Prevention of posterior capsular opacification

•Many signaling pathways and molecules are involved in PCO development.•The growth factor TGF-β plays a significant role.•Various surgical and pharmacological forms of PCO prevention have been examined.•The most effective method so far is implantation of IOLs with sharp edged optics.•Nanomedicine addressing biological pathways can be promising for PCO prevention.

Posterior capsular opacification (PCO) is a common complication of cataract surgery. The development of PCO is due to a combination of the processes of proliferation, migration, and transdifferentiation of residual lens epithelial cells (LECs) on the lens capsule. In the past decades, various forms of PCO prevention have been examined, including adjustments of techniques and intraocular lens materials, pharmacological treatments, and prevention by interfering with biological processes in LECs. The only method so far that seems effective is the implantation of an intraocular lens with sharp edged optics to mechanically prevent PCO formation. In this review, current knowledge of the prevention of PCO will be described. We illustrate the biological pathways underlying PCO formation and the various approaches to interfere with the biological processes to prevent PCO. In this type of prevention, the use of nanotechnological advances can play a role.