thoroughly described in previous studies. [<xref rid="pone.0148553.ref008" ref-type="bibr">8</xref>–<xref rid="pone.0148553.ref010" ref-type="bibr">10</xref>] In brief, custom-built UL-OCT with 7.5 μm axial resolution and 7.8mm scan depth was used in this study to evaluate the capsular bend. Examinations were postoperatively performed on day 3, 7, 14 and 28. Up to 1% tropicamide and 2.5% phenylephrine hydrochloride were used to dilate the pupil to at least 6.5 mm. The scan width was then set to 12 mm, and the X axis and Y axis were simultaneously aligned to the apex. After adjusting the scan position perpendicular to the haptic line, the nasal and temporal sides of the capsular bend-IOL complex images were captured. The superior side was identified as temporal side when the haptic line was horizontal.</p></sec><sec id="sec013"><title>2.2.2 Slit lamp</title><p>After the UL-OCT examination, the anterior segment was photographed via slit lamp, and its condition was examined in terms of anterior chamber inflammation and anterior and posterior capsules. Posterior capsule opacification was assessed using retroillumination photographs. Once observed posterior capsule opacity within the IOL optic edge, PCO positive were recorded.</p></sec><sec id="sec014"><title>2.2.3 Histopathological section</title><p>On day 11 postoperatively, three rabbits were sacrificed by overdose injection of 3% pentobarbital sodium (2 mL/kg). After enucleation, the capsular bend-IOL complexes were sufficiently fixed and dehydrated in 70%, 85%, 95%, and 100% ethyl alcohol for 1, 1, 2, and 3 h, respectively. After being washed with distilled water, the specimens were embedded with Technovit 7100 (T7100) (Heraeus Kulzer, Germany) in accordance with the manufacturer’s instructions, as follows. First, the specimens were placed in liquid A, which contained 100 mL of T7100 and 1 g of hardening agent I, for 1 h. The specimens were then washed twice with distilled water and placed in liquid B, which contained 15 mL of liquid A and 1 mL of hardening agent II for 12 h. The specimens in the scan position were sliced into 10 to 13 μm-thick sections and observed under a microscope after being stained with toluidine blue.</p></sec></sec><sec id="sec015"><title>2.3 Statistical analyses</title><p>Data were analyzed using SPSS 18.0 software. Fisher’s exact test was used to compare the differences between two groups. P values below 0.05 were considered statistically significant.</p></sec></sec><sec sec-type="results" id="sec016"><title>Results</title><sec id="sec017"><title>3.1 Rabbit</title><p>Based on the relationship between the anterior capsule and IOL, the rabbits were divided into complete overlap group (CO group, i.e., the anterior capsular edge completely overlapped with the IOL optic edge) and incomplete overlap group (ICO group, i.e., the anterior capsule did not cover the IOL optic edge or showed significantly eccentric overlap), which comprised six and four rabbits, respectively. Detailed images are shown in <xref ref-type="fig" rid="pone.0148553.g001">Fig 1</xref>, and a flow chart that summarizes the experiment is illustrated in <xref ref-type="fig" rid="pone.0148553.g002">Fig 2</xref>. Three out of the 10 rabbits were sacrificed on day 11 for histopathological sectioning in the OCT scan position. In addition, the pupils of the rabbits cannot be sufficiently dilated in some instances. Thus, the numbers of rabbit eyes captured were inconsistent across each examination time point.</p><fig id="pone.0148553.g001" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.g001</object-id><label>Fig 1</label><caption><title>Schematic of relationship between anterior capsule (white arrow) and IOL optic edge (white triangle) in the scan position (green lines).</title><p>N stand for nasal side, while T stand for temporal side. (A) The temporal side illustrates an undesirable overlap (the capsule overlap less on the IOL optic edge), and the right side illustrates a complete overlap (the capsule complete overlap the IOL in the scan position). (B) The temporal side capsule does not overlap the IOL optic.</p></caption><graphic xlink:href="pone.0148553.g001"></graphic></fig><fig id="pone.0148553.g002" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.g002</object-id><label>Fig 2</label><caption><title>Flow chart of the experiment.</title><p>Levofloxacin and tobramycin dexamethasone eye drop or oculentum were used for anti-infection and anti-inflammatory for at least 7 days after surgery.