A Systems View of Posterior Capsule Opacification: TGF-β/ROS Signaling, Mitochondrial Homeostasis, and Injury/Aging Cues—Therapeutic Opportunities

Posterior capsule opacification is a common long-term complication of cataract surgery that can cause persistent visual impairment in some patients despite advances in surgical techniques and IOL design. Most current studies focus on single signaling pathways or isolated time windows, showing benefits in some models but with limited overall translation. This review organizes existing evidence into a pathological network in which TGF-β signaling initiation and amplification, mitochondrial dysfunction, and microenvironmental cues related to surgical trauma and aging collectively shape the susceptibility, progression, and persistence of posterior capsule opacification and outlines potential opportunities for combination therapy, time-sensitive intervention windows, and local delivery.