Optimizing in vitro posterior capsule opacification models in lens epithelial cells: A systematic review

Posterior capsule opacification (PCO) remains the most common complication following cataract surgery, and transforming growth factor-beta 2 (TGF-β2) is a key mediator of its pathogenesis. This systematic review evaluates the culture media, TGF-β2 concentrations, and incubation periods used in in vitro PCO models to identify conditions that favour reproducibility. A comprehensive literature search was performed in PubMed, ScienceDirect, SpringerLink, Taylor & Francis and SAGE Journals using the MeSH terms “posterior capsule opacification” OR “posterior capsular opacification” OR “capsule opacifications” OR “secondary cataract” OR “PCO” AND “lens epithelial cells” AND “TGF-β2” OR “epithelial–mesenchymal transition (EMT)”. Original full-text English articles published between 1 June 2014 and 30 July 2024 were included; abstracts, preprints, and non-English reports were excluded. Sixteen eligible studies were retrieved. Three studies employed 5 ng/mL TGF-β2, whereas seven used 10 ng/mL; both doses induced morphological changes in lens epithelial cells. Nine studies utilised Dulbecco’s modified Eagle medium (DMEM). Most experiments (n=8) incubated cells for 24 h, whereas others extended incubation to ≥ 48 h depending on study design. Collectively, 10 ng/mL TGF-β2, DMEM and an incubation period of 24–48 h represent the most frequently used conditions and may improve the reproducibility of in vitro PCO models, ultimately guiding the development of interventions to prevent PCO after cataract surgery.