Foldable Glistening-Free Acrylic Intraocular Lens Biomaterials with Dual-Side Heterogeneous Surface Modification for Postoperative Endophthalmitis and Posterior Capsule Opacification Prophylaxis

Hydrophobic acrylic intraocular lenses (IOLs) are widely used in cataract treatment for posterior capsule opacification (PCO) prophylaxis. However, undesired glistening and postoperative endophthalmitis are two major potential risks. Hence, a series of poly(2-phenoxyethyl methacrylate-co-2-phenoxyethyl acrylate-co-2-ethylhexyl methacrylate) (PPPE) acrylic IOL materials were synthesized for "glistening-free" optimization. The selected PPPE with 2% 2-ethylhexyl methacrylate showed excellent optical, foldable, and thermomechanical properties. The anterior surface of PPPE was coated with polydopamine followed by gentamycin conjugation (PDA/GS). It inhibited bacterial adhesion by 74% and decreased the biofilm thickness by 87%. In inflammatory mimicking conditions, bacterial proliferation was restrained, with acidic-dependent GS release behavior. The surface of PPPE toward the posterior capsule remained hydrophobic. It was conducive to human lens epithelial cell adhesion, collagen IV and fibronectin adsorption, and the following "sealed sandwich structure" formation. In summary, the PPPE with a dual-side heterogeneous surface displayed good application prospects in postoperative endophthalmitis and PCO prevention.

A review of late intraocular lens opacifications

PURPOSE OF REVIEW

Phacoemulsification cataract surgery is one of the most commonly performed surgical procedure worldwide. In the majority of cases, intraocular lenses (IOLs) are implanted. Due to the increasing life expectancy and the fact that cataract surgery is performed in earlier stages, the anticipated IOL duration in the eye has increased over the last decades. The aim of this study was to review the types and describe the characteristics of late intraocular lens opacifications.

RECENT FINDINGS

Calcification was the most commonly reported type of opacification in hydrophilic IOLs; it usually negatively impacted the visual function and required IOL explantation. Glistening manifested in hydrophobic acrylic lenses and was frequent in some IOL models. In most cases glistening and subsurface nanoglistenigs do not lead to a decline in visual acuity or require IOL exchange. Current studies indicate that fluid-related phenomena may induce straylight, leading to a decrease of comfort and quality of vision.

SUMMARY

Several reports on late IOL opacifications have been published in recent years. In some cases, particularly in glistening, the development of the opacifications might be related to IOL aging. The influence of the fluid-related microvacuoles on the quality of vision requires further research.

Incidence of posterior capsular opacification requiring Nd:YAG capsulotomy after cataract surgery and implantation of enVista® MX60 IOL

PURPOSE

To evaluate incidence of posterior capsule opacification requiring Nd:YAG capsulotomy over 3 years in a large series of eyes implanted with the enVista^® MX60 Intraocular Lens (IOL).

METHODS

A university-based, single-center, observational study of patients' medical records was conducted. Uneventful cataract surgery patients with in-the-bag implantations of the enVista^® MX60 IOL with a minimum of 24 months follow-up were included in the study. Exclusion criteria were insufficient follow-up (<24 months), intraoperative complications and combined surgery. The primary outcome measure was rate of YAG laser capsulotomy, while secondary outcome measures were time to YAG laser capsulotomy and rate of glistenings.

RESULTS

A total of 245 eyes of 143 patients received the MX60 IOL and were followed in the same center. Of these, 226 eyes were included in the study. Mean age was 80.7±8.3 years and M/F ratio was 42/101 (29.4/70.6%). The mean preoperative distance (logMAR) visual acuity was 0.67±0.5, while postoperatively it was 0.31±0.5 and 0.32±0.5 at the last visit. The Mean±SD follow-up time (min-max) was 35.2±7.2, (24-48.4) months. The incidence of Nd:YAG capsulotomy over 3 years was 5/226 (2.2%). Average time between surgery and Nd:YAG capsulotomy was 32.17 months. Univariate analysis of age, gender, presence of comorbidity and baseline visual acuity found no predictive factors for capsulotomy. No glistenings were reported at any postoperative visit.

CONCLUSION

The three-year cumulative incidence of PCO requiring Nd:YAG laser capsulotomy was 2.2% for the enVista^® MX-60 IOL, with no glistenings observed during follow-up. This low rate confirms the excellent safety profile of this IOL.