High refractive index polysiloxane as injectable, in situ curable accommodating intraocular lens

Thermo-sensitive Poloxamer based antibacterial anti-inflammatory and photothermal conductive multifunctional hydrogel as injectable, in situ curable and adjustable intraocular lens

Cataract patients look forwards to fewer postoperative complications and higher vision quality after surgery. However, the current intraocular lens (IOL) implanted after cataract surgery neither can adjust focal length in response to ciliary muscle contraction as natural lens nor have the ability to prevent postoperative complications. Herein, a thermosensitve Poloxamer based hybrid hydrogel with antibacterial anti-inflammatory and photothermal functional elements doping was designed and used as injectable, in situ curable, and adjustable IOL (FHTAB IOL). The FHTAB IOL was composed of thermosensitve triblock-polymer F127DA and a small amount of HAMA, combined with BP NS, TA, and Ag NPs. FHTAB IOL can be injected into the empty lens capsule after cataract surgery via an injectable thermos-gel under NIR illumination and then be rapidly cured to form a full-size IOL under short-time blue light irradiation. The designed injectable FHTAB IOL possesses high transparency and transmittance, with a refractive index similar to the natural lens and adjustable properties. It was stabilized as a refractive medium without any leakage in the eye. In addition, the TA and Ag NPs loaded in the FHTAB IOL displayed significant antibacterial and anti-inflammatory effects in vitro and vivo. This study presents a potentially effective new strategy for the development of multifunctional adjustable IOLs.

Recent Advances of Intraocular Lens Materials and Surface Modification in Cataract Surgery

Advances in cataract surgery have increased the demand for intraocular lens (IOL) materials. At present, the progress of IOL materials mainly contains further improving biocompatibility, providing better visual quality and adjustable ability, reducing surgical incision, as well as dealing with complications such as posterior capsular opacification (PCO) and ophthalmitis. The purpose of this review is to describe the research progress of relevant IOL materials classified according to different clinical purposes. The innovation of IOL materials is often based on the common IOL materials on the market, such as silicon and acrylate. Special properties and functions are obtained by adding extra polymers or surface modification. Most of these studies have not yet been commercialized, which requires a large number of clinical trials. But they provide valuable thoughts for the optimization of the IOL function.

A Long-Term Clearing Cranial Window for Longitudinal Imaging of Cortical and Calvarial Ischemic Injury through the Intact Skull

Skull is a reservoir for supplying immune cells that mediate brain immune surveillance. However, during intravital optical imaging of brain, conventional cranial windows requiring skull thinning or removal disrupt brain immunity integrity. Here, a novel long-term clearing cranial window (LCCW) based on the intact skull, dedicated to chronic skull transparency maintenance, is proposed. It significantly improves optical imaging resolution and depth, by which the cortical and calvarial vascular injury and regeneration processes after ischemic injury are longitudinally monitored in awake mice. Results show that calvarial blood vessels recover earlier than the cortex. And the transcriptome analysis reveals that gene expression patterns and immune cells abundances exist substantial differences between brain and skull after ischemic injury, which may be one of the causes for the time lag between their vascular recovery. These findings bring great enlightenment to vascular regeneration and reconstruction. Moreover, LCCW provides a minimally invasive approach for imaging the brain and skull bone marrow.

Foldable Bulk Anti-adhesive Polyacrylic Intraocular Lens Material Design and Fabrication for Posterior Capsule Opacification Prevention

