Irregularities on the surface of single-piece AcrySof SA60AT intraocular lenses

PURPOSE

To report a case series of what initially appeared to be macroscopic biomaterial deposits and irregularities on the surface of AcrySof SA60AT intraocular lenses (IOLs) (Alcon Inc.)

SETTING

Department of Ophthalmology and Somerset Hospital, Taunton, United Kingdom; Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA; and Intraocular Implant Unit, Sydney Eye Hospital, University of Sydney, Sydney, Australia.

METHODS

Twelve AcrySof SA60AT IOLs were initially thought to have irregularities on their surfaces when examined under the operating microscope before implantation in the capsular bag during cataract surgery. The IOLs were sent for further analysis, including gross examination and light and scanning electron microscopy, to John A. Moran Eye Center, Salt Lake City, Utah, USA, and to Alcon Laboratories, Hemel Hempstead, United Kingdom.

RESULTS

Light microscopy revealed the presence of irregular fine lesions on the IOLs' optics and haptics. The lesions consisted of elevations and depressions of the IOL surface that were present on both the anterior and the posterior surfaces of the IOLs. Scanning electron microscopy confirmed the presence of physical/mechanical damage to the IOLs, which was thought to originate from the packaging. The manufacturer believed this to have resulted from compression of the IOL between the container and its cover.

CONCLUSIONS

Implantation of an imperfect IOL remains a potentially serious occurrence. Faults still occur in modern IOLs, and some defects can be detected by examining the IOL under the operating microscope before implantation into the eye.

Effect of aqueous Euphorbia hirta leaf extract on gastrointestinal motility

The aqueous leaf extract of Euphorbia hirta decreased the gastrointestinal motility in normal rats and decreased the effect of castor oil-induced diarrhoea in mice.

Postoperative opacification of the peripheral optic region and haptics of a hydrophilic acrylic intraocular lens

We report the first case of opacification of the BioComFold 92S (Morcher GmbH) intraocular lens. The opacification pattern is unique, presenting mainly in the periphery of the optic and the haptics of the lens, leaving the central portion of the optic clear. The clinical course of this opacification pattern is not observed typically with other hydrophilic acrylic lens designs and requires further study.

Intraoperative explantation of two single-piece hydrophobic acrylic intraocular lenses due to surface deposits

PURPOSE

To report clinical, pathological, and laboratory analyses of two cases of single-piece hydrophobic acrylic intraocular lenses (IOLs), which presented with significant surface deposits during implantation.

METHODS

The lenses were implanted with the manufacturer's recommended injector (loaded with Viscoat and Healon GV, respectively). Immediately after injection into the anterior chamber, areas on the lenses' surfaces were covered by deposits, which could not be entirely removed by irrigation/aspiration. The lenses were explanted and replaced with lenses of the same design. They underwent gross analyses, light microscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy for analysis of the elemental composition of the deposits. Liquid chromatography/mass spectroscopy was also performed to identify the presence of proteins.

RESULTS

The deposits on the first lens had a granular appearance, forming a homogeneous layer mostly on the posterior lens surface. Larger crystal-like deposits were present mostly on the anterior surface of the second lens. Elemental analyses of the deposits in both cases revealed the presence of peaks of sodium, chloride, phosphate, and potassium, in addition to the peaks of carbon and oxygen (normal constituents of the lens material). Only protein components normally found in the anterior chamber during surgery, such as haemoglobin and albumin, were identified.

CONCLUSIONS

The results obtained suggest that the deposits in both cases may have resulted from crystallization of the ophthalmic viscosurgical device normally used during the loading of the IOLs into the cartridges.

Selective death of lens epithelial cells using demineralized water and Triton X-100 with PerfectCapsule sealed capsule irrigation: a histological study in rabbit eyes

BACKGROUND

Sealed irrigation of the capsular bag after removal of the cataractous lens isolates the interior of the capsular bag from the anterior segment, permitting isolated targeting of lens epithelial cells (LECs) in vivo using pharmacologic agents while minimizing the risk of damage to other intraocular structures.

OBJECTIVES

To assess the ability to deliver a nonspecific, extremely toxic agent (Triton X-100) directly to the LECs after crystalline lens removal, and to assess the eyes histologically for evidence of collateral damage.