</p></caption><graphic xlink:href="pone.0148553.g002"></graphic></fig></sec><sec id="sec018"><title>3.2 Capsular bend type</title><p>During the postoperative observation, the following six types of capsular bend were identified: anterior adhesion (A), middle adhesion (M), posterior adhesion (P), detachment (D), funnel adhesion (Fun) and furcate adhesion (Fur). The UL-OCT images and corresponding schematic of these types are presented in <xref ref-type="fig" rid="pone.0148553.g003">Fig 3</xref>.</p><fig id="pone.0148553.g003" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.g003</object-id><label>Fig 3</label><caption><title>UL-OCT images (A-C & G-I) and corresponding schematic (D-F & J-L) of capsular bend types.</title><p>Red arrows demonstrate the characteristics of different capsular bend types. In schematic images, black and gray lines represent anterior and posterior capsules, respectively. (A and D) Anterior adhesion type: the posterior and anterior capsule form a stable adhesion at the anterior surface of the IOL optic edge. (B and E) Middle adhesion type: the posterior and anterior capsule wrapped around the IOL and met at the middle of the IOL edge. (C and F) Posterior adhesion type: the anterior and posterior capsule form a stable adhesion at the posterior surface of the IOL. (G and J) Detachment type: the anterior capsule detached from the IOL optic edge. (H and K) Funnel adhesion type: the posterior and anterior capsules adhered to each other, but a space between the capsule and IOL remained and showed the appearance of a funnel. (I and L) Furcate adhesion capsule type: the inner sides of the posterior and anterior capsules adhered, whereas the peripheral side was separated.</p></caption><graphic xlink:href="pone.0148553.g003"></graphic></fig></sec><sec id="sec019"><title>3.3 Histopathological section</title><p>The histopathological section findings acquired after 11 days revealed anterior capsular bend type and unformed capsular bend configurations, which were consistent with optical sectioning results. Sample results from one of these rabbits are displayed in <xref ref-type="fig" rid="pone.0148553.g004">Fig 4</xref>.</p><fig id="pone.0148553.g004" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.g004</object-id><label>Fig 4</label><caption><title>Histopathological section observations on day 11 postoperatively and OCT images on day 7 postoperatively at the scan position.</title><p>(A) Unformed capsular bend configuration at temporal side (blue triangle). (B) Anterior adhesion type at nasal side (white arrow). (C) OCT image of the same rabbit showing the same capsular bend configuration at the same place. The white asterisk indicates the iris.</p></caption><graphic xlink:href="pone.0148553.g004"></graphic></fig></sec><sec id="sec020"><title>3.4 Capsular bend evolution</title><p>Each eye with two sides was observed in this study. The number of each capsular bend type at each observation time is demonstrated in <xref ref-type="fig" rid="pone.0148553.g005">Fig 5</xref>. On the postoperative day 7, the Fun type transformed into A or M type. Interestingly, on day 14 after surgery, the D types that evolved from A and P types were found on two undesirable overlap sides. The capsular bends of the complete overlap sides were nearly maintained on day 28 postoperatively. However, one A type transformed into a Fun type on an undesirable side (<xref ref-type="fig" rid="pone.0148553.g006">Fig 6</xref>). The capsular bends were classified into incomplete adhesion (Fun and Fur), complete adhesion (A, M, and P), and special adhesion (D) types based on the configuration of the characteristic of their evolution. The capsular bend evolutions of the six rabbits that survived for 28 days with sufficient pupil dilation are listed in <xref ref-type="table" rid="pone.0148553.t001">Table 1</xref>.</p><fig id="pone.0148553.g005" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.g005</object-id><label>Fig 5</label><caption><title>Different types of capsular bends at various times after surgery.</title><p>A = anterior adhesion type, M = middle adhesion type, P = posterior adhesion type, Fun = funnel adhesion type, Fur = furcate adhesion type, and D = detachment type.</p></caption><graphic xlink:href="pone.0148553.g005"></graphic></fig><fig id="pone.0148553.g006" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.g006</object-id><label>Fig 6</label><caption><title>Slit lamp image of a posterior capsule and an OCT image of capsular bend of an incompletely overlapped eye 7 days (A and C) and 28 days postoperatively (B and D).