Posterior capsular opacification (PCO) is a primary complication after phacoemulsification combined with intraocular lens (IOL) implantation, which is attributed to adhesion, proliferation, and migration of residual lens epithelial cells on IOL. Although surface hydrophilic coating is considered to be a powerful way to inhibit PCO incidence after surgery, it requires complex post-production processes, thus limiting their applicability. In comparison, bulk modification is a stable, effective, and facile IOL synthesis method for PCO prevention. Herein, a new anti-adhesive IOL material was designed and successfully synthesized by radical copolymerization of ethylene glycol phenyl ether methacrylate (EGPEMA) and 2-(2-ethoxyethoxy) ethyl acrylate (EA). The physicochemical properties of P(EGPEMA-co-EA) copolymer materials, including chemical structure, mechanical, thermal, surface, and optical properties, were analyzed by using ¹H NMR spectroscopy, FT-IR spectroscopy, tensile test, thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), water contact angle measurement, and UV-vis spectroscopy. The elongation at break and the modulus of elasticity of the copolymer were tunable through the change of the composition of monomers. Compared to other components, the tensile results showed that P(EGPEMA-co-EA) materials (70% EGPEMA in mass ratio, F7) are suitable for the preparation of foldable intraocular lens with lower elastic modulus and higher elongation at break. TGA and DSC showed that the material has high thermal stability, and the glass transition temperature of F7 material is 16.1 °C. The water contact angle measurement results showed that the introduction of EA improved the hydrophilicity of the material. The percentage of transmittance of all copolymers at 400-800 nm is above 85%. Then, the biocompatibility of the materials was evaluated by in vitro assay and subcutaneous implantation. Both in vitro results and subcutaneous implantation experiments showed that the designed IOL materials exhibited a good anti-adhesion effect and no cytotoxicity. Finally, phacoemulsification and IOL intraocular implantation were performed, and the in vivo results confirmed the good PCO prevention ability as well as the biocompatibility of the new IOL materials.

Polymeric Materials for Eye Surface and Intraocular Applications

Ocular applications of polymeric materials have been widely investigated for medical diagnostics, treatment, and vision improvement. The human eye is a vital organ that connects us to the outside world so when the eye is injured, infected, or impaired, it needs immediate medical treatment to maintain clear vision and quality of life. Moreover, several essential parts of the eye lose their functions upon aging, causing diminished vision. Modern polymer science and polymeric materials offer various alternatives, such as corneal and scleral implants, artificial ocular lenses, and vitreous substitutes, to replace the damaged parts of the eye. In addition to the use of polymers for medical treatment, polymeric contact lenses can provide not only vision correction, but they can also be used as wearable electronics. In this Review, we highlight the evolution of polymeric materials for specific ocular applications such as intraocular lenses and current state-of-the-art polymeric systems with unique properties for contact lens, corneal, scleral, and vitreous body applications. We organize this Review paper by following the path of light as it travels through the eye. Starting from the outside of the eye (contact lenses), we move onto the eye's surface (cornea and sclera) and conclude with intraocular applications (intraocular lens and vitreous body) of mostly synthetic polymers and several biopolymers. Initially, we briefly describe the anatomy and physiology of the eye as a reminder of the eye parts and their functions. The rest of the Review provides an overview of recent advancements in next-generation contact lenses and contact lens sensors, corneal and scleral implants, solid and injectable intraocular lenses, and artificial vitreous body. Current limitations for future improvements are also briefly discussed.

Advances in the Study of Lens Refilling

The ultimate goal of cataract surgery is to restore the accommodation while restoring distance visual acuity. Different kinds of accommodative intraocular lens (IOLs) and surgical techniques have been suggested to apply during the surgery, but they showed poor postoperative accommodation. It is possible to achieve this goal by refilling the lens with an injectable polymer. We present a summary of the existing materials, methods, results, and some obstacles in clinical application that remain of lens refilling for restoration of accommodation. Two main problems have restricted the clinical application of this technique. One was the formation of postoperative secondary capsule opacification and the other was the different accommodative power after surgery.

One-component waterborne in vivo cross-linkable polysiloxane coatings for artificial skin

Polysiloxane-based artificial skins are able to emulate the mechanical and barrier performance of human skin. However, they are usually fabricated in vitro, restricting their diverse applications on human body. Herein, we presented one-component waterborne cross-linkable polysiloxane coatings prepared from emulsified vinyl dimethicone, emulsified hydrogen dimethicone, and Karstedt catalyst capsules that were first synthesized by solvent evaporation method. The coating had good storage stability and meanwhile could form an elastic film quickly through merging of silicone oil droplets and subsequent hydrosilylation reaction. It was found that the mass ratio of vinyl dimethicone emulsion/hydrogen dimethicone emulsion (V/H), and the dosage of Karstedt catalyst capsules (K/(V + H)) were critical to the curing time, morphology, and mechanical properties of the coatings. With appropriate values of V/H and K/(V + H), the polysiloxane film had the mechanical performance comparable to that from solvent-based one. The coating could be topically applied to human skin in vivo and in situ turned into an elastic, invisible thin film with good water resistance. In contrast to those reported polysiloxane materials, the one-component waterborne polysiloxane coating was nontoxic and convenient for in vivo application on human body, making it be a promising candidate as artificial skin in the fields of cosmetics, medical treatment, and E-skin.

