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Long-Term Clinically Significant Posterior Capsular Opacification Development Pattern in Eyes Implanted with an Aspheric Monofocal Intraocular Lens with a Square Optic Edge. J Ophthalmol 2021; 2021:4566436. [PMID: 34631162 PMCID: PMC8497157 DOI: 10.1155/2021/4566436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To analyse the posterior capsular opacification (PCO) development pattern in the long term in eyes implanted with a monofocal intraocular lens (IOL) with a square edge all around the optic. Methods Longitudinal retrospective study is data analyzed from a total of 7059 eyes from 4764 patients (mean age: 75.8 years) undergoing cataract surgery with implantation of an aspheric monofocal IOL (Bi-Flex HL 677AB/677P, Medicontur, Budapest, Hungary). These data were retrospectively collected using the electronic medical record of the hospitals involved. Nd : YAG capsulotomy rates were calculated per year during a follow-up of more than 10 years. The Kaplan–Meier analysis was used to establish the transparent capsule survival rate. Results The Nd : YAG capsulotomy rate increased from 1.1% at 1 year postoperatively to 17.2% at 5 years after surgery. No significant differences were found between eyes with and without capsulotomy in terms of age (p = 0.202), gender (p = 0.061), type of anaesthesia used (p = 0.128), and presence of conditions such as hard cataract (p = 0.111) or pseudoexfoliation (p = 0.137). IOL power was significantly lower in those eyes of patients requiring Nd : YAG capsulotomy during the follow-up (p < 0.001). Significantly more eyes implanted with the preloaded model of the IOL required capsulotomy (p < 0.001). Mean survival time and rate were 9.38 years and 85.9%, respectively. Conclusions Most eyes undergoing cataract with implantation of the Bi-Flex IOL do not develop a clinically significant PCO requiring Nd : YAG capsulotomy in the long term. IOL material and design may be the main factors accounting for this finding.
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Factors Affecting Posterior Capsule Opacification in the Development of Intraocular Lens Materials. Pharmaceutics 2021; 13:pharmaceutics13060860. [PMID: 34200928 PMCID: PMC8230425 DOI: 10.3390/pharmaceutics13060860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/01/2023] Open
Abstract
Posterior capsule opacification (PCO) is the most common complication arising from the corrective surgery used to treat cataract patients. PCO arises when lens epithelial cells (LEC) residing in the capsular bag post-surgery undergo hyper-proliferation and transdifferentiation into myofibroblasts, migrating from the posterior capsule over the visual axis of the newly implanted intraocular lens (IOL). The developmental pathways underlying PCO are yet to be fully understood and the current literature is contradictory regarding the impact of the recognised risk factors of PCO. The aim of this review is firstly to collate the known biochemical pathways that lead to PCO development, providing an up-to-date chronological overview from surgery to established PCO formation. Secondly, the risk factors of PCO are evaluated, focussing on the impact of IOLs’ properties. Finally, the latest experimental model designs used in PCO research are discussed to demonstrate the ongoing development of clinical PCO models, the efficacy of newly developed IOL technology, and potential therapeutic interventions. This review will contribute to current PCO literature by presenting an updated overview of the known developmental pathways of PCO, an evaluation of the impact of the risk factors underlying its development, and the latest experimental models used to investigate PCO. Furthermore, the review should provide developmental routes for research into the investigation of potential therapeutic interventions and improvements in IOL design in the aid of preventing PCO for new and existing patients.
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Werner L. Intraocular Lenses: Overview of Designs, Materials, and Pathophysiologic Features. Ophthalmology 2020; 128:e74-e93. [PMID: 32619547 DOI: 10.1016/j.ophtha.2020.06.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
This article provides an overview of intraocular lenses (IOLs) currently used in cataract surgery. Aspects presented include design features related to IOL construction and sites of fixation; optic, filter, and haptic materials; as well as pathophysiologic features of uveal biocompatibility, capsular biocompatibility, and postoperative IOL opacification. This overview also includes supplementary (add-on; piggyback) lenses implanted in eyes that are already pseudophakic and considerations on IOLs used in the pediatric population. Different IOLs are made available to surgeons each year, including lenses with increasingly complex design characteristics owing to advancements in manufacturing and surgical techniques.
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Affiliation(s)
- Liliana Werner
- Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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Koch CR, Santhiago MR, Jorge PA, Sena P, Kara-Júnior N. Posterior Capsule Opacification after Cataract Surgery in Children Over Five Years of Age with Square-edge Hydrophobic versus Hydrophilic Acrylic Intraocular Lenses: A Prospective Randomized Study. Clinics (Sao Paulo) 2020; 75:e1604. [PMID: 32401967 PMCID: PMC7196726 DOI: 10.6061/clinics/2020/e1604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare the effects of hydrophobic and hydrophilic materials in square-edged acrylic intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. METHODS Patients were randomly assigned to group 1 (hydrophobic acrylic square-edged IOLs; 13 eyes) or group 2 (hydrophilic acrylic square-edged IOLs; 13 eyes). The study evaluated PCO rates using Evaluation of Posterior Capsule Opacification (EPCO) 2000 software at one, three, six and 12 months postoperatively. Postoperative measurements also included corrected distance visual acuity (CDVA), neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy and postoperative complications other than PCO. RESULTS Both groups had significant increases in PCO rates after one year. Comparison of the groups showed no significant differences in the EPCO scores at three (group 1, 0.007±0.016 vs group 2, 0.008±0.014; p=0.830), six (group 1, 0.062±0.103 vs group 2, 0.021±0.023; p=0.184), or twelve months postoperatively (group 1, 0.200±0.193 vs group 2, 0.192±0.138; p=0.902). We also found no significant group differences regarding the change (delta, Δ) in EPCO scores between three and six months (group 1, 0.055±0.09 vs group 2, 0.013±0.02; p=0.113) or between six and twelve months postoperatively (group 1, 0.139±0.14 vs group 2, 0.171±0.14; p=0.567). Twenty-three percent of patients required Nd:YAG capsulotomy at the twelve-month visit. CONCLUSIONS No differences in PCO rates were found between hydrophobic and hydrophilic acrylic square-edged IOLs in children between five and twelve years of age at one year of follow-up.