METHODS

Twelve eyes from 6 New Zealand White rabbits were divided into 3 groups of 4 eyes that underwent phacoaspiration of the crystalline lens. Group 1 was a control. In group 2, the anterior segment was irrigated with Triton X-100 and demineralized water for injection for 5 minutes. In group 3, the lens capsule was isolated from the anterior segment using sealed capsule irrigation (SCI) with PerfectCapsule (Milvella Pty Ltd, Sydney, Australia). After surgery, the rabbits were humanely euthanized. The enucleated eyes were immediately fixed in 10% neutral buffered formalin, histological analysis was performed to assess the corneal endothelium, iris, and retina, and the capsular bag and residual equatorial LECs were assessed.

RESULTS

The capsular bag was sealed and inflated under SCI in all treated eyes in group 3. Histological evaluation revealed no evidence of collateral damage in group 1 and group 3. Significant histological damage to the cornea, iris, and peripheral retina was noted in group 2. Histological evaluation of each capsular bag suggests presence of LECs in group 1 and group 2. In the presence of SCI, Triton X-100 caused almost complete destruction of LECs in the capsular bag.

CONCLUSIONS

Results suggest that SCI allows selective delivery of toxic agents directly into the capsular bag, preventing collateral damage to surrounding intraocular structures. The PerfectCapsule device kept the capsular bag well inflated intraoperatively, which may allow the isolated, safe delivery of pharmacologic agents into the capsular bag during cataract surgery. Clinical Relevance Postoperative proliferation of LECs in the capsular bag remains the most frequent complication of cataract surgery. Unprotected intraocular infusion of cytotoxic drugs, antimetabolites, or hypo-osmotic agents during cataract surgery has the potential risk of causing toxic effects in corneal endothelium and adjacent intraocular tissues. Selective delivery of pharmacologic/hypo-osmotic agents into the capsular bag requires positive pressure inflation of the bag and is now possible using an SCI device. This device allows the surgeon to reseal the capsular bag intraoperatively, achieve positive pressure inflation of the capsular bag, and direct selective targeting of LECs.

Multimodality Agents for Tumor Imaging (PET, Fluorescence) and Photodynamic Therapy. A Possible “See and Treat” Approach

Methyl 3-(1'-m-iodobenzyloxyethyl)-3-devinylpyropheophorbide-a (2), obtained in a sequence of reactions from pyropheophorbide-a (a chlorophyll-a derivative), was found to be a promising imaging agent and a photosensitizer for photodynamic therapy (PDT). The electrophilic aromatic iodination of the corresponding trimethylstannyl intermediate with Na124I in the presence of an Iodogen bead afforded 124I-labeled photosensitizer 4 with >95% radioactive specificity. In addition to drug-uptake, the light fluence and fluence rate that were used for the light treatment had a significant impact in long-term tumor cure. The iodo photosensitizer 2 (nonlabeled analogue of 4) produced 100% tumor cure (5/5 mice were tumor free on day 60) at a dose of 1.5 micromol/kg and a light dose of 128 J/cm2, 14 mW/cm2 for 2.5 h (lambda(max) 665 nm) at 24 h postinjection. The photosensitizer also showed promising tumor fluorescence and PET imaging ability. Our present work demonstrates the utility of the first 124I-labeled photosensitizer as a "multimodality agent", which could further be improved by using more tumor-avid and/or target-specific photosensitizers.

Cocooning of an iris-fixated intraocular lens in a 3-year-old child after perforating injury: Clinicopathologic correlation

We present a 3-year-old patient who developed extensive noninflammatory fibrous membrane formation in the anterior chamber involving the present iris-fixated intraocular lens (IOL), with subsequent need for explantation. The child had had repair of a corneal injury, crystalline lens extraction and Artisan iris-claw IOL (Ophthec) implantation after a penetrating injury 2 months before. Histopathologic analyses were consistent with a retrocorneal membrane that originated from the corneal stroma and formed a "cocoon" membrane on the iris-claw IOL.

Evaluation of the cataractogenic effect of viscoanesthetic solutions on the rabbit crystalline lens

PURPOSE

To evaluate the toxicity and cataractogenic effect of solutions combining sodium (Na) hyaluronate 1.0% and 1.5% with lidocaine 1.0% on the rabbit crystalline lens. The amount of pupil dilation provided by the addition of lidocaine to the Na hyaluronate solutions was also assessed.