The Ultrafast and Continuous Fabrication of a Polydimethylsiloxane Membrane by Ultraviolet-Induced Polymerization

The polydimethylsiloxane (PDMS) membrane commonly used for separation of biobutanol from fermentation broth fails to meet demand owing to its discontinuous and polluting thermal fabrication. Now, an UV-induced polymerization strategy is proposed to realize the ultrafast and continuous fabrication of the PDMS membrane. UV-crosslinking of synthesized methacrylate-functionalized PDMS (MA-PDMS) is complete within 30 s. The crosslinking rate is three orders of magnitude larger than the conventional thermal crosslinking. The MA-PDMS membrane shows a versatile potential for liquid and gas separations, especially featuring an excellent pervaporation performance for n-butanol. Filler aggregation, the major bottleneck for the development of high-performance mixed matrix membranes (MMMs), is overcome, because the UV polymerization strategy demonstrates a freezing effect towards fillers in polymer, resulting in an extremely high-loading silicalite-1/MA-PDMS MMM with uniform particle distribution.

Long-term prevention of capsular opacification after lens-refilling surgery in a rabbit model

Purpose

To reduce capsular opacification by a peri‐surgical treatment of the lens capsule with drugs in an in vivo rabbit model. Lens‐refilling surgery is a potential therapeutic intervention to treat patients with a cataract lens. The lens material is replaced with an injectable (bio)polymer that retains the natural mechanical and optical lens properties, therewith allowing accommodation. The occurrence of capsular opacification mediated by lens epithelial cells negatively affects accommodation and vision and should be avoided in this lens restoration approach.

Methods

An in vivo rabbit animal model was used with lens replacement with a silicone‐based gel‐like polymer and concurrent treatment of the lens epithelium with drugs. A case‐study approach was applied as both drug combinations and implantation times were varied. The following drugs were investigated for their potential to prevent capsular opacification long‐term: actinomycin D, methotrexate, paclitaxel and Tween‐20. All were administered in a hyaluronic acid vehicle. The rabbits were clinically followed for periods up to 4 years postimplantation. Eyes, corneas and lenses were analysed post‐mortem using MRI and confocal microscopy.

Results

Treatment combinations containing actinomycin D generally led to the least appearance of capsular fibrosis. The use of Tween‐20 or paclitaxel without actinomycin D resulted in much earlier and pronounced fibrotic responses. The aspect of capsular opacification was highly variable in individual animals. Application of the drugs in a hyaluronic acid vehicle appeared to be a safe method that spared the corneal endothelium.

Conclusion

The feasibility of long‐term prevention of fibrosis over a period of more than 4 years has been demonstrated in lens refilling in the rabbit model.

In Situ Generated Medical Devices

Medical devices play a major role in all areas of modern medicine, largely contributing to the success of clinical procedures and to the health of patients worldwide. They span from simple commodity products such as gauzes and catheters, to highly advanced implants, e.g., heart valves and vascular grafts. In situ generated devices are an important family of devices that are formed at their site of clinical function that have distinct advantages. Among them, since they are formed within the body, they only require minimally invasive procedures, avoiding the pain and risks associated with open surgery. These devices also display enhanced conformability to local tissues and can reach sites that otherwise are inaccessible. This review aims at shedding light on the unique features of in situ generated devices and to underscore leading trends in the field, as they are reflected by key developments recently in the field over the last several years. Since the uniqueness of these devices stems from their in situ generation, the way they are formed is crucial. It is because of this fact that in this review, the medical devices are classified depending on whether their in situ generation entails chemical or physical phenomena.

Polymerizable-group capped ZnS nanoparticle for high refractive index inorganic-organic hydrogel contact lens

Refractive index (RI) is an important parameter for contact lens biomaterials. In this paper, a novel polymerizable-group capped ZnS nanoparticle (NP) was synthesized by chemical link between hydroxyl group on the surface of ZnS (ME-capped) and isocyanate group of polymerizable molecule of 2-isocyanatoethyl methacrylate. Then the ZnS NP copolymerized with monomer of 2-hydroxyethyl methacrylate (HEMA) and N,N-dimethylacrylamide (DMA) to prepare high refractive index hydrogel contact lens with high content of inorganic ZnS NP. Increasing polymerizable-group capped ZnS content in the hydrogels improved its RI value and mechanical properties, however decreased slightly its transmittance, equilibrium (ESR) and lysozyme deposition on the hydrogel surface. The ZnS-containing hydrogels possessed good cytocompatibility and in vivo biocompatibility in rabbit eyes, demonstrating a potential application as high RI ocular refractive correction biomaterial.