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Affiliation(s)
- Camila Ribeiro Koch
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Humberto Castro Lima, Salvador, BA, BR
- Corresponding author. E-mail:
| | - Marcony R Santhiago
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- University of Southern California Roski Eye Institute, Los Angeles, CA, USA
- Departamento de Oftalmologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Priscilla A Jorge
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo Sena
- Hospital Humberto Castro Lima, Salvador, BA, BR
| | - Newton Kara-Júnior
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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[Posterior capsule opacification, glistenings and visual outcomes: 3 years after implantation of a new hydrophobic IOL]. J Fr Ophtalmol 2018; 41:513-520. [PMID: 29934027 DOI: 10.1016/j.jfo.2017.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the visual outcomes, the incidence of glistenings and posterior capsule opacification in a series of consecutive eyes with a new blue light-filtering hydrophobic acrylic intraocular lens (IOL) SETTING: Service d'ophtalmologie, clinique Beausoleil, avenue de Lodève, Montpellier. DESIGN Retrospective, cross-sectional study. METHODS This study included a series of 66 eyes that underwent routine cataract surgery with PODEye (PhysIOL SA, Liège, Belgium) monofocal IOL implantation between May 2011 and November 2011. These eyes were compared for glistenings with patients implanted with Acrysof material IOL (Alcon, Fort Worth, USA) who had a routine postoperative examination between January 2015 and August 2015. The safety of the IOL was assessed by visual acuity outcomes, as well as rotational stability, centration and postoperative medication. The incidence and severity of glistenings were evaluated with the slit lamp. Glistenings and PCO were graded subjectively (0=absent; 1=moderate; 2=dense). Follow-up was 3 years. RESULTS The mean visual acuity after PODEye implantation was 0.98±0.05 (n=50) in decimal notation at 1 year, 0.98±0.06 at 1 week, (n=66), 1.00±0.01 at 3 weeks (n=64) and 0.99±0.02 at 3 months (n=59). The IOL displayed stable positioning in all axes. Glistenings of grade 2 were absent in the G-Free/PODEye group, whereas they were significantly present in the Acrysof group. One out of 43 eyes at 3-year follow-up underwent YAG capulotomy at 37 months. Sixty-six percent of eyes had no PCO (grade 0) at 3 years. CONCLUSIONS The PODEye IOL was safe and stable. Glistenings grade 2 or more were not found with this blue light-filtering hydrophobic acrylic IOL. PCO occurrence was low at three years.
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Koshy J, Hirnschall N, Vyas AKV, Narendran R, Crnej A, Gangwani V, Nishi Y, Maurino V, Findl O. Comparing capsular bag performance of a hydrophilic and a hydrophobic intraocular lens: A randomised two-centre study. Eur J Ophthalmol 2018; 28:639-644. [DOI: 10.1177/1120672117752133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the capsular bag performance and posterior capsule opacification development of two intraocular lenses differing in material and design. Methods: This study included patients who were scheduled for cataract surgery and compared a hydrophilic intraocular lens (Super flex® intraocular lens; Rayner Surgical, Worthing, UK) with a hydrophobic intraocular lens (AcrySof® SA60AT; Alcon, Fort Worth, TX, USA). Follow-ups were performed 1 month and 2 years after cataract surgery, including a slit lamp examination and retroillumination images. Results: In total, 80 eyes of 80 patients were recruited. At the 1-month follow-up, 6 of 39 cases had a gap between the posterior lens capsule and intraocular lens (1 case in the hydrophilic intraocular lens group and 5 cases in the hydrophobic intraocular lens group; p = 0.348). Objective and subjective posterior capsule opacification scoring showed no statistically significant difference between both groups (p = 0.123). Conclusion: Both intraocular lens showed a good capsular bag performance and a relatively low posterior capsule opacification development within the first 2 years after surgery.
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Affiliation(s)
- John Koshy
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Nino Hirnschall
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- VIROS – Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | | | | | - Alja Crnej
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Vinod Gangwani
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Yutaro Nishi
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Oliver Findl
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- VIROS – Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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Jorge PA, Koch CR, Jorge D, Kara-Junior N. Long-term efficiency of cataract surgery with hydrophilic acrylic Ioflex intraocular lens. Clinics (Sao Paulo) 2017; 72:543-546. [PMID: 29069257 PMCID: PMC5629703 DOI: 10.6061/clinics/2017(09)04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/16/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns. METHODS Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated. RESULTS The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group. CONCLUSIONS The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.
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Affiliation(s)
- Priscilla A. Jorge
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Camila Ribeiro Koch
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Delano Jorge
- Departamento de Oftalmologia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Newton Kara-Junior
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Kalauz M, Masnec S, Kordić R, Kuzman T, Vidas S, Škegro I, Jandroković S, Perić S. Posterior Capsule Opacification and Nd:YAG Rates with Two Acrylic Intraocular Lenses after Age-Related Cataract Treatment: Three-year Results. Semin Ophthalmol 2016; 33:395-401. [DOI: 10.1080/08820538.2016.1247182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Miro Kalauz
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Sanja Masnec
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Rajko Kordić
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Tomislav Kuzman
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Sania Vidas
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Ivan Škegro
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Sonja Jandroković
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Sanja Perić
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
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Choi M, Kim SY, Lee MY, Lee YC, Kim SY. Comparison of Nd:YAG Capsulotomy Rates between Hydrophobic and Hydrophilic Intraocular Lenses. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mihyun Choi
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sun Young Kim
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Mee Yon Lee
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young-Chun Lee
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Su-Young Kim
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Souza VL, Pellizzon CH, Sereno MG, Soares RT, Ranzani JJT, Rodrigues ACL, Padovani CR, Brandão CVS. Avaliação histopatológica da cápsula posterior associada ao implante de lente intraocular com superfície modificada com plasma de flúor e polietilenoglicol em coelhos. ARQ BRAS MED VET ZOO 2015. [DOI: 10.1590/1678-4162-7975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMOO objetivo deste estudo foi avaliar o efeito do tratamento da superfície de lentes intraoculares acrílicas utilizando-se plasma de flúor ou polietilenoglicol na prevenção da opacidade de cápsula posterior. Foram analisados 40 olhos de coelhos, submetidos à cirurgia de facoemulsificação e distribuídos em quatro grupos experimentais (n=10), sendo estes: grupo controle, coelhos sem implante de lente intraocular; grupo com lente intraocular tratada com plasma de polietilenoglicol; grupo com lente intraocular tratada com plasma de flúor; e grupo com lente intraocular comercial. As cápsulas posteriores das lentes dos grupos foram avaliadas por meio de análise histopatológica (morfometria e imuno-histoquímica). Os grupos com lente intraocular tratada com polietilenoglicol e com lente intraocular comercial apresentaram menor espessura da cápsula posterior na avaliação inicial (12 semanas) em relação ao grupo controle. No período final de avaliação (6 meses), os tratamentos da superfície da lente intraocular à base de plasma de flúor e polietilenoglicol não reduziram o desenvolvimento das alterações histológicas associadas à opacidade de cápsula posterior. O tratamento das superfícies das lentes intraoculares com plasma de flúor e polietilenoglicol pode ser realizado como adjuvante na prevenção da opacidade de cápsula posterior, pois não causa alterações na morfologia da lente após facoemulsificação.