SETTING

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

Five solutions were injected into the anterior chamber of 18 pigmented rabbits in a randomized manner by the same surgeon, the intraocular component of VisThesia (Na hyaluronate 1.5%/lidocaine 1.0%), the intraocular component of VisThesia Light (Na hyaluronate 1.0%/lidocaine 1.0%), Ophthalin Plus (Na hyaluronate 1.5%), and a balanced salt solution; and both eyes of 2 other rabbits were injected with nonpreserved aqueous lidocaine 1.0%. The pupil diameter of each eye was measured before injection, immediately after, and 1 and 5 minutes after injection. After a follow-up of 3 months with slitlamp examinations, the rabbits were killed, and their eyes were enucleated. The crystalline lenses were evaluated from a posterior or Miyake-Apple view, and the eyes were fixated in 10% formalin for histopathologic analyses.

RESULTS

Pupil diameter was significantly larger 1 and 5 minutes after injection in the VisThesia (P = .01 and P = .007) and VisThesia Light (P = .008 and P = .007) groups, whereas the differences were not significant in the Ophthalin Plus (P = .317 and P = .102) and balanced salt solution groups (P = .317 and P = .180). Fast and large pupillary dilation was observed in the aqueous lidocaine group, starting during the injection. No differences in the transparency of the natural lens and the red fundus reflex were noted during slitlamp examinations. Postmortem analyses from a posterior view also showed no differences in the transparency of the crystalline lens. The histopathologic appearance of the lens capsule, anterior and equatorial lens epithelial cells, and epithelial lens bow was comparable in the eyes, without signs of cell vacuolization or disruption.

CONCLUSIONS

Intracameral injection of the solutions used in this study caused no localized opacity or overall change in the transparency of the crystalline lenses as observed during clinical and postmortem examinations as well as histopathologic analyses of the enucleated rabbit eyes. Viscoanesthesia may have application in phakic intraocular lens implantation.

Professor Peter Choyce: an early pioneer of intraocular lenses and corneal/refractive surgery

Professor Peter Choyce, FRCS, DOMS, MS, was one of the pioneers of intraocular lens implant surgery. He developed an interest in artificial lens implantation following cataract surgery, a procedure that was widely criticized by the ophthalmic establishment in the UK, Europe, North America and other countries. Owing to the opposition to the intraocular lenses, Peter Choyce together with Sir Harold Ridley co-founded the International Intraocular Implant Club in 1966, which was responsible for the gradual acceptance of artificial lens implantation. Peter Choyce developed several models of intraocular lens, but did not patent the majority of them. The Choyce Mark IX, manufactured by Rayner Intraocular Lenses, became the first US Food and Drug Administration-approved intraocular lens in 1981. A review of Peter Choyce's record confirms a significant number of original innovations in the field of anterior segment surgery, including many procedures taken for granted today, but not associated with his name. These include early work on both kerato- and intraocular lens-refractive procedures, keratoprosthesis, pioneering paediatric implant procedures and others. Unfortunately his tenacious adherence to anterior chamber lens technology, while in general clinically sound, caused many to question his influence and hence he remained poorly understood even until after his death. He passed away on 8 August 2001 after a long fight with colon cancer. In this article, we provide evidence and elaborate Peter Choyce's accomplishments, which places him as one of the most innovative ophthalmologist in his surgical field in the twentieth century.

Posterior capsule opacification in rabbit eyes implanted with 1-piece and 3-piece hydrophobic acrylic intraocular lenses

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.

Analysis of the capsule edge after Fugo plasma blade capsulotomy, continuous curvilinear capsulorhexis, and can-opener capsulotomy

PURPOSE

To compare the quality of the edges of anterior capsulotomies performed in porcine eyes using 3 different techniques.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA.

METHODS

Four porcine eyes were submitted to the center in 10% neutral buffered formalin. The cornea of the eyes had been removed, and a continuous capsulotomy had been performed in each eye using the Fugo plasma blade. To provide morphologic correlation, 4 additional porcine eyes were used in the study. In 2, a manual continuous curvilinear capsulorhexis (CCC) was performed after the cornea or cornea/iris was removed and in the other 2, a can-opener capsulotomy (COC) was performed. The eyes were then placed in 10% neutral buffered formalin. Gross (macroscopic) and microscopic analysis of each eye was performed, and photographs were taken. One eye in each group was also prepared and analyzed under scanning electron microscopy (SEM).

