Evaluating impact of Nd: YAG laser associated defects on optical quality of hydrophilic and hydrophobic intraocular lenses using visualization of light propagation and USAF test targets

Image Contrast and Spectral Transmission of Presbyopia-Correcting Intraocular Lenses: Evaluating the Impact of Nd:YAG Laser Associated Defects

PURPOSE

Neodymium yttrium aluminum garnet (Nd:YAG) laser capsulotomy is considered gold standard in the treatment of posterior capsule opacification (PCO). In this laboratory study, we measured spectral transmission to evaluate the image contrast and analyze the impact of Nd:YAG associated defects in presbyopia-correcting intraocular lenses (IOLs).

METHODS

Two hydrophobic, acrylic IOLs as classic multifocal lenses with diffractive ring segments and different amount of near addition (A, B), one hydrophilic, trifocal IOL (C), one sector-shaped, plate haptic IOL (D) and one hydrophobic, enhanced depth of focus (EDOF) IOL (E) were studied. Measurements included surface topography characterization, United States Air Force resolution test chart (USAF) analysis, spectral transmittance measurements and through focus contrast measurement. Measurements were done with unaltered samples, damages (n = 7) were intentionally created in the central 3.5 mm zone using a photodisruption laser (2.0 mJ) and measurements were repeated.

RESULTS

Significant differences were shown between unmodified samples and samples with YAG pits. The YAG-pits decreased the image contrast and spectral transmission and changed results of USAF test images. The imaging contrast decreased to 66%, 64%, 60%, 52% and 59% with the YAG shots in samples (A-E). The light transmission decreased to 88%, 87%, 92%, 79% and 91% (A-E) on average between 400 nm to 800 nm. In all IOLs a reduction of the relative intensity of transmitted light was observed.

CONCLUSION

The image performance of all tested presbyopia-correcting IOLs is significantly influenced and disturbed by YAG-pits. The intensity of transmitted light is reduced in the wavelength between 450-800 nm. USAF test targets show worse results compared to unmodified samples and contrast is significantly deteriorated. No ranking/rating among tested IOLs should be made as many other factors play a role in real world scenario. High care should be taken when performing Nd:YAG capsulotomy on premium IOLs to avoid any damages.

Incorrectly Focused Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) Laser Beam Leads to Massive Destructive Effects in Small-Aperture (Pinhole) Intraocular Lenses

INTRODUCTION

Pinhole intraocular lenses (IOLs) were developed to improve reading by compensating for loss of accommodative function. The IC-8® Apthera™ is a small-aperture presbyopia-correcting IOL that combines the proven principle of small-aperture optics with an aspheric monofocal lens to deliver a continuous range of vision for patients with cataracts from distance to near vision. Posterior capsule opacification is the most common sequela after cataract surgery. It is effectively treated by laser capsulotomy. However, if the laser beam is incorrectly focused, the IOL can be permanently damaged (pits/shots).

METHODS

In this experimental study, yttrium-aluminum-garnet (YAG) pits were purposefully created. Defects were analyzed and compared between the periphery of the ring in the clear area of the hydrophobic acrylic lens and at the carbon black (CB)-polyvinylidene fluoride (PVDF) filtering component (FilterRing™) of the pinhole lens. All defects were made using identical settings/energy levels (2.6 mJ). The damage induced to the IC-8® Apthera™ IOL was examined by low-magnification images, light microscopy, scanning electron microscopy, and micro-computed tomography (micro-CT).

RESULTS

YAG defects in the carbon black filter ring were much more severe than those in the clear zone due to the high absorption of the carbon black. Massive defects and destruction of the lens with tearing out of fragments and particles were observed. The missing volume calculated from the micro-CT reconstruction was 0.266 mm3, which is 1.6% of the entire IOL volume, or more than 1000 times the volume damaged in the largest shot in the periphery.

CONCLUSION

Based on the results, we highly recommend using the lowest possible energy levels, posterior offset setting, and circular pattern for maximum safety when performing laser capsulotomy with pinhole implants. Care should be taken to avoid creating irreversible iatrogenic defects that may affect overall quality. The safest area for performing capsulotomy seems to be the periphery of the ring segment. Video available for this article.

Examining Penetration and Residual Depth in Modern Acrylic Foldable Intraocular Lenses: A Laboratory Study Using Differential Interference Contrast Microscopy to Compare Hydrophilic and Hydrophobic Materials

Introduction The material of modern intraocular lenses must meet the highest standards and fulfill various requirements. It is crucial that the material shows the best biocompatibility and should be flexible for an uncomplicated implantation process through small corneal incisions but also sufficiently rigid for good stability and centering in the capsular bag. In addition, the optic must remain clear for life and retain the best optical properties. Methods In this laboratory experiment, we performed scratch tests for the mechanical assessment of acrylic intraocular lenses. The aim was to determine differences in the behavior in regard to the manufacturing process and water content of hydrophilic and hydrophobic acrylic intraocular lenses. The scratch tests were performed using a Nano Scratch Tester. A conical indenter with a tip radius of 1 µm and a cone angle of 90° was selected to scratch the samples at three different constant loads of 5, 10, and 15 mN, respectively. The scratch length was set to 100 µm at a scratch speed of 200 µm/min. Hydrophilic and hydrophobic acrylic intraocular lenses (with different water content) were tested. Results The results showed that for sample A (hydrophilic acrylate), the penetration depth increases steadily with increasing force from 25-30 µm (5 mN) to 28-33 µm (10 mN) and 34-37 µm (15 mN). The penetration depths during the scratches seem to be load-dependent. In sample B (hydrophobic acrylate), the same forces lead to steadily increasing penetration depths: 25-30 µm (5 mN), 40-44 µm (10 mN), and 54-57 µm (15 mN). The evaluation of the residual depth showed much lower values for all samples. In the hydrophilic, softer samples (A), the residual depth was between 1 µm and 4 µm. In the hydrophobic, more solid, samples (B), the residual depth was more pronounced with values between 5 µm and 17 µm. The plastic influence and deformation zone seemed to be wider for the hydrophobic samples than for the hydrophilic samples. Conclusion The laboratory experiment confirms that modern, acrylic intraocular lenses are sensitive to scratches/touch, and penetration depths during scratching depend on the load. The remaining depths after the scratches are significantly lower and show a load dependence. The deforming zone was higher in the hydrophobic acrylates than in the hydrophilic acrylates. However, the results confirm that damage can occur with hydrophobic and hydrophilic acrylic materials, depending on the force applied. Therefore, careful handling during the preparation and implantation process is crucial to prevent permanent defects.