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Double-C loop platform in combination with hydrophobic and hydrophilic acrylic intraocular lens materials. J Cataract Refract Surg 2015; 41:1490-502. [DOI: 10.1016/j.jcrs.2014.10.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022]
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Evaluation of uveal and capsule biocompatibility of a single-piece hydrophobic acrylic intraocular lens with ultraviolet–ozone treatment on the posterior surface. J Cataract Refract Surg 2015; 41:1081-7. [DOI: 10.1016/j.jcrs.2014.11.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 11/17/2022]
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Floyd AM, Werner L, Liu E, Stallings S, Ollerton A, Leishman L, Bodnar Z, Morris C, Mamalis N. Capsular bag opacification with a new accommodating intraocular lens. J Cataract Refract Surg 2013; 39:1415-20. [DOI: 10.1016/j.jcrs.2013.01.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/14/2013] [Accepted: 01/18/2013] [Indexed: 11/30/2022]
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Ollerton A, Werner L, Fuller SR, Kavoussi SC, McIntyre SJ, Mamalis N. Evaluation of a new single-piece 4% water content hydrophobic acrylic intraocular lens in the rabbit model. J Cataract Refract Surg 2012; 38:1827-32. [DOI: 10.1016/j.jcrs.2012.05.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/02/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
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Leishman L, Werner L, Bodnar Z, Ollerton A, Michelson J, Schmutz M, Mamalis N. Prevention of capsular bag opacification with a modified hydrophilic acrylic disk-shaped intraocular lens. J Cataract Refract Surg 2012; 38:1664-70. [DOI: 10.1016/j.jcrs.2012.04.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 11/16/2022]
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16
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Davis JL, Yi NY, Salmon JH, Charlton AN, Colitz CMH, Gilger BC. Sustained-release celecoxib from incubated acrylic intraocular lenses suppresses lens epithelial cell growth in an ex vivo model of posterior capsule opacity. J Ocul Pharmacol Ther 2012; 28:359-68. [PMID: 22372691 DOI: 10.1089/jop.2011.0196] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To determine whether celecoxib (CXB) can be released from incubated intraocular lenses (IOLs) sufficiently to inhibit lens epithelial cell (LEC) growth in an ex vivo model of posterior capsule opacification (PCO). MATERIALS LEC growth was evaluated for 14 days in canine lens capsules (LCs) that had been exposed to media containing 20 μM CXB for 1-5 days. After the incubation of hydrophilic and hydrophobic IOLs in CXB solution, the determination of the in vitro release of CXB from the IOLs was performed for up to 28 days. The incubated and nonincubated IOLs were evaluated in the ex vivo model of PCO, and the rate of LEC growth was evaluated over 28 days. RESULTS The treatment of LCs with 20 μM CXB for 4 and 5 days completely inhibited LEC growth. LEC repopulation did not occur after the removal of CXB. IOLs incubated in CXB for 24 h resulted in a sustained release of CXB in vitro at levels theoretically sufficient to inhibit PCO. LCs in the ex vivo model of PCO treated with acrylic IOLs incubated in CXB had significantly suppressed LEC ingrowth compared with untreated and IOL-only LCs. CONCLUSIONS A 4-day treatment of LCs with a concentration of 20 μM CXB may effectively prevent PCO. IOLs incubated in CXB for 24 h resulted in a sustained release of CXB in vitro at levels sufficient to inhibit LEC growth in the ex vivo model of PCO. Further studies are needed to determine whether CXB-incubated IOLs can effectively prevent the development of PCO in vivo.
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Affiliation(s)
- Jennifer L Davis
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC 27607, USA
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McIntyre SJ, Werner L, Fuller SR, Kavoussi SC, Hill M, Mamalis N. Assessment of a single-piece hydrophilic acrylic IOL for piggyback sulcus fixation in pseudophakic cadaver eyes. J Cataract Refract Surg 2012; 38:155-62. [DOI: 10.1016/j.jcrs.2011.06.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/25/2011] [Accepted: 06/03/2011] [Indexed: 11/17/2022]
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18
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Kavoussi SC, Werner L, Fuller SR, Hill M, Burrow MK, McIntyre SJ, Mamalis N. Prevention of capsular bag opacification with a new hydrophilic acrylic disk-shaped intraocular lens. J Cataract Refract Surg 2011; 37:2194-200. [DOI: 10.1016/j.jcrs.2011.05.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 10/15/2022]
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19
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Vasavada AR, Raj SM, Shah A, Shah G, Vasavada V, Vasavada V. Comparison of posterior capsule opacification with hydrophobic acrylic and hydrophilic acrylic intraocular lenses. J Cataract Refract Surg 2011; 37:1050-9. [PMID: 21596247 DOI: 10.1016/j.jcrs.2010.12.060] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 12/11/2010] [Accepted: 12/18/2010] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare posterior capsule opacification (PCO) 3 years postoperatively in contralateral eyes with a single-piece hydrophobic acrylic and 1 of 2 single-piece hydrophilic acrylic intraocular lenses (IOLs) with different configurations. SETTING Iladevi Cataract and IOL Research Institute, Ahmedabad, India. DESIGN Prospective randomized clinical trial. METHODS A hydrophobic Acrysof (hydrophobic group) or a hydrophilic C-flex (hydrophilic group C) or Akreos Adapt IOL (hydrophilic group A) was randomized for implantation in the fellow eye or vice versa of each patient. The Evaluation of Posterior Capsule Opacification (EPCO) area, EPCO score, and neodymium:YAG (Nd:YAG) capsulotomy rates were compared using digital photographs. RESULTS The study enrolled 68 patients. Although there was no significant difference at 1 month, the median EPCO score was statistically significantly lower in the hydrophobic group than in hydrophilic group C (P = .00) and hydrophilic group A (P = .000) at 3 years. There were no significant differences in the median EPCO area at 1 month; however, the area was statistically significantly less in the hydrophobic group than in hydrophilic group C and hydrophilic group A at 3 years (both P = .000). Four (12.9%) of 31 eyes in hydrophilic group C and 5 (16%) of 31 eyes in hydrophilic group A required an Nd:YAG capsulotomy; no eye in the hydrophobic group required a capsulotomy (P = .04 and P = .02, respectively). CONCLUSION Posterior capsule opacification was significantly less with the Acrysof hydrophobic acrylic IOL at 3 years. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Abhay R Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India
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Maddula S, Werner L, Ness PJ, Davis D, Zaugg B, Stringham J, Burrow M, Yeh O. Pathology of 157 human cadaver eyes with round-edged or modern square-edged silicone intraocular lenses: analyses of capsule bag opacification. J Cataract Refract Surg 2011; 37:740-8. [PMID: 21420600 DOI: 10.1016/j.jcrs.2010.10.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 10/12/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the degree of capsular bag opacification in human cadaver eyes with silicone intraocular lenses (IOLs), specifically comparing the differences between round-edged IOLs and modern square-edged IOLs. SETTING John A. Moran Eye Center, University of Utah, USA. DESIGN Experimental study. METHODS The eyes were immersed in 10% formalin on enucleation. They had anterior segment scanning with a very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess the degree of capsular bag opacification, coverage of the IOL edge by the anterior capsule, and IOL fixation. Selected eyes also had histopathologic examination. RESULTS Eighty-seven eyes with a 3-piece round-edged IOL, 43 with a 3-piece square-edged IOL, 26 with a 1-piece plate IOL, and 1 with an accommodating IOL design were included in the analyses of capsular bag opacification. Comparison between 3-piece round-edged IOLs and square-edged IOLs showed statistically significant differences in central posterior capsule opacification (PCO) (P=.0001687) and peripheral PCO (P<.0001). In eyes with square-edged IOLs, PCO had a tendency to start in areas without capsulorhexis coverage of the optic. Twenty-one of 26 eyes with a silicone plate IOL had a neodymium:YAG posterior capsulotomy for dense PCO. CONCLUSIONS This first study using pseudophakic human cadaver eyes that includes a significant number of modern 3-piece silicone IOLs with square optic edges confirmed the role of this design in the prevention of PCO. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Surekha Maddula
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Pathology of 219 human cadaver eyes with 1-piece or 3-piece hydrophobic acrylic intraocular lenses: capsular bag opacification and sites of square-edged barrier breach. J Cataract Refract Surg 2011; 37:923-30. [PMID: 21419595 DOI: 10.1016/j.jcrs.2010.11.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess capsular bag opacification and sites of initial posterior capsule opacification (PCO) in human cadaver eyes with square-edged 1-piece or 3-piece hydrophobic acrylic intraocular lenses (IOLs). SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Eyes were immersed in 10% formalin after enucleation and had anterior segment scanning with very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess capsular bag opacification, anterior capsule coverage of the IOL edge, and IOL fixation. Selected eyes had histopathologic examination. RESULTS One hundred nineteen eyes with 1-piece IOLs and 100 with 3-piece IOLs were included in the analyses of capsular bag opacification. There was no difference in central (P=.29) or peripheral (P=.76) PCO. In 63 of 84 eyes with a 1-piece IOL and peripheral PCO, the optic-haptic junction was the site of initiation. In eyes with a 3-piece IOL, initial peripheral PCO was observed at nearly the same rate whether there was full 360-degree anterior capsulorhexis overlap of the optic or no overlap (P=.13). In the latter, the site of PCO initiation was in areas lacking capsulorhexis coverage in 46% of eyes. CONCLUSIONS There was no difference in central or peripheral PCO between 1-piece and 3-piece hydrophobic acrylic IOLs. With 1-piece IOLs, PCO tended to start at the optic-haptic junctions. With 3-piece IOLs, full anterior capsule coverage did not produce a statistically significant benefit with respect to PCO prevention.
