Cataract Prophylaxis, Treatment & Pharmacological Approaches

Due in part to a general decline in postoperative infections, cataract surgery has become incredibly safe and effective. However, endophthalmitis rates have increased after clear corneal phacoemulsification, according to retrospective clinical evidence.

Endophthalmitis is an inflammation of the inner structures of the eye, including the retina, choroid, and vitreous. It is typically caused by an infection and can lead to severe vision loss if not treated

Corneal phacoemulsification is a surgical procedure that is used to remove the cloudy natural lens (also known as the crystalline lens) of the eye in order to treat cataracts. The procedure involves making a small incision in the cornea, through which an ultrasound probe is inserted. The probe emits ultrasound waves that break up (emulsify) the cloudy lens into tiny pieces, which are then suctioned out of the eye.

The prevention of endophthalmitis before cataract surgery involves two steps. In order to prevent the introduction of organisms into the eye during surgery, the initial step entails eliminating infectious pathogens from the ocular surface and the surrounding tissue. It seems reasonable to think about the second stage of prophylaxis involving the diffusion of antibiotic into the ocular tissues, including the cornea, aqueous humor, and vitreous, to kill any organisms that, despite disinfecting the surface, may have been inoculated during cataract surgery, even though there is no concrete evidence that antibiotics can diffuse into ocular tissues or eradicate pathogens in the eye after topical use.

According to the authors of an article that reviewed the effects of natural and synthetic agents on experimentally induced cataracts, several substances show promising potential for preventing and reversing cataracts in preclinical studies and warrant further investigation as potential pharmacotherapy alternatives to surgical management. The fact that more people are projected to get cataracts as the population ages and that cataract surgery is not widely available worldwide has sparked interest in pharmacotherapy for the condition.

“With the projected increase in life expectancies, the number of people affected with cataract is predicted to increase worldwide,” the authors wrote. In low-income countries without convenient and affordable access to cataract surgery, the prognosis for the illness is at best uncertain.

Therefore, the potential therapeutic and financial benefits of pharmaceutical cataract treatments are incalculable and range from improved quality of life to a reduction in financial load. The authors go on to say that chemicals or extracts from plants are particularly appealing, particularly in developing countries. According to their explanation, the accessibility of plant-derived drugs may result in reduced development and patient usage costs than with conventional pharmaceuticals. The authors outline the anatomy, physiology, transparency, and antioxidant systems of the lens as background information before discussing several cataract treatment options.

The models based on protein aggregation and/or loss of protein solubility are included in their summary of the molecular mechanisms of cataract formation. The authors' list of substances that have been looked into for their potential to treat cataracts includes substances derived from plants, herbal remedies, ketoacids and amino acids, as well as other substances that have antioxidant and free radical-scavenging properties.

Along with agents that target glycation-specific mechanisms, phase separation, the transforming growth factor- pathway, and matrix metalloproteinase, the substances under investigation also include pharmacological chaperons that bind -crystallins in the lens to reverse protein aggregation and improve protein solubility. The study article includes 2 tables that highlight significant findings from studies that are pertinent to cataract pharmacotherapy. The studies of ex vivo and in vitro cataractogenesis are listed in one table, while the studies of in vivo cataractogenesis are listed in the other. With only two trials done on rabbits and one on guinea pigs, the latter research were conducted almost entirely in murine models.

Subcutaneous injection, dietary changes, topical treatments, oral (including gavage/gastric intubation), and intraperitoneal or subcutaneous injection are some of the application methods.

The Future

The authors hypothesized that more effective drug delivery techniques would enable greater efficacy, noting that lutein/zeaxanthin supplementation did not significantly benefit for slowing down the progression of senile cataract in the age-related eye disease study 2 and that a thorough Cochrane review failed to discover any anticataract benefit of antioxidant vitamin supplementation.

Looking ahead, the researchers recommended that efforts be made to gain a deeper comprehension of how cataracts form because doing so might help find novel therapeutic targets for drugs that prevent or treat lens opacity.