Neodymium-doped yttrium aluminum garnet (Nd: YAG) laser treatment in ophthalmology: a review of the most common procedures Capsulotomy and Iridotomy

Nowadays, lasers are used in various medical fields. Ophthalmology was the first medical specialty to utilize lasers in patient treatment and still remains the leading medical field that uses laser energy for both therapeutic and diagnostic purposes. The neodymium: yttrium-aluminum-garnet (Nd: YAG) laser is one of the most common lasers used in ophthalmology. It is a solid-state laser with a wavelength of 1064 nm that works on the principle of photodisruption. Since its introduction in ophthalmology over 40 years ago, it has found various applications, mainly for procedures where cutting or disruption of ocular tissue is required. Compared to surgical alternatives, the use of Nd: YAG lasers on ocular tissue is minimally invasive. In this review, we focus on the two most common ophthalmic applications of Nd: YAG laser - laser peripheral iridotomy and posterior capsulotomy. The history of the techniques, current trends, potential complications, and the prognosis for future use is discussed.

A Novel 3D High Resolution Imaging Method Using Correlative X-Ray and Electron Microscopy to Study Neodymium-Doped Yttrium Aluminum Garnet Laser-Induced Defects in Intraocular Lenses

INTRODUCTION

Cataract extraction is the most frequently performed ophthalmological procedure worldwide. Posterior capsule opacification remains the most common consequence after cataract surgery and can lead to deterioration of the visual performance with cloudy, blurred vision and halo, glare effects. Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy is the gold standard treatment and a very effective, safe and fast procedure in removing the cloudy posterior capsule. Damaging the intraocular lens (IOL) during the treatment may occur due to wrong focus of the laser beam. These YAG-pits may lead to a permanent impairment of the visual quality.

METHODS

In an experimental study, we intentionally induced YAG pits in hydrophilic and hydrophobic acrylic IOLs using a photodisruption laser with 2.6 mJ. This experimental study established a novel 3D imaging method using correlative X-ray and scanning electron microscopy (SEM) to characterize these damages. By integrating the information obtained from both X-ray microscopy and SEM, a comprehensive picture of the materials structure and performance could be established.

RESULTS

It could be revealed that although the exact same energies were used to all samples, the observed defects in the tested lenses showed severe differences in shape and depth. While YAG pits in hydrophilic samples range from 100 to 180 µm depth with a round shape tip, very sharp tipped defects up to 250 µm in depth were found in hydrophobic samples. In all samples, particles/fragments of the IOL material were found on the surface that were blasted out as a result of the laser shelling.

CONCLUSION

Defects in hydrophilic and hydrophobic acrylic materials differ. Material particles can detach from the IOL and were found on the surface of the samples. The results of the laboratory study illustrate the importance of a precise and careful approach to Nd:YAG capsulotomy in order to avoid permanent damage to the IOL. The use of an appropriate contact glass and posterior offset setting to increase safety should be carried out routinely.

Image Contrast and Spectral Transmission in Intraocular Lenses with Nd:YAG Pits

PURPOSE

Neodymium yttrium aluminum garnet (Nd:YAG) laser capsulotomy is considered as safe and effective method in the treatment of posterior capsule opacification. Nevertheless, side effects are described. The incorrectly adjusted focus of the laser beam during the procedure can lead to so-called YAG-pits or YAG-shots. In this experimental study, we measured spectral transmission to evaluate the image contrast and analyze the impact of YAG-pits in intraocular lenses (IOL).

METHODS

Acrylic, foldable, one-piece IOLs with 6.0 mm optic and different material properties were studied. These included: monofocal IOLs and enhanced monofocal IOLs with water content of 0.3%, 26.0%, and 4.0% and a refractive index of 1.49, 1.46, and 1.54, respectively. All measurements were done with new, unaltered IOLs and IOLs with YAG-pits. Damage was intentionally created, performing YAG-pits (n = 7) in the central zone (3.5 mm) using a photodisruption laser (2.0mJ). All laboratory measurements were repeated: These included surface topography characterization, United States Air Force (USAF) resolution test chart analysis, spectral transmittance measurements and through focus contrast measurement.

RESULTS

Significant differences were found between the unaltered lenses and lenses with defects. The YAG-pits within the optic of the IOLs decreased the image contrast and spectral transmission and changed results of USAF test images at the focal position by 62%, 57% and 54%, respectively. In all IOLs a reduction of the relative intensity of total transmitted light was observed between 450 and 700 nm wavelength.

CONCLUSION

This experimental study confirmed that the IOL image performance deteriorates with YAG-pits. The total intensity of transmitted light or transmittance (without scattering) was reduced in the wavelength between 450 and 700 nm. The contrast was significantly reduced and USAF test targets showed much worse results compared to unmodified counterparts. There was no systematic difference between monofocal and enhanced monofocal lenses. Further experiments should investigate the effect of YAG-pits on diffractive IOLs.