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Mathew RG, Coombes AGA. Reduction of Nd:YAG capsulotomy rates after implantation of a single-piece acrylic hydrophilic intraocular lens with 360° squared optic edge: 24-month results. Ophthalmic Surg Lasers Imaging Retina 2010; 41:651-5. [PMID: 20954645 DOI: 10.3928/15428877-20100929-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 07/29/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Posterior capsule opacification remains a significant problem following cataract surgery. The aim of the study was to evaluate the incidence of symptomatic posterior capsule opacification requiring Nd:YAG capsulotomy in patients who underwent cataract extraction and implantation of the Rayner C-flex 570C intraocular lens (IOL) (Rayner Intraocular Lens, Ltd., Sussex, UK). PATIENTS AND METHODS A retrospective study of 3,461 eyes that underwent cataract extraction and insertion of the Rayner C-flex IOL from January 2004 to December 2005. The cases that received Nd: YAG capsulotomies were evaluated. RESULTS Over a 24-month period, 3,461 Rayner C-flex IOLs were implanted. Nd:YAG capsulotomy was performed in 58 of these cases. The rate of Nd:YAG capsulotomy was 0.6% at 12 months and 1.7% at 24 months. The mean time to Nd:YAG capsulotomy was 9.3 months (range: 1.3 to 22.7 months). The follow-up period was 5.3 to 29.0 months. CONCLUSION The incidence of symptomatic posterior capsule opacification with the Rayner C-flex IOL is low.
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Nixon DR, Woodcock MG. Pattern of posterior capsule opacification models 2 years postoperatively with 2 single-piece acrylic intraocular lenses. J Cataract Refract Surg 2010; 36:929-34. [PMID: 20494763 DOI: 10.1016/j.jcrs.2009.12.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 12/10/2009] [Accepted: 12/13/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare posterior capsule opacification (PCO) in eyes with 1 of 2 models of 1-piece acrylic intraocular lenses (IOLs). SETTING Ambulatory surgery center. METHODS This paired-eye study evaluated patients who had implantation of a Tecnis AAB00 IOL with a continuous optic edge in 1 eye and an AcrySof SA60AT or SN60AT IOL with an interrupted optic edge in the fellow eye. Exclusion criteria were anterior capsule overlap onto the IOL optic of fewer than 360 degrees, neodymium:YAG laser capsulotomy, postoperative time fewer than 24 months or more than 30 months, pseudoexfoliation, glaucoma, history of iritis, and surgical complications that would affect the assessment of PCO. Posterior capsule opacification was assessed using the Evaluation of Posterior Capsular Opacification (EPCO) system on a scale of 0 (none) to 4 (severe opacity with a darkening effect). RESULTS In 13 of 14 patients, the eye with the interrupted-edge IOL had a higher EPCO score than the eye with the continuous-edge IOL. The mean EPCO score was 0.39 and 0.08, respectively; the difference was statistically significant (P = .012). The PCO density was greater in eyes with the interrupted-edge IOL, with 35% having an EPCO score of 3 or 4; no eye with a continuous-edge IOL had a score that high. CONCLUSION Eyes with an IOL with a continuous 360-degree square edge had significantly less PCO than eyes with an IOL with a square edge that was interrupted at the optic-haptic junction.
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Affiliation(s)
- Don R Nixon
- Royal Victoria Hospital, Barrie, Ontario, Canada.
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Saiki M, Negishi K, Dogru M, Yamaguchi T, Tsubota K. Biconvex posterior chamber accommodating intraocular lens implantation after cataract surgery: long-term outcomes. J Cataract Refract Surg 2010; 36:603-8. [PMID: 20362852 DOI: 10.1016/j.jcrs.2009.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 11/07/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the long-term efficacy of a biconvex accommodating intraocular lens (IOL) to restore near visual performance. SETTING Department of Ophthalmology, Keio University Hospital, Tokyo, Japan. METHODS This 4-year study comprised eyes that had cataract surgery with implantation of a 1CU accommodating IOL. At all postoperative visits, the following were assessed: subjective spherical equivalent (SE) refraction; uncorrected (UDVA) and corrected (CDVA) distance visual acuities; uncorrected (UNVA), distance-corrected (DCNVA), and corrected (CNVA) near visual acuities; change in minimum additional (add) power (diopters) to attain CNVA; and accommodation amplitude. A questionnaire was administered at the last visit. RESULTS Twelve eyes of 8 cataract patients (mean age 59.0 years +/- 18.4 [SD]) were evaluated. Postoperatively, the mean SE at 1 year and 4 years was significantly more hyperopic than at 1 month (P<.05). The mean UDVA increased significantly at 4 years compared with 1 month (P<.05). There were no significant changes in CDVA, UNVA, CNVA, and DCNVA throughout the follow-up period. The change in the minimum add power to attain CNVA and in the subjective and objective accommodation amplitudes also did not change significantly over time. Eighty-three percent of patients reported being satisfied with the results. CONCLUSION Four years after implantation of an accommodating IOL, most patients had good vision and were satisfied, although the accommodation amplitude for near vision was not sufficient throughout the follow-up.