</title><p>(A and C) On day 7 postoperatively, the capsule was smooth, no opacity was present, and both sides formed anterior adhesion types. (B and D) On day 28 postoperatively, the temporal side (black and white asterisk) exhibited an undesirable overlap, abundant proliferation, and migration of LECs into the posterior capsule. The detachment and funnel adhesion types emerged at the temporal and nasal sides, respectively. Increased thickness of the posterior capsule (white arrow) was apparent in both slit lamp and OCT images.</p></caption><graphic xlink:href="pone.0148553.g006"></graphic></fig><table-wrap id="pone.0148553.t001" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.t001</object-id><label>Table 1</label><caption><title>Different capsular bend types of six rabbits at two sides (nasal and temporal) postoperatively.</title></caption><alternatives><graphic id="pone.0148553.t001g" xlink:href="pone.0148553.t001"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="center" rowspan="1" colspan="1">Rabbit</th><th align="center" rowspan="1" colspan="1">Side</th><th align="center" rowspan="1" colspan="1">Day 3</th><th align="center" rowspan="1" colspan="1">Day 7</th><th align="center" rowspan="1" colspan="1">Day 14</th><th align="center" rowspan="1" colspan="1">Day 28</th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">R1</td><td align="center" rowspan="1" colspan="1">Nasal</td><td align="center" rowspan="1" colspan="1">Un</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td></tr><tr><td align="center" rowspan="1" colspan="1">R1</td><td align="center" rowspan="1" colspan="1">Temporal</td><td align="center" rowspan="1" colspan="1">Un</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">D</td><td align="center" rowspan="1" colspan="1">D</td></tr><tr><td align="center" rowspan="1" colspan="1">R2</td><td align="center" rowspan="1" colspan="1">Nasal</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td></tr><tr><td align="center" rowspan="1" colspan="1">R2</td><td align="center" rowspan="1" colspan="1">Temporal</td><td align="center" rowspan="1" colspan="1">NULL</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td></tr><tr><td align="center" rowspan="1" colspan="1">R3</td><td align="center" rowspan="1" colspan="1">Nasal</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">M</td></tr><tr><td align="center" rowspan="1" colspan="1">R3</td><td align="center" rowspan="1" colspan="1">Temporal</td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">M</td></tr><tr><td align="center" rowspan="1" colspan="1">R4</td><td align="center" rowspan="1" colspan="1">Nasal</td><td align="center" rowspan="1" colspan="1">Un</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td></tr><tr><td align="center" rowspan="1" colspan="1">R4</td><td align="center" rowspan="1" colspan="1">Temporal</td><td align="center" rowspan="1" colspan="1">Fun</td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">M</td><td align="center" rowspan="1" colspan="1">M</td></tr><tr><td align="center" rowspan="1" colspan="1">R5</td><td align="center" rowspan="1" colspan="1">Nasal</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">Fun</td></tr><tr><td align="center" rowspan="1" colspan="1">R6</td><td align="center" rowspan="1" colspan="1">Temporal</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">D</td></tr><tr><td align="center" rowspan="1" colspan="1">R6</td><td align="center" rowspan="1" colspan="1">Nasal</td><td align="center" rowspan="1" colspan="1">Fun</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">A</td></tr><tr><td align="center" rowspan="1" colspan="1">R6</td><td align="center" rowspan="1" colspan="1">Temporal</td><td align="center" rowspan="1" colspan="1">P</td><td align="center" rowspan="1" colspan="1">P</td><td align="center" rowspan="1" colspan="1">D</td><td align="center" rowspan="1" colspan="1">D</td></tr></tbody></table></alternatives><table-wrap-foot><fn id="t001fn001"><p>NULL means UL-OCT observations were hindered by unfavorable mydriasis. Un = unformed capsular bend, A = anterior adhesion type, M = middle adhesion type, P = posterior adhesion type, D = detachment type, and Fun = funnel adhesion type.</p></fn></table-wrap-foot></table-wrap></sec><sec id="sec021"><title>3.5 Relationship between capsular bend stability and PCO</title><p>The earliest posterior capsule opacity within the IOL optic zone were found on day 7 in the incomplete group and 28 in the complete group (<xref ref-type="table" rid="pone.0148553.t002">Table 2</xref>). Five sides of the 12 incomplete sides showed PCO positive on 7 day after surgery, whereas none of the six complete sides presented such opacity, and this difference was significant (p = 0.038). Furthermore, after 14 days postoperatively, all the eight incomplete sides but not the four complete sides exhibited PCO positive; this difference was also significant (p = 0.002). Incomplete overlaps were more prone to form unstable capsular bend that led to the early emergence of PCO. An integrated process of a capsular bend and a PCO of the most typical rabbit are illustrated in <xref ref-type="fig" rid="pone.0148553.g007">Fig 7</xref>.