RESULTS

The capsulotomy margin in the Fugo blade group presented some regularly spaced tags directed centrally with smooth edges at the base. Such a configuration would not interfere with the dynamics of the capsulorhexis sphincter and would generally not lead to radial tears. The smooth and regular nature of the capsulotomy margin in the CCC group was confirmed by gross and microscopic examinations of the eyes. The capsulotomy margin in the COC group presented some sharp notches directed outward, irregularly spaced, and irregular in shape. These are known to have a tendency to extend and form radial tears.

CONCLUSION

Although performance of an anterior capsulotomy with the Fugo blade was associated with some margin irregularities, the geometry of the centrally directed tags prevented them from becoming the site of radial tear formation. The base of the capsulotomy performed with the Fugo blade appeared to be almost as smooth and regular as in the CCC under SEM evaluation.

Effect ofAsparagus racemosus rhizome (Shatavari) on mammary gland and genital organs of pregnant rat

Asparagus racemosus (AR) Willd (family Liliaceae) is commonly known as Shatavari. The alcoholic extract of its rhizome was administered orally to adult pregnant female albino rats at a dose of 30 mg/100 g body weight, daily for 15 days (days 1-15 of gestation). The macroscopic findings revealed a prominence of the mammary glands, a dilated vaginal opening and a transversely situated uterine horn in the treated group of animals. The weight of the uterine horns of the treated group was found to be significantly higher (p < 0.001) but the length was shorter (p > 0.01). Microscopic examination of the treated group showed proliferation in the lumen of the duct of mammary gland. It was obliterated due to hypertrophy of ductal and glandular cells. Hyperplasia of the glandular and muscular tissue and hypertrophy of the glandular cells were observed in the genital organs. The parenchyma of the genital organs showed abundant glycogen granules with dilated blood vessels and thickening of the epithelial lining. The oviduct in the treated group showed hypertrophied muscular wall, whereas the ovary revealed no effect of the drug. The results suggest an oestrogenic effect of Shatavari on the female mammary gland and genital organs.

Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants

PURPOSE

To report clinical, pathologic, histochemical, ultrastructural, and spectroscopic analyses of MemoryLens intraocular lenses (IOLs) explanted from patients who had visual disturbances caused by postoperative opacification of the lens optic.

DESIGN

Noncomparative, large case series with clinicopathologic correlation.

PARTICIPANTS

A total of 106 hydrophilic acrylic IOLs of the same design explanted from 106 different patients. All patients had decreased visual acuity at presentation approximately 2 years after cataract surgery, associated with a whitish fine granularity on the optical surfaces of the IOLs.

METHODS

The explanted IOLs were submitted to the John A. Moran Eye Center and were examined under light microscopy, histochemically, and with scanning electron microscopy (SEM) equipped with an energy dispersive x-ray spectroscopy detector with light element capabilities (EDS).

MAIN OUTCOME MEASURES

The IOLs were examined for distribution, structure, and composition of the deposits causing opacification of their optic components.

RESULTS

The average interval between lens implantation and opacification was 25.8+/-11.9 months. The most frequently associated medical and ophthalmic conditions were diabetes and glaucoma. However, some patients did not have any preexisting medical or ophthalmic conditions. Most of the IOLs had been implanted in 1999 and 2000. Microscopic analyses revealed the presence of multiple fine, granular deposits of variable sizes on the anterior and posterior optic surfaces, especially on the anterior surface. The deposits stained positive for calcium. The EDS confirmed the presence of calcium and phosphate within the deposits.

CONCLUSIONS

The results obtained suggest the surface deposits to be composed, at least in part, by calcium and phosphate. A special polishing technique used in the manufacture of most of these IOLs may have caused changes in the lens surface leading to deposit formation. Further studies should be undertaken to confirm this hypothesis.