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Affiliation(s)
- Megumi Saiki
- From the Department of Ophthalmology (Saiki, Negishi, Yamaguchi, Tsubota), and Johnson and Johnson Ocular Surface and Visual Optics Department (Dogru), Keio University School of Medicine, Tokyo, Japan
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Werner L, Tetz M, Feldmann I, Bücker M. Evaluating and defining the sharpness of intraocular lenses: microedge structure of commercially available square-edged hydrophilic intraocular lenses. J Cataract Refract Surg 2009; 35:556-66. [PMID: 19251151 DOI: 10.1016/j.jcrs.2008.11.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/14/2008] [Accepted: 11/24/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the microstructure of the edges of currently available hydrophilic acrylic intraocular lenses (IOLs) in terms of their deviation from an "ideal" square as a follow-up of preliminary in vitro studies of experimental poly(methyl methacrylate) IOLs and commercially available foldable hydrophobic IOLs. SETTING Berlin Eye Research Institute, Berlin, Germany. METHODS Twenty-four designs of hydrophilic acrylic IOLs were used in this study. For each design, a +20.0 diopter (D) IOL and a +0.0 D IOL (or the lowest available plus dioptric power) were evaluated. The IOL edge was imaged under low-vacuum (0.7 torr), high-magnification scanning electron microscopy (SEM) using an environmental microscope and standardized technique. The photographs were imported to a digital computer program, and the area above the posterior-lateral edge, representing the deviation from a perfect square, was measured in square microns. RESULTS Currently available hydrophilic acrylic IOLs labeled as square edged had an area of deviation from a perfect square ranging from 60.84 to 871.51 microm(2) for the +20.0 D IOLs and from 35.52 to 826.55 microm(2) for the low-diopter IOLs. Although some differences in edge finishing between the IOLs analyzed were observed, edge surfaces of hydrophilic acrylic IOLs appeared overall smooth under environmental SEM. CONCLUSIONS Analysis of the microstructure of the optic edge of currently available square-edged hydrophilic acrylic IOLs showed a large variation of the deviation area from a perfect square.
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Pereira FA, Werner L, Milverton JE, Coroneo MT. Miyake-Apple posterior video analysis/photographic technique. J Cataract Refract Surg 2009; 35:577-87. [DOI: 10.1016/j.jcrs.2008.11.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/17/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
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Werner L. Secondary Cataract. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lee DK, Lee SJ, You YS. Prediction of refractive error in combined vitrectomy and cataract surgery with one-piece acrylic intraocular lens. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 22:214-9. [PMID: 19096237 PMCID: PMC2629921 DOI: 10.3341/kjo.2008.22.4.214] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose To compare the predicted and actual refractive errors of hydrophilic, one-piece, C-flex®570C (C-flex) intraocular lens (IOL) implantation in simultaneous vitrectomy and lens extraction in various conditions. Methods One hundred fifty-nine eyes of patients who had lens extraction between March 2004 and September 2005 were enrolled in a retrospective study. Group 1 had lens extraction and IOL implantation, and Group 2 had lens extraction and IOL implantation with vitrectomy. IOL calculation was done with axial length and keratometry measurements. The actual and predicted refractive errors were compared at 1 and 6 months postoperatively. The factors influencing the postoperative refractive outcomes were analyzed. Results The mean refractive predictive error (i.e., the actual minus predicted spherical equivalent) was +0.19±0.39 D (Diopter) and -0.26±0.45 D at 1 and 6 months postoperatively (all: p<0.001) in group 1, and -0.22±0.39 D and -0.06±0.62 D at 1 and 6 months postoperatively (p=0.013, p=0.399 respectively). In group 2, all surgical factors related to refractive errors were not statistically significant (all: p>0.05). Conclusions Refractive errors in combined surgery showed myopic shift of -0.50 D and -0.32 D at 1 and 6 months postoperatively compared with C-flex IOL implantation alone. With the hyperopic tendency of IOL and myopic tendency of vitrectomy, the combined surgery made postoperative refractive errors near emmetropia.
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Affiliation(s)
- Dong Kyu Lee
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea
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Hancox J, Spalton D, Cleary G, Boyce J, Nanavaty MA, Thyagarajan S, Marshall J. Fellow-eye comparison of posterior capsule opacification with AcrySof SN60AT and AF-1 YA-60BB blue-blocking intraocular lenses. J Cataract Refract Surg 2008; 34:1489-94. [DOI: 10.1016/j.jcrs.2008.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 05/02/2008] [Indexed: 10/21/2022]
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Li N, Chen X, Zhang J, Zhou Y, Yao X, Du L, Wei M, Liu Y. Effect of AcrySof versus Silicone or Polymethyl Methacrylate Intraocular Lens on Posterior Capsule Opacification. Ophthalmology 2008; 115:830-8. [PMID: 17964657 DOI: 10.1016/j.ophtha.2007.06.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 06/21/2007] [Accepted: 06/26/2007] [Indexed: 10/22/2022] Open
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Abstract
PURPOSE OF REVIEW To provide an update on currently available materials used in the manufacture of intraocular lenses, as well as new materials under development, especially with regard to their uveal and capsular biocompatibility. RECENT FINDINGS The biocompatibility of intraocular lens materials should be assessed in terms of uveal biocompatibility, related to the inflammatory foreign-body reaction of the eye against the implant, as well as in terms of capsular biocompatibility, determined by the relationship of the intraocular lens with remaining lens epithelial cells within the capsular bag. This situation may result in different entities, e.g. anterior capsule opacification, interlenticular opacification (between piggyback intraocular lenses), posterior capsule opacification and lens epithelial cell ongrowth. Reports on intraocular lens opacification suggest that the potential to calcify should also be taken into consideration when evaluating the long-term biocompatibility of a new material. SUMMARY Intraocular lenses are being progressively implanted in much earlier stages of life (refractive lens exchange, pediatric implantation) and are expected to remain in the intraocular environment for many decades. Materials used in intraocular lens manufacture should, therefore, insure long-term uveal and capsular biocompatibility, as well as ultimate transparency after implantation.
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Evaluating and defining the sharpness of intraocular lenses. J Cataract Refract Surg 2008; 34:310-7. [DOI: 10.1016/j.jcrs.2007.09.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 09/23/2007] [Indexed: 11/19/2022]
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Salati C, Salvetat ML, Zeppieri M, Brusini P. Pupil size influence on the intraocular performance of the multifocal AMO-Array intraocular lens in elderly patients. Eur J Ophthalmol 2007; 17:571-8. [PMID: 17671933 DOI: 10.1177/112067210701700415] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To study the relationship between pupil size and AMO-Array multifocal intraocular lens (MIOL) performance in a population of elderly patients. METHODS This prospective trial included 62 patients (mean age 76 years; range 70 to 86) undergoing bilateral cataract phacoemulsification and MIOL (AMO-Array SA-40N, Allergan) implantation. Patients were divided into two groups based on preoperative pupil diameter: small pupil group (pupil size of 2.5-2.9 mm; 45 subjects) and large pupil group (pupil size of 3-5 mm; 17 subjects). The analysis included uncorrected (UC) and best-corrected (BC) near and distance visual acuity (VA), spectacle dependence, and photic phenomena complaints (postoperative follow-up 16.6+/-6.2 months; range 11-26 months). RESULTS Patients in the small pupil group showed postoperatively significantly higher distance UCVA and BCVA, but lower near UCVA compared to those in the large pupil group (Mann-Whitney test, p< or = 0.02). Patients with small pupils also tended to: be more (not statistically significant) spectacle independent for distance (73.3% versus 47.1%) and spectacle-dependent for near vision (55.6% versus 28.4%); report significantly less photic phenomena complaints (37.8% versus 93.1%, chisquare test, p<0.001); and, more satisfied with the surgery (95.5% versus 76.5%). Posterior capsular opacification (PCO) was observed in 19.4% of the patients. CONCLUSIONS Bilateral AMO-Array MIOL implantation in elderly patients seems to be an effective and safe surgical procedure that improves distance and near UCVA, providing spectacle independence in many cases. The use of these MIOLs, however, can induce photic phenomena and cause PCO. Patients with small preoperative pupils (<3 mm) presented less photic phenomena complaints and expressed a higher visual outcome satisfaction after surgery.