</p><fig id="pone.0148553.g007" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.g007</object-id><label>Fig 7</label><caption><title>Observation of capsular bend via slit lamp (A-D) and UL-OCT optical sections (E-H) with schematic images embedded in the center of the images.</title><p>Red lines stand for anterior capsule and yellow squares for IOLs. (A and E) On day 3 postoperatively, an incomplete overlap, anterior capsule not overlapping the IOL at 9 o’clock to 11 o’clock temporally existed, and no opacity were found in the posterior capsule. Neither nasal nor temporal side formed a capsular bend. (B and F) On day 7 postoperatively, the temporal side of the anterior capsule came close to the IOL, and the capsule partially wrapped around the optic edge because of posterior capsular contraction. LECs migrated into the center of the temporal posterior capsule. Both sides formed anterior adhesion types. (C and G) On day 14 postoperatively, the LECs elongated and integrated into a fibrous-like membrane. The anterior capsule detached from the temporal IOL optic edge (white triangle) and transformed into the detachment type, whereas the nasal side remained the anterior adhesion type. (D and H) On day 28, the entire posterior capsule was covered by LECs, and exacerbation of the posterior capsular contraction and increased thickness of the posterior capsule (white arrow) were present. The temporal and nasal sides remained the anterior detachment and anterior adhesion types, respectively.</p></caption><graphic xlink:href="pone.0148553.g007"></graphic></fig><table-wrap id="pone.0148553.t002" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0148553.t002</object-id><label>Table 2</label><caption><title>Number (%) of sides showing PCO in the two groups.</title></caption><alternatives><graphic id="pone.0148553.t002g" xlink:href="pone.0148553.t002"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col><col align="left" valign="middle" span="1"></col></colgroup><thead><tr><th align="center" rowspan="1" colspan="1">Groups</th><th align="center" rowspan="1" colspan="1">Day 3</th><th align="center" rowspan="1" colspan="1">Day 7</th><th align="center" rowspan="1" colspan="1">Day 14</th><th align="center" rowspan="1" colspan="1">Day 28</th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">Incomplete overlap group</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">7(58.3%)</td><td align="center" rowspan="1" colspan="1">8(100%)</td><td align="center" rowspan="1" colspan="1">8(100%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Complete overlap group</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">4(100%)</td></tr></tbody></table></alternatives></table-wrap></sec></sec><sec sec-type="conclusions" id="sec022"><title>Discussion</title><p>PCO is a major complication after cataract surgery, which is related to numerous factors, [<xref rid="pone.0148553.ref002" ref-type="bibr">2</xref>, <xref rid="pone.0148553.ref011" ref-type="bibr">11</xref>–<xref rid="pone.0148553.ref015" ref-type="bibr">15</xref>] including the material, [<xref rid="pone.0148553.ref016" ref-type="bibr">16</xref>–<xref rid="pone.0148553.ref018" ref-type="bibr">18</xref>] biocompatibility [<xref rid="pone.0148553.ref018" ref-type="bibr">18</xref>] and design of the IOL. [<xref rid="pone.0148553.ref002" ref-type="bibr">2</xref>, <xref rid="pone.0148553.ref005" ref-type="bibr">5</xref>, <xref rid="pone.0148553.ref019" ref-type="bibr">19</xref>–<xref rid="pone.0148553.ref021" ref-type="bibr">21</xref>] Several studies [<xref rid="pone.0148553.ref003" ref-type="bibr">3</xref>–<xref rid="pone.0148553.ref006" ref-type="bibr">6</xref>, <xref rid="pone.0148553.ref013" ref-type="bibr">13</xref>] have proven that sharp-edge designed IOL can significantly reduce the incidence of PCO. Previous researches on capsular bend mainly focused on human and animal models in vitro. However, the differences in capsular bend formation between humans and animals remain unknown.