Anatomical variations of the splenic artery and its clinical implications

The variations in orgin, course, and terminal branching pattern of the splenic artery were studied in 320 cadavers. The artery originated from the coeliac trunk in the majority of cadavers (90.6%), followed by abdominal aorta (8.1%), and other sights (1.3%). A suprapancreatic course of the artery was commonly observed (74.1%) followed by enteropancreatic (18.5%), intrapancreatic (4.6%), and retropancreatic (2.8%) courses. In two cases (0.63%) the proximal part of the splenic artery made a loop that was embedded in the substance of the pancreas, which is an interesting and rare finding. In five cases (1.5%) the proximal part of the artery divided into two or more branches that had suprapancreatic and enteropancreatic courses. The splenic artery divided into terminal branches in 311 (97%) cadavers. In nine (2.8%) cadavers it passed through the hilum of spleen without dividing. Two terminal branches were the most common (63.1%) followed by four (18.8%), six (9.7%), and more than six (5.6%) branches. The present study clearly indicates that there is variation in origin, course, and terminal distribution pattern of the splenic artery. The knowledge of these variations are of significant importance during surgical and radiological procedure of upper abdominal region to avoid any catastrophic complications.

Correlation between different measurements within the eye relative to phakic intraocular lens implantation

PURPOSE

To obtain measurements of the white-to-white distance and the anterior chamber and ciliary sulcus diameters in phakic human eyes obtained post-mortem to find a correlation between these measurements.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

Twenty-two phakic human eyes obtained from eye banks within 24 hours of death were evaluated. The following measurements were performed: white-to-white distance, anterior chamber diameter with a plastic sizer after a small limbal incision, and anterior chamber and ciliary sulcus diameters after fixation and sagittal section of the eyes. The first 10 eyes were studied at the 6 o'clock to 12 o'clock meridian and the last 12 eyes, at the 3 o'clock to 9 o'clock meridian.

RESULTS

A positive correlation was found between the white-to-white measurements and the anterior chamber diameter in the 10 eyes studied at the 6 o'clock to 12 o'clock meridian but not in the 12 eyes studied at the 3 o'clock to 9 o'clock meridian. The latter is the meridian frequently used by surgeons to perform white-to-white measurements and thus choose the overall size of the phakic intraocular lens to be implanted. No correlation was found between the white-to-white measurements and the ciliary sulcus diameter in the 2 meridians.

CONCLUSION

Experimental studies using cadaver eyes are helpful in evaluating sizing techniques for phakic IOL implantation as well as in better understanding the anatomical relationships between ocular structures.

Posterior capsule opacification in rabbit eyes implanted with hydrophilic acrylic intraocular lenses with enhanced square edge

PURPOSE

To evaluate the development of posterior capsule opacification (PCO) after implantation of single-piece hydrophilic acrylic intraocular lenses (IOLs) with an enhanced square edge.

SETTING

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

The standard 570H Centerflex (Rayner Ltd.) design was compared to 2 new designs with enhanced square edges: the 570E and the 570C. Ten IOLs of each type were implanted in a randomized manner by the same surgeon in 15 pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and the eyes were analyzed from the posterior view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was graded from 0 to 4. The area of Soemmering's ring was graded from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL edge and IOL centration and fixation. Results from the posterior view were complemented by histopathological evaluation.

RESULTS

Posterior capsule opacification was lowest in the 570C group, highest in the 570H group, and intermediate in the 570E group. There was a statistically significant difference between the 3 groups in peripheral PCO (P = .039). No significant difference was found between the groups in the other parameters analyzed. When cell ingrowth occurred with the 570H, it started at the optic-haptic junctions, as observed during the clinical follow-up and confirmed by gross and histopathological analyses.

CONCLUSIONS

The square optic edge is the most important IOL design feature for PCO prevention. However, it should be present for 360 degrees around the IOL optic to provide an effective barrier effect.

A tribute to Charles David Kelman MD: ophthalmologist, inventor and pioneer of phacoemulsification surgery