Gelatin-Based Photocurable Hydrogels for Corneal Wound Repair

In this study, an injectable, photocurable gelatin system, consisting of acrylated gelatin and thiolated gelatin, with tunable mechanical, biodegradation, and biological properties was used as a potential cell-supportive scaffold for the repair of focal corneal wounds. The mechanical property of hydrogels can be readily modified (postcure shear modulus of between 0.3 and 22 kPa) by varying the ratio of acrylate to thiol groups, photointensity, and solid content, and the biodegradation times also varied with the change of solid content. More importantly, the generated hydrogels exhibited excellent cell viability in both cell seeding and cell encapsulation experiments. Furthermore, the hydrogels were found to be biocompatible with rabbit cornea and aided the regeneration of a new tissue under a focal corneal wound (exhibiting epithelial wound coverage in <3d), and ultraviolet irradiation did not have any obvious harmful effect on the cornea and posterior eye segment tissues. Along with their injectability and tunable mechanical properties, the photocurable thiol-acrylate hydrogels showed promise as corneal substitutes or substrates to construct a new corneal tissue.

A novel crosslinking agent of polymethyl(ketoxime)siloxane for room temperature vulcanized silicone rubbers: synthesis, properties and thermal stability

A novel cross-linker polymethyl(ketoxime)siloxane (PMKS) with dense pendant reactive groups based on polymethylhydrosiloxane (PMHS) was synthesized via dehydrocoupling reaction. The novel PMKS cross-linker was applied to a hydroxyl-terminated polydimethylsiloxane (HPDMS) matrix to prepare a series of novel RTV silicone rubbers. The chemical structure of PMKS and curing reaction between HPDMS and PMKS by hydrolytic condensation were verified by IR spectroscopy and ¹H NMR. Thermal stability and mechanical properties of these novel RTV silicone rubbers have been studied by means of thermal gravimetric analysis (TGA) and universal tensile testing machine, respectively. The results displayed that a pronounced enhancement effect of the novel cross-linker PMKS on thermal stabilities and mechanical properties of RTV silicone rubbers as compared with the traditional cross-linking agent of methyltris(methylethylketoximino)silane (MTKS). Subsequently, the degradation residues were also characterized by FT-IR and X-ray photoelectron spectrometer (XPS). It was found that the striking enhancements in thermal properties and improvements on mechanical properties could be the synergistic effect of the T-type branched structure of PMKS cross-linker, in situ formation of dense PMKS phase in the chain network by self-crosslinking and the uniform distribution of PMKS cross-linker in the HPDMS matrix.

A novel cross-linker polymethyl(ketoxime)siloxane was synthesized and then was cured with hydroxyl-terminated polydimethylsiloxane matrix to fabricate a series of novel RTV silicone rubber. Their properties was comparatively investigated.

Injectable hydrogels for ophthalmic applications

The demand for effective eye therapies is driving the development of injectable hydrogels as new medical devices for controlled delivery and filling purposes. This article introduces the properties of injectable hydrogels and summarizes their versatile application in the treatment of ophthalmic diseases, including age-related macular degeneration, cataracts, diabetic retinopathy, glaucoma, and intraocular cancers. A number of injectable hydrogels are approved by FDA as surgery sealants, tissue adhesives, and are now being investigated as a vitreous humor substitute. Research on hydrogels for drug, factor, nanoparticle, and stem cell delivery is still under pre-clinical investigation or in clinical trials. Although substantial progress has been achieved using injectable hydrogels, some challenging issues must still be overcome before they can be effectively used in medical practice.