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Affiliation(s)
- C Salati
- Department of Ophthalmology, Santa Maria della Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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Effect of square-edged intraocular lenses on neodymium:YAG laser capsulotomy rates in the United States. J Cataract Refract Surg 2007; 33:1899-906. [DOI: 10.1016/j.jcrs.2007.06.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 06/26/2007] [Indexed: 11/15/2022]
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Vyas AV, Narendran R, Bacon PJ, Apple DJ. Three-hundred-sixty degree barrier effect of a square-edged and an enhanced-edge intraocular lens on centripetal lens epithelial cell migration Two-year results. J Cataract Refract Surg 2007; 33:81-7. [PMID: 17189798 DOI: 10.1016/j.jcrs.2006.08.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 08/24/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the 360-degree barrier effect of an intraocular lens (IOL) with a square edge at the optic and an enhanced square edge at the optic-haptic junctions (Rayner 570C C-flex) on centripetal migration of lens epithelial cells (LECs) over a 2-year period. SETTING Department of Ophthalmology, Scarborough Hospital, Scarborough, United Kingdom. METHODS In a prospective study of 40 consecutive eyes, a C-flex IOL was implanted in the bag after phacoemulsification surgery. Eyes with intraoperative complications, requiring additional procedures, without 360-degree overlap of the optic, or with capsule block syndrome were excluded. Follow-up was at 6, 10, 18, and 24 months. At each visit, high-magnification retroillumination digital photographs were taken using a slitlamp-attached digital camera. The barrier effect to LEC migration across the optic edge and the enhanced square edge at the optic-haptic junction was graded as complete (no epithelial pearls or sheet), partial (few epithelial pearls without sheet), and minimal/none (epithelial sheet behind the IOL optic). RESULTS Twenty-four patients came to the final follow-up at 24 months. Fifteen of these eyes (63%) had a complete barrier effect throughout the 360 degrees of the IOL. Three eyes (13%) had a partial barrier effect throughout the 360 degrees of the IOL. Three eyes had a complete optic barrier effect but a partial optic-haptic junction barrier effect. Three eyes had a partial optic barrier effect but a complete optic-haptic junction barrier effect. No eye had epithelial sheets extending behind the optic at any location. CONCLUSIONS This study showed the barrier effect of the edge design of the C-flex IOL and the efficacy of the enhanced edge in preventing LEC migration at the optic-haptic junction. The enhanced edge was as effective as a sharp square edge in restricting the LEC migration.
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Affiliation(s)
- Ashokkumar V Vyas
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, Salt Lake City, Utah, USA.
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Hancox J, Spalton D, Heatley C, Jayaram H, Yip J, Boyce J, Marshall J. Fellow-eye comparison of posterior capsule opacification rates after implantation of 1CU accommodating and AcrySof MA30 monofocal intraocular lenses. J Cataract Refract Surg 2007; 33:413-7. [PMID: 17321391 DOI: 10.1016/j.jcrs.2006.10.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To measure posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between the AcrySof MA30 intraocular lens (IOL) (Alcon) and the 1CU IOL (HumanOptics) in a fellow-eye comparison. SETTING Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom. METHODS Thirty patients who had bilateral cataract surgery with a 1CU IOL prospectively randomly allocated to 1 eye and an AcrySof MA30 monofocal IOL to the other eye were examined. Best corrected distance visual acuity was recorded using the Early Treatment Diabetic Retinopathy Study logMAR chart. Digital retroillumination images of the posterior capsule were taken with the pupil dilated and analyzed with POCO software. RESULTS Eyes with the 1CU IOL had significantly higher PCO rates than eyes with the MA30 IOL at all time points. By 2 years after surgery, 50% of eyes with a 1CU IOL had required Nd:YAG capsulotomy compared with no eyes with an MA30 IOL. There was no significant difference in visual acuity at any time point when post Nd:YAG capsulotomy was taken in to account. CONCLUSIONS The 1CU IOL has 4 broad optic-haptic junctions where the square-edged barrier is breached; this appeared to allow passage of lens epithelial cells, leading to an increase in PCO. However, the increased PCO cannot be attributed to this alone as the 1CU is hydrophilic, a factor known to be associated with higher PCO rates.
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Affiliation(s)
- Joanne Hancox
- Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom
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Nishi Y, Rabsilber TM, Limberger IJ, Reuland AJ, Auffarth GU. Influence of 360-degree enhanced optic edge design of a hydrophilic acrylic intraocular lens on posterior capsule opacification. J Cataract Refract Surg 2007; 33:227-31. [PMID: 17276262 DOI: 10.1016/j.jcrs.2006.10.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 10/12/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the rate of posterior capsule opacification (PCO) with the single-piece hydrophilic acrylic foldable Rayner Centerflex 570H intraocular lens (IOL), which has a sharp optic edge design excluding the optic-haptic junction, and the Rayner C-flex 570C IOL, which has an improved 360-degree sharp edge. SETTING Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. METHODS As part of a multicenter U.S. Food and Drug Administration (FDA) study, 42 patients who had implantation of a C-flex IOL in 1 eye after uneventful phacoemulsification were enrolled. Six and 12 months postoperatively, PCO was evaluated by retroillumination photographs using Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software. The data were then compared with those in a matched group of patients with a Centerflex IOL who participated in a previous FDA study. RESULTS The mean age of the patients with the C-flex IOL was 71.5 years +/- 8.2 (SD) There was a statistically significant difference in EPCO scores between the C-flex group and Centerflex group. Six months after surgery, the mean EPCO value (total IOL optic) was 0.07 +/- 0.17 in the C-flex group (n = 37) and 0.20 +/- 0.20 in the Centerflex group (n = 36) (P<.01, Wilcoxon test). By 12 months, the mean had increased to 0.16 +/- 0.20 in the C-flex group (n = 37) and 0.35 +/- 0.22 in the Centerflex group (n = 31) (P<.01, Wilcoxon test). CONCLUSIONS The C-flex IOLs showed good functional results and significantly lower PCO formation than the earlier model Centerflex IOL. The enhanced edge of the C-flex IOL seemed to improve PCO prevention clinically.