</p><p>Previous studies on human capsular bends have primarily used slit lamp or Scheimplflug techniques, [<xref rid="pone.0148553.ref013" ref-type="bibr">13</xref>, <xref rid="pone.0148553.ref022" ref-type="bibr">22</xref>], whereas early OCT research[<xref rid="pone.0148553.ref023" ref-type="bibr">23</xref>, <xref rid="pone.0148553.ref024" ref-type="bibr">24</xref>] was limited by axial resolution, and the images obtained were not sufficiently clear. Zhao Y et al [<xref rid="pone.0148553.ref008" ref-type="bibr">8</xref>] first used UL-OCT with high axial resolution to investigate the different capsular bend-IOL complex evolutions in highly myopic and emmetropic eyes during the early postoperative period. Nevertheless, clinical studies entail many restrictions precluding the use of in-depth histopathological and cytological experiments. Nishi et al [<xref rid="pone.0148553.ref003" ref-type="bibr">3</xref>–<xref rid="pone.0148553.ref006" ref-type="bibr">6</xref>] established a capsular bend animal model and reported beneficial morphological findings based on histopathological sections that contributed to the understanding of PCO; however, classifications and evolution of capsular bends could not been performed in their study. Therefore, the present animal model in vivo is designed to identify additional details in the observations and provide an efficient approach to investigate the mechanisms of capsular bend formation and LECs behavior.</p><p>First, this animal model showed its capability of reliable and repeating observation of capsular bend types. Sacu and coauthors [<xref rid="pone.0148553.ref023" ref-type="bibr">23</xref>] classified four capsular bend configurations by slit lamp, namely, Y, parallel, right-angle and wrapping capsular bend configuration, in which R configurations (same as the anterior capsular bend type in our study) was the most common type. While Zhao Y and coauthors [<xref rid="pone.0148553.ref008" ref-type="bibr">8</xref>] identified six capsular bend types by UL-OCT, namely, anterior adhesion, middle adhesion, posterior adhesion, funnel adhesion, furcate adhesion and parallel adhesion, during their investigation of patients with different axial lengths after cataract surgery. They also found that anterior capsular bend type was the most common type. Our finding performed in animal was similar to Zhao Y et al. [<xref rid="pone.0148553.ref008" ref-type="bibr">8</xref>] Meanwhile, we performed histopathological section and its findings at the scan position were consistent with the UL-OCT. It was interesting that the detachment type that transformed from anterior or posterior capsular bend types was firstly identified in this study, which might be involved with the anterior capsule overlap condition and capsule contraction.</p><p>Second, our animal model was able to perfectly mimic the capsular bend evolution as well as the PCO process. Many researchers have described various stage of capsular bend formation. [<xref rid="pone.0148553.ref022" ref-type="bibr">22</xref>–<xref rid="pone.0148553.ref024" ref-type="bibr">24</xref>] Although their descriptions were different, their findings indicated that capsular bend types were in evolutionary states and they were not pertinent during their formation. Zhao Y et al [<xref rid="pone.0148553.ref008" ref-type="bibr">8</xref>] observed that the parallel type can transformed into the Fun, and then transformed into the A type, which was consistent with the capsular bend formation stage theory. Interestingly, in this animal model, we observed that the A and P types might transform into D type, and the A type even occasionally converted into Fun type (<xref ref-type="fig" rid="pone.0148553.g006">Fig 6</xref>) which may result from capsule contraction. Furthermore, the speed of capsular bend formation and the development of PCO were closely related. Sacu et al [<xref rid="pone.0148553.ref023" ref-type="bibr">23</xref>] found that one-piece acrylic IOL could develop stable capsular bends after 10 days, but this development was observed on day 7 in the present study, which was much earlier than that observed in humans. [<xref rid="pone.0148553.ref023" ref-type="bibr">23</xref>, <xref rid="pone.0148553.ref024" ref-type="bibr">24</xref>] Nishi et al [<xref rid="pone.0148553.ref003" ref-type="bibr">3</xref>] investigated the LECs at the capsular bend through immunohistochemical staining with Ki-67 antibody following surgery and revealed that the contact inhibition of the LECs was induced once the capsular bend formed. If the capsular bend formed after LECs migration, it could not exert its contact inhibition effect, and the LECs proliferated and rapidly migrated into the posterior capsule.