Advanced Silicon Chemistry in Australia: Forming Strong Links with Asia

This paper details Australian commercial and academic silicon research. Areas of interest include silicon metal, polysiloxane polymers, copolymers, cyclics, emulsions, microemulsions, silanes, silane coupling agents, sol-gel chemistry and water-treatments, porous silicon, polysiloxane degradation, silicon hydrogel contact lenses, silanolate synthesis, siloxane interfacial polymerisation, hydrosilylation, polysiloxane electrolytes for lithium ion batteries, silanes for PBX materials, octafunctionalized polyhedral oligomeric silsesquioxanes (POSS), POSS hybrids, sol-gel hydrogenation catalysts, silane modification of silica, sol-gel energy storage, silicate grout stabilisation, GeoPolymer concretes, aerogel insulating foams, "Phaco-Ersatz" Accommodating Gel-Intraocular Lens technologies. Strong collaborative opportunities, in silicon, with Asia, exist with organisations such as: 1) The Asian Silicon Society and 2) The Agency for the Assessment and Application of Technology (BPPT) Indonesia.

Enhancement of OCT images with vinyl polysiloxane (VPS)

Several studies have shown that optical coherence tomography (OCT) can be used to measure the remaining enamel thickness and detect the location of subsurface lesions hidden under the sound enamel. Moreover studies have shown that high refractive index liquids can be used to improve the visibility of subsurface lesions in OCT images. In this study, we demonstrate that vinyl polysiloxane (VPS) impression materials which are routinely used in dentistry can be used to enhance the detection of dentinal lesions on tooth occlusal surfaces. Lesion presence was confirmed with polarized light microscopy and microradiography.

Nanotechnology for the Prevention and Treatment of Cataract

PURPOSE

The purpose of this article was to review recent advances in the applications of nanotechnology in cataract treatment and prevention strategies.

DESIGN

A literature review on the use of nanotechnology for the prevention and treatment of cataract was done.

METHODS

Research articles about nanotechnology-based treatments and prevention technologies for cataract were searched on Web of Science, and the most recent advances were reported.

RESULTS

Nonsteroid anti-inflammatory drugs, natural antioxidants, biologic and chemical chaperones, and chaperones such as molecules have found great application in preventing and treating cataracts. Current scientific research on new treatment strategies, which focuses on the biochemical basis of the disease, will likely result in new anticataract agents. However, none of the drug formulations will be approved for use unless efficient delivery is promised. Nanoparticle engineering together with biomimetic strategies enable the development of next-generation, more efficient, less complex, and personalized treatments.

CONCLUSIONS

The only currently available treatment for cataracts, surgical replacement of the opacified lens, is not an easily accessible option in developing countries. New treatment strategies based on topical drugs would enable treatment to reach massive populations facing the threat of blindness and more effectively deal with the postsurgical complications. Nanotechnology plays a key role in improving drug delivery systems with enhanced controlled release, targeted delivery, and bioavailability to overcome diffusion limitations in the eye.

Cataract

Cataract is the leading cause of reversible blindness and visual impairment globally. Blindness from cataract is more common in populations with low socioeconomic status and in developing countries than in developed countries. The only treatment for cataract is surgery. Phacoemulsification is the gold standard for cataract surgery in the developed world, whereas manual small incision cataract surgery is used frequently in developing countries. In general, the outcomes of surgery are good and complications, such as endophthalmitis, often can be prevented or have good ouctomes if properly managed. Femtosecond laser-assisted cataract surgery, an advanced technology, can automate several steps; initial data show no superiority of this approach over current techniques, but the results of many large clinical trials are pending. The greatest challenge remains the growing 'backlog' of patients with cataract blindness in the developing world because of lack of access to affordable surgery. Efforts aimed at training additional cataract surgeons in these countries do not keep pace with the increasing demand associated with ageing population demographics. In the absence of strategie that can prevent or delay cataract formation, it is important to focus efforts and resources on developing models for efficient delivery of cataract surgical services in underserved regions. For an illustrated summary of this Primer, visit: http://go.nature.com/eQkKll.

Carbazole-grafted silicone hydrogel with a high refractive index for intraocular lens

The refractive index (RI) is an important parameter for intraocular lens biomaterials.

Synthesis and evaluation of novel siloxane-methacrylate monomers used as dentin adhesives

OBJECTIVES

The objectives of this study were to synthesize two new siloxane-methacrylate (SM) monomers for application in dentin adhesives and to investigate the influence of different functionality of the siloxane-containing monomers on the adhesive photopolymerization, water sorption, and mechanical properties.