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Affiliation(s)
- Yutaro Nishi
- International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Werner L, Chew J, Mamalis N. Experimental evaluation of ophthalmic devices and solutions using rabbit models. Vet Ophthalmol 2006; 9:281-91. [PMID: 16939455 DOI: 10.1111/j.1463-5224.2006.00495.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze and compare the geometry of the anterior segment of rabbit and human eyes, with relevance for the evaluation of intraocular lenses, and to review rabbit models used in our laboratory for the evaluation of different ophthalmic devices and solutions. PROCEDURES Fifteen rabbit and 15 human eyes (10 phakic and 5 pseudophakic/group) obtained postmortem were used. Anterior-posterior length, equatorial diameter, and white-to-white (corneal diameter) were measured with calipers. The eyes were then analyzed with a very high-frequency ultrasound (Artemis, Ultralink) for measurements of the anterior chamber depth, and anterior chamber and ciliary sulcus diameters. The capsular bag diameter was measured with calipers from a posterior view, and the diameter and thickness of the crystalline lenses were measured after their excision from the phakic eyes. RESULTS Although the size of the rabbit eye is overall smaller than the size of the human eye, the dimensions of the anterior segment of rabbit eyes are generally larger. The differences between rabbit and human eyes were statistically significant (Wilcoxon rank sum test) in terms of anterior-posterior length, equatorial diameter, white-to-white measurements (P < 0.0001), anterior chamber diameter (P = 0.0004), ciliary sulcus diameter (P = 0.0012), and crystalline lens diameter and thickness (P = 0.0003). CONCLUSIONS Experimental evaluation of design features of new phakic intraocular lenses in rabbit eyes may be inconclusive without adaptation of their size/design, contrary to the evaluation of new pseudophakic lenses by implantation in the capsular bag. The rabbit is a very valuable model for the experimental evaluation of different ophthalmic devices and solutions.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
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Nixon DR, Apple DJ. Evaluation of lens epithelial cell migration in vivo at the haptic-optic junction of a one-piece hydrophobic acrylic intraocular lens. Am J Ophthalmol 2006; 142:557-62. [PMID: 17011844 DOI: 10.1016/j.ajo.2006.05.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 05/11/2006] [Accepted: 05/21/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the pattern of lens epithelial cell (LEC) ingrowth behind the intraocular lens (IOL) optic in patients implanted with the AcrySof SA60AT one-piece IOL. DESIGN Retrospective case series. METHODS Patients implanted with the AcrySof SA60AT one-piece IOL with complete overlap of the capsulorrhexis and IOL optic and no ocular pathology were selected from the practices of six surgeons. High-resolution digital images of the distribution of LECs were captured. Circumferential location and extent of LEC growth behind the optic were measured. RESULTS Mean +/- SD follow-up was 13.2 +/- 1.7 months for 40 patients (mean age 72 years). LEC migration beyond the edge of the IOL optic was displayed by 57.5% (23/40) of patients. LECs migrated into the visual axis in 22.5% (9/40) of patients, leading to a visual acuity of <6/9 (20/30) in 10% (4/40) of patients. Cell migration was located preferentially at the optic-haptic junction. Serial photographs were used to monitor LEC migration over time. In some cases, LECs extended from the opposing optic-haptic junctions to converge in the center of the IOL, creating a path across the optic. CONCLUSIONS The optic-haptic junction of the AcrySof one-piece IOL is a point of weakness in the barrier effect of the square-edge IOL design that provides migrating LECs access to the posterior capsule.
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Werner L, Mamalis N, Romaniv N, Haymore J, Haugen B, Hunter B, Stevens S. New photochromic foldable intraocular lens: Preliminary study of feasibility and biocompatibility. J Cataract Refract Surg 2006; 32:1214-21. [PMID: 16857512 DOI: 10.1016/j.jcrs.2006.01.105] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 01/23/2006] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate a new hydrophobic acrylic intraocular lens (IOL) with photochromic properties in vitro and in vivo in a rabbit model. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS The photochromic optic change of 5 study IOLs was evaluated in vitro on ultraviolet (UV) light exposure. The tests were done in the dry state and during immersion of the lenses in a balanced salt solution. Six additional IOLs were implanted in the right eye of New Zealand rabbits. The left eyes were implanted with SA60AT or SN60AT IOLs (Alcon Laboratories, 3 each). After a clinical follow-up of 6 months, the rabbits were killed and their eyes enucleated. Three study IOLs and 2 control SN60AT IOLs were evaluated in vitro on UV exposure after explantation. The other IOLs and the rabbit eyes had histopathologic examination. RESULTS On in vitro UV light exposure, the optic of the study IOLs changed from colorless to yellow, turning again colorless on discontinuation of UV light projection. The same photochromic change was also observed on UV light exposure throughout the clinical follow-up of 6 rabbits, as well as after explantation of the IOLs. Postoperative clinical inflammatory reactions and cellular reactions on the surface of the explanted IOLs were similar in the study and control groups. No sign of untoward toxicity was observed in the histopathological sections of the rabbit eyes in all groups. CONCLUSIONS The new photochromic IOL turned yellow only on exposure to UV light; otherwise it remained clear. This lens was also found to be biocompatible.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
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Chew J, Werner L, Stevens S, Hunter B, Mamalis N. Evaluation of the effects of hydrodissection with antimitotics using a rabbit model of Soemmering's ring formation. Clin Exp Ophthalmol 2006; 34:449-56. [PMID: 16872342 DOI: 10.1111/j.1442-9071.2006.01247.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Regeneration/proliferation of lens material within the capsular bag still is the most frequent complication after cataract surgery. We aimed to evaluate the effects of hydrodissection with low doses of antimitotics on the overall regeneration/proliferation of lens material in rabbit eyes, using a model allowing the lens material to be confined to the equatorial region of the capsular bag, facilitating its quantification. METHODS Twelve albino rabbits underwent bilateral phacoemulsification. Their eyes were randomized to receive 0.4 cc of balanced salt solution, 5-fluorouracil (12.5 mg/mL) or mitomycin C (0.1 mg/mL) during hydrodissection. They were left aphakic, so the capsulorhexis would fuse with the posterior capsule postoperatively. After 4 weeks, killing/enucleation was performed. Regeneration/proliferation of lens material within the equatorial capsular bag (Soemmering's ring) was graded from the Miyake-Apple view (0-4). Its area was also calculated (microm(2)) from direct measurements performed on histological sections. RESULTS The capsulorhexis margin fused with the peripheral posterior capsule, so the central posterior capsule remained clear. There was no significant difference among the groups (Kruskal-Wallis test) regarding Soemmering's ring gross grading (P = 0.511), number of lens epithelial cell layers lining the inner surface of the capsular bag (P = 0.310) and Soemmering's ring microscopic cross-sectional area (P = 0.638). CONCLUSIONS The effect of different solutions on after-cataract should be assessed in terms of overall regeneration/proliferation of lens material within the capsular bag, in addition to posterior capsule opacification. When administered in low doses during hydrodissection, 5-fluorouracil and mitomycin C did not show a significant inhibitory effect on after-cataract formation in rabbit eyes.
