Dr. Santaro Noguchi, a dedicated intraocular lens (IOL) specialist at Tsukazaki Hospital (Japan), is dominating cataract and refractive film festivals with another groundbreaking invention—an artificial capsular bag that tackles persistent challenges in cataract surgery, enhances IOL longevity and opens up new possibilities for lens replacement. With a string of accolades under his belt, Dr. Noguchi could be on the cusp of something extraordinary.
Already, Dr. Noguchi’s work has earned him Grand Prizes at both the 2024 ASCRS and APACRS Film Festivals, where his video showcasing the innovative capsular bag captivated judges. Now, all eyes are on the upcoming 2024 ESCRS Film Festival in Barcelona. Will he complete the trifecta and secure another grand prize, cementing his legacy as a true trailblazer in the ophthalmic world?
The problems that the artificial capsular bag has sought to solve were long thought to be unfortunate, inevitable consequences of cataract surgery.
“Refractive errors and secondary cataracts after cataract surgery seem unavoidable,” Dr. Noguchi reflected. “The clear intraocular environment achieved immediately after surgery doesn’t last long. As time goes by, the IOL adheres to the capsular bag, making it impossible to exchange.”
These limitations have long frustrated ophthalmologists. Determined to find a solution, he set out to develop an artificial capsular bag that could prevent such complications. And in this quest, Dr. Noguchi has upended conventional thinking about the possibilities of cataract surgery.
How it works
Building on the pioneering work of predecessors like Dr. Tsutomu Hara, Dr. Okihiro Nishi and Dr. Toshiyuki Nagamoto, who had explored ways to prevent secondary cataracts using silicone rings and sharp optic edges, Dr. Noguchi sought to take their ideas further.
His goal was to create a versatile device that not only prevents opacity but also allows for easy IOL exchange. “I began to think that eventually free replacement of intraocular lenses would be possible,” he recalls.
Dr. Noguchi’s artificial capsular bag is made of hydrophilic acrylic, which prevents lens epithelial cell (LEC) adhesion and reduces the risk of dead bag syndrome. Its semicircular ring-shaped design lines and widens the lens capsule to prevent opacity and adhesion with the IOL.1
A unique clip system holds the IOL optics securely in place, ensuring consistent exposure of the anterior and posterior capsules to the aqueous flow—crucial for preventing LEC migration and minimizing the risk for secondary cataracts. Moreover, the device is compatible with any standard 6 mm IOL, offering surgeons great flexibility.1
The surgical procedure is fairly simple. It begins by using an IOL injector to place the artificial capsular bag inside the eye. Once fixated within the natural capsule, the IOL is inserted and clipped into place.1
A team effort
The story behind Dr. Noguchi’s creation is just as compelling as its ingenious design.
It all started in 2011, when he was living in Ishinomaki City in the wake of the Great East Japan Earthquake. Inspired by his own clinical experience and frustrated by the limitations of existing solutions, he dreamed of a device that could address common postoperative challenges.
The development of the artificial capsular bag was not without its challenges. Dr. Noguchi’s initial designs, while promising, needed refinement.
“In the beginning, I drew my own blueprints, asked an IOL company to make a demo device and went through a trial-and-error process,” Dr. Noguchi recalls. “We’ve continued to make improvements to the current fourth generation device.”
A major turning point came when he joined forces with Prof. Ioannis Pallikaris, founder and director of The Institute of Vision and Optics at the University of Crete (Greece), who happened to be working on a similar concept. Their partnership enabled further advancements in the device’s design and paved the way for clinical trials.
“I realized that it would be impossible for me, as a single ophthalmologist, to implant the device into a human eye and achieve clinical results. The cost of conducting clinical trials would be enormous,” Dr. Noguchi acknowledges.
By December 2023, their artificial capsular bag had been implanted in 110 eyes with impressive outcomes. Patients experienced promising long-term refractive stability without any complications. The device demonstrated a 7% decrease in corneal endothelial cells six months post-surgery, with postoperative flare levels comparable to those seen in standard cataract surgeries. Refractive index outcomes were similar to or better than those using conventional IOL formulas.
Expanded possibilities
The artificial capsular bag could fundamentally reshape cataract surgery, paving the way for more frequent and safe lens replacements. This change may encourage patients to opt for premium IOLs, knowing they can be easily replaced in the future.
“I think the conventional wisdom that cataract surgery is a one-time operation will disappear,” Dr. Noguchi predicts. His innovation could make premium IOLs more attractive, expanding access to advanced visual benefits.
Beyond cataract surgery, Dr. Noguchi envisions his device as a platform for transformative advancements in ocular and even systemic healthcare. “Currently, the space is just to accommodate the IOL, but IOL haptics are not needed to hold the IOL in place,” he explains. “That leaves a large space inside the capsule, where a 24-hour monitoring device could be implanted.”
This potential opens the door to implantable health-monitoring devices that could manage systemic conditions like diabetes through continuous monitoring within the eye. “In the future, it may be possible to implant drug delivery systems and devices inside the artificial capsular bag that perform 24-hour monitoring of IOP and cytokine,” Dr. Noguchi suggests.
Next stop: Barcelona
By addressing post-cataract-surgery complications and offering a versatile platform for future innovations, Dr. Noguchi’s artificial capsular bag is poised to reshape cataract surgery and the industry as we know it. This explains why film festival judges the world over have lavished top honors on the video introducing it.
As Dr. Noguchi emphasizes, “A new category and a new surgery have arrived in the field of ophthalmology and refractive cataract surgery.”
With its proven success in clinical trials and compatibility across IOL brands, the artificial capsular bag is more than just a solution to an existing problem—it’s a catalyst for innovation with the potential for further breakthroughs. As Dr. Noguchi’s vision continues to unfold, the ophthalmic community eagerly anticipates the results of the 2024 ESCRS Film Festival and the next chapter in this groundbreaking story.
Editor’s Note: The 42nd Congress of the European Society of Cataract and Refractive Surgery (ESCRS 2024) is being held from 6-10 September in Barcelona, Spain. The Video Award Session is taking place on Sunday, 8 September at 14.00-16.00, Plenary Hall of the Fira Barcelona Gran Via.
Reference
- Noguchi S. “Breakthrough with Artificial Capsular Bag in Cataract Surgery.” Video presented at APACRS, Chengdu, China, May 2024. Available at: https://apacrs.org/filmfestival_2024.asp?info=9