METHODS

Two siloxane-methacrylate monomers (SM1 and SM2) with four and eight methacrylate groups were synthesized. Dentin adhesives containing BisGMA, HEMA and the siloxane-methacrylate monomers were photo-polymerized. The experimental adhesives were compared with the control adhesive (HEMA/BisGMA, 45/55, w/w) and characterized with regard to degree of conversion (DC), water miscibility of the liquid resin, water sorption and dynamic mechanical analysis (DMA).

RESULTS

The experimental adhesives exhibited improved water miscibility as compared to the control. When cured in the presence of 12 wt% water to simulate the wet environment of the mouth, the SM-containing adhesives showed DC comparable to the control. The experimental adhesives showed higher rubbery modulus than the control under dry conditions. Under wet conditions, the mechanical properties of the formulations containing SM monomer with increased functionality were comparable with the control, even with more water sorption.

SIGNIFICANCE

The concentration and functionality of the newly synthesized siloxane-methacrylate monomers affected the water miscibility, water sorption and mechanical properties of the adhesives. The experimental adhesives show improved water compatibility compared with the control. The mechanical properties were enhanced with an increase of the functionality of the siloxane-containing monomers. The results provide critical structure/property relationships and important information for future development of durable, versatile siloxane-containing dentin adhesives.

In vitro methods of assessing ocular biocompatibility using THP-1-derived macrophages

Macrophages play an important role in the elimination of infections, the removal of debris and in tissue repair after infection and trauma. In vitro models that assess ocular biomaterials for toxicity typically focus on the effects of these materials on epithelial or fibroblast cells. This investigation evaluated known ocular toxins deposited on model materials for their effects on the viability and activation of macrophages. THP-1-derived macrophages were cultured onto silicone films (used as a base biomaterial) deposited with chemical toxins (benzalkonium chloride (BAK), zinc diethyldithiocarbamate (ZDEC) and lipopolysaccharide (LPS)). Utilizing three fluorescent dyes calcein, ethidium homodimer-1 (EthD-1) and annexin V, the viability of macrophages attached to the biomaterial was determined using confocal microscopy. Propidium iodide (PI) staining and alamarBlue® (resazurin) reduction were used to assess cell death and metabolic activity. CD14, CD16, CD33, CD45, and CD54 expression of adherent macrophages, were also evaluated to detect LPS activation of macrophages using flow cytometry. The sensitivity of this test battery was demonstrated as significant toxicity from treated surfaces with ZDEC (0.001-0.01%), and BAK (0.001%-0.1%) was detected. Also, macrophage activation could be detected by measuring CD54 expression after exposure to adsorbed LPS. These in vitro methods will be helpful in determining the toxicity potential of new ocular biomaterials.

Fast in situ enzymatic gelation of PPO-PEO block copolymer for injectable intraocular lens in vivo

Foldable intraocular lenses (IOLs) have been utilized to substitute natural lens of cataract patients. In this study, we developed a fast, in situ gelable hydrogel requiring no toxic agent as an injectable IOL material. A 4-armed PPO/PEO-phenol conjugate by a non-degradable linker was synthesized to form a hydrogel in situ by horseradish peroxidase. The gelation time and modulus could be controlled, ranging from 20 s to 2 min and from 1 to 43 kPa. The adhesion of human lens epithelial cells on the hydrogel was significantly reduced compared to that on commercial IOLs. The hydrogels were injected into the rabbit eyes to evaluate the in vivo biocompatibility for 8 weeks. Corneal endothelial cell loss and central corneal thickness were comparable with the common IOL implantation procedure. Histologically, the cornea and retina showed the intact structure. The change of refraction after application of pilocarpine was +0.42 D preoperatively and +0.83 D postoperatively, which may indicate the maintenance of accommodation amplitude.

Biomechanical eye model and measurement setup for investigating accommodating intraocular lenses

We present a biomechanical eye model to induce pseudophakic accommodative movement for evaluation of the focal shift of accommodative intraocular lenses. Therefore, an accommodative intraocular lens (IOL) was implanted into freshly enucleated porcine eyes. The eyes were glued into a mechanical apparatus to expand the ciliar body effectuating mechanical accommodation. An optical coherence tomographer was used to measure positional and geometrical changes of the IOL for different levels of expansion. The expansion unit allowed stretching of the globe of several millimeters. With the biomechanical eye model we were able to simulate the mechanical functionality of accommodation as well as to measure the lens vault and change in geometry. Accommodative vault could only be measured with an intact vitreous, indicating that the vitreous plays an important role for the functionality of accommodative IOLs.