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Affiliation(s)
- Jesse Chew
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Becker KA, Martin M, Rabsilber TM, Entz BB, Reuland AJ, Auffarth GU. Prospective, non-randomised, long term clinical evaluation of a foldable hydrophilic single piece intraocular lens: results of the Centerflex FDA study. Br J Ophthalmol 2006; 90:971-4. [PMID: 16687454 PMCID: PMC1857197 DOI: 10.1136/bjo.2006.092437] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Owing to the improvement of modern intraocular lenses (IOLs) in terms of design and material, posterior capsule opacification (PCO) usually takes 2-3 years to develop. Thus, long term clinical evaluation of new implants is important. METHODS As part of a prospective, non-randomised FDA trial, the Rayner Centerflex, a foldable hydrophilic acrylic, single piece IOL was implanted in one eye of 83 patients (mean age 73.5 (SD 7.0) years). Over 3 years postoperatively, a standardised FDA protocol concerning IOL safety and efficacy was followed including evaluation of spherical equivalent (SE), best corrected distance visual acuity (BCDVA), endothelial cell count (ECC), flare meter values, PCO development, and anterior capsule shrinkage. RESULTS Postoperatively, mean SE was stable ranging between -0.3D and 0.17D. After 1-2 months, all patients achieved a BCDVA of 20/40 or better. At 3-6 months postoperatively, mean ECC decreased from 2612 (SD 346) cells/mm2 to 2380 (316) cells/mm2. Mean PCO score for the entire optic increased from 0.20 (0.20) months (3-6 months postoperatively) to 0.87 (0.57) resulting in a Nd:YAG rate of 29.41% after 3 years. No anterior capsule shrinkage was found. CONCLUSION The Centerflex showed excellent functional results, low values for endothelial cell loss and inflammatory signs, and no anterior capsule shrinkage. PCO formation was higher compared to other IOLs, which could be explained by the incomplete sharp edge at the optic-haptic junctions representing an "Achilles' heel" for cell ingrowth.
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Affiliation(s)
- K A Becker
- Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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Werner L, Mamalis N, Stevens S, Hunter B, Chew JJL, Vargas LG. Interlenticular opacification: Dual-optic versus piggyback intraocular lenses. J Cataract Refract Surg 2006; 32:655-61. [PMID: 16698490 DOI: 10.1016/j.jcrs.2006.01.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 05/31/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate and compare the incidence of capsular bag opacification, particularly interlenticular opacification (ILO), in rabbit eyes implanted with a dual-optic silicone intraocular lens (IOL) or piggyback lenses. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS Ten dual-optic study IOLs (Synchrony), 10 control pairs of piggyback silicone-plate lenses, and 10 control pairs of piggyback single-piece hydrophobic acrylic lenses were implanted in the capsular bag of 30 rabbit eyes following phacoemulsification. After a 6-week follow-up, the rabbits were killed and their eyes enucleated. Anterior capsule opacification and posterior capsule opacification were graded on a 0 to 4 scale from a posterior or Miyake-Apple view. Interlenticular opacification was noted in relation to the center of the interlenticular space (periphery, paracentral, and central area) and to the number of quadrants involved. The eyes were then evaluated histopathologically. RESULTS Postoperative inflammatory reaction was similar in all groups. Interlenticular opacification formation was statistically different among the 3 groups of lenses (ILO extension, P = .0013, and ILO extension x ILO quadrants, P = .0023; Kruskal-Wallis test). Pairwise post comparisons of ILO formation showed that the differences between the study IOL group and the silicone-plate lens group were not significant. Interlenticular opacification post comparisons between the hydrophobic acrylic lenses and the study lens or the silicone-plate lenses were significant (P = .002 and P = .001, respectively). Histopathologic examination showed extension of the proliferating cortical material from the peripheral Soemmering's ring into the interlenticular space, causing ILO, especially with the pairs of hydrophobic acrylic lenses. CONCLUSIONS In this rabbit model, ILO was significantly associated with pairs of hydrophobic acrylic lenses implanted in the bag. This study appears to confirm clinical observations that implantation of 2 silicone-plate lenses in the bag is not associated with ILO. There was also a relative lack of ILO with the dual-optic silicone lens.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
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Abstract
PURPOSE OF REVIEW This paper assesses the factors that contribute to the formation of an effective capsular bend as a deterrent to posterior capsule opacification. Its goal is to assist the practicing ophthalmologist in separating current understanding of this process from various working models previously proposed. RECENT FINDINGS While a square-edge design appreciably improves resistance to posterior capsule opacification, significant factors remain under the control of the surgeon. These factors combine to form the physical and psychological barrier of a capsular bend. Innovative digital imaging has shown lens epithelial cell migration, allowing for a more rapid assessment of posterior capsule opacification resistance. A three-piece intraocular lens allows for full 360 degree capsular bend formation surrounding the optic edge; some single-piece designs may inhibit capsular bend formation. Decreasing, but not eliminating, the surviving lens epithelial cell population may diminish capsular bend strength, which may decrease resistance to posterior capsule opacification in the face of a regenerating cortex. All demographic features of clear/refractive lens exchange suggest higher rates of posterior capsule opacification than with standard cataract surgery. SUMMARY The quality of capsular bend formation will determine how resistant an intraocular lens will be to posterior capsule opacification as a consequence of regenerating cortex. As refractive lens exchange and new accommodating intraocular lens designs become more popular, the problems of regenerating cortex will increase in magnitude.
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Affiliation(s)
- Steven Dewey
- Colorado Springs Health Partners, PC, 209 South Nevada Avenue, CO 80903, USA.
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Werner L, Mamalis N, Izak AM, Pandey SK, Davis BL, Nilson CD, Weight C, Apple DJ. Posterior capsule opacification in rabbit eyes implanted with 1-piece and 3-piece hydrophobic acrylic intraocular lenses. J Cataract Refract Surg 2005; 31:805-11. [PMID: 15899460 DOI: 10.1016/j.jcrs.2004.06.088] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2004] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the outcome of posterior capsule opacification (PCO) after implantation in rabbit eyes of currently available 3-piece and 1-piece hydrophobic acrylic intraocular lenses (IOLs) with square optic edges. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS The 3-piece designs evaluated were the AR40e (Advanced Medical Optics Inc.) and the MA60AC (Alcon, Inc.); the 1-piece designs were the SA60AT and the SA30AT (Alcon, Inc.). Nine lenses of each type were implanted in a randomized manner by the same surgeon in 18 Dutch Belted pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and analyses of the enucleated eyes were performed from the posterior or Miyake-Apple view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was scored from 0 to 4. The area of Soemmering's ring formation was also scored from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL anterior surface, IOL centration, fixation, and presence of striae. Results from the posterior view were complemented by histopathologic evaluation of the eyes. RESULTS No statistically significant difference was found between the 4 groups of IOLs in the parameters analyzed from the posterior view. When cell ingrowth occurred with the 1-piece designs, causing peripheral and central PCO formation, it was more likely to start at the optic-haptic junctions, as observed during the clinical follow-up with slitlamp examination and confirmed by gross and histopathologic analyses of the enucleated eyes. CONCLUSIONS The square, truncated optic edge is the most important IOL design feature for PCO prevention. The optic-haptic junctions of the 1-piece designs appear to be sites where the barrier effect of the truncated optic edge is less effective.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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