</p><p>In addition, another promising aspect of our model was that it could investigate the relationship of capsule overlap and PCO prevention. Previous study has reported that desirable overlap of the anterior capsule is beneficial to the stable formation of capsular bends and prevention of PCO. [<xref rid="pone.0148553.ref025" ref-type="bibr">25</xref>] In the present study, PCO were observed in the incomplete overlap sides on day 7 after surgery, which was sooner than that in the complete group. Moreover, capsular bend configurations of the completely overlapped eyes did not change on day 7 after surgery, so this finding might be ascribed to the stable formation of the capsular bend. It was postulated that overlapping conditions of the anterior capsule and delayed capsular bend barrier destruction may exerted devastating influences on the stability of the capsular bends. Less extensive investigation has been performed in capsular bend association with PCO. Whether the speed of capsular bend formation or the stability exerted a certain effect on PCO prevention deserve further investigation and is a worthwhile unanswered question.</p><p>In summary, the main advantages of the present animal model were derived from the optical section functionality of UL-OCT in animal experiments. First, observations of capsular bend configurations and monitoring can be performed in vivo. Second, the capsular bag could be extracted at any desired time to investigate the cytoskeleton and cell behavior of LCEs at different stages by immunohistochemical or fluorescence staining. Some experiments related to fluorescence staining and preparations of the contact inhibited LECs at the capsular bend have recently been performed and have achieved some progress. Nonetheless, additional studies are needed.</p><p>However, several potential limitations of this experiment should be pointed out. First, the slit lamp and UL-OCT observations should be conducted after dilating the pupil to at least 6.5 mm. However, the rabbit pupil cannot always be dilated large enough. Hence, observations may sometimes be hindered by unfavorable mydriasis. Second, only two sides were scanned rather than all dimensions because of time constraints; however, the mutual effects of both sides and the evolution of the entire bag cannot be ignored. Moreover, the spherical lens and large capsular bag of the rabbit resulted in mismatches between the IOL and the capsular bag that led to IOL rotation and shifts in the early period following surgery. Thus, the largest IOL with haptic length of 13.0 mm and perfect adhesion characteristics were used to reduce the maximum degree of effect among different species.</p><p>In conclusion, the application of this optical-section assisted capsular bend animal model in vivo not only mimics capsular bend evolution and PCO but also produces OCT optical section images equivalent to and more repeatable than those acquired with histopathology. Thus, this model provides a promising method for further investigations of PCO.</p></sec><sec sec-type="supplementary-material" id="sec023"><title>Supporting Information</title><supplementary-material content-type="local-data" id="pone.0148553.s001"><label>S1 Table</label><caption><title>Different capsular bend types and PCO of the whole rabbits at two sides (nasal and temporal) postoperatively.</title><p>(DOC)</p></caption><media xlink:href="pone.0148553.s001.doc"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material></sec></body><back><ack><p>We thank Yingjie Ma for providing editing service for this manuscript.</p></ack><ref-list><title>References</title><ref id="pone.0148553.ref001"><label>1</label><mixed-citation publication-type="journal"><name><surname>Knight-Nanan</surname><given-names>D</given-names></name>, <name><surname>O'Keefe</surname><given-names>M</given-names></name>, 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Li</name><name sortKey="Lin, Lei" sort="Lin, Lei" uniqKey="Lin L" first="Lei" last="Lin">Lei Lin</name><name sortKey="Yu, Fang" sort="Yu, Fang" uniqKey="Yu F" first="Fang" last="Yu">Fang Yu</name><name sortKey="Yu, Xiaoyu" sort="Yu, Xiaoyu" uniqKey="Yu X" first="Xiaoyu" last="Yu">Xiaoyu Yu</name><name sortKey="Zhao, Yinying" sort="Zhao, Yinying" uniqKey="Zhao Y" first="Yinying" last="Zhao">Yinying Zhao</name><name sortKey="Zhao, Yun E" sort="Zhao, Yun E" uniqKey="Zhao Y" first="Yun-E" last="Zhao">Yun-E Zhao</name><name sortKey="Zheng, Qian" sort="Zheng, Qian" uniqKey="Zheng Q" first="Qian" last="Zheng">Qian Zheng</name><name sortKey="Zhu, Weigen" sort="Zhu, Weigen" uniqKey="Zhu W" first="Weigen" last="Zhu">Weigen Zhu</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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