Charles David Kelman was born in Brooklyn, New York, USA, on 23 May 1930 and passed away in Boca Raton, Florida, USA, on 1 June 2004 at the age of 74 years after a long battle with cancer. He received a Bachelor of Science degree from Tufts University in 1950 and completed medical studies at the University of Geneva, Switzerland, in 1956. He was Clinical Professor of Ophthalmology at New York Medical College and an Attending Surgeon at New York Eye and Ear Infirmary and Manhattan Eye, Ear and Throat Hospital. Although a prolific inventor, he will be best remembered for developing phacoemulsification, following his realization while sitting in a dentist's chair, that ultrasonic vibrations could be used to emulsify the aged crystalline lens through a very small incision. His pioneering work revolutionized cataract surgery. He also pioneered cryo-extraction of cataracts, the use of freezing for the repair of retinal detachments and designed numerous ophthalmic instruments and intraocular lenses. Dr Kelman received numerous awards, including the American Academy of Ophthalmology Achievement Award (1970), the Ridley Medal from the International Congress of Ophthalmology (1990), and the Inventor of the Year Award from The New York Patent, Trademark and Copyright Law Association (1992). Most recently (2003), Dr Kelman was honoured by the American Academy of Ophthalmology with the Laureate Recognition award. Dr Kelman was also an accomplished Broadway producer, composer and jazz saxophonist. With his demise, the ophthalmic and medical community lost a famed inventor with multifaceted talents and one of the great ophthalmologists of the twentieth century.

Capsulorhexis ovaling and capsular bag stretch after rigid and foldable intraocular lens implantation

PURPOSE

To compare the amount of capsulorhexis ovaling and capsular bag stretch produced by various intraocular lenses (IOLs) implanted in pediatric human eyes obtained post-mortem.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Salt Lake City, Utah, USA.

METHODS

In this nonrandomized comparative study, 16 pediatric human eyes obtained postmortem were divided into 2 groups: Eight eyes were obtained from children younger than 2 years (Group A), and 8 eyes were obtained from children older than 2 years (Group B). All eyes were prepared according to the Miyake-Apple posterior video technique. Six types of rigid and foldable posterior chamber IOLs manufactured from poly(methyl methacrylate) (single-piece), silicone (plate and loop haptics), and hydrophobic acrylic (single-piece and 3-piece AcrySof, Alcon Laboratories) biomaterials were implanted. The capsulorhexis opening and capsular bag diameters were measured before IOL implantation and after in-the-bag IOL fixation with the haptics (or the main axis) at the 3 to 9 o'clock meridian. The percentage of ovaling of the capsulorhexis opening was calculated by noting the difference in the opening's horizontal diameter before and after IOL implantation. The percentage of capsular bag stretch was also calculated by noting the difference in the horizontal capsular bag diameter before and after IOL implantation.

RESULTS

All IOLs produced ovaling of the capsulorhexis opening and stretching of the capsular bag parallel to the IOL haptics. There were significant differences in capsulorhexis ovaling and capsular bag stretch (P<.001, analysis of variance) between the 6 IOL types in each group of eyes. The postimplantation difference was significant only between the single-piece hydrophobic acrylic IOL (AcrySof) and the other IOLs. The single-piece hydrophobic acrylic IOL was associated with significantly less capsulorhexis ovaling and capsular bag stretch in both groups (mean 12.06% +/- 0.59% [SD] and 7.6% +/- 1.47%, respectively).

CONCLUSIONS

Modern rigid and foldable IOLs designed for the adult population implanted in the capsular bag of infants and children produced variable degrees of capsulorhexis ovaling and capsular bag stretch. The Miyake-Apple posterior video technique confirmed the well-maintained configuration of the capsular bag (with minimal ovaling) after implantation of a single-piece hydrophobic acrylic IOL because of its flexible haptic design.

Pathological evaluation of postmortem human eyes implanted with a new single-piece hydrophobic acrylic lens

PURPOSE

To report the pathological findings in 14 human cadaver eyes implanted with a single-piece AcrySof(Alcon Laboratories) posterior chamber intraocular lens (IOL).

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

Fourteen human autopsy eyes implanted with a single-piece AcrySof (SA30AL) IOL were evaluated. The eyes were sectioned at the equatorial plane, and the anterior segment containing the IOL in the capsular bag was evaluated from a posterior perspective (Miyake-Apple view) and from an anterior perspective (surgeon's view) after removal of cornea and iris. They were then processed through paraffin, sectioned, and stained with hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome and examined under light microscopy.

RESULTS

All IOLs had symmetric in-the-bag fixation. Slight decentration was measured in 1 eye, which also had an anterior capsule tear. Grade 1 anterior capsule opacification was present in 9 eyes. No central posterior capsule opacification or posterior capsule folds were observed in any eye. Soemmering's ring formation was observed in 5 eyes. Zonular stretch caused by different degrees of capsular bag contraction was present in 4 eyes without decentration of the IOL.

CONCLUSIONS

Analyses of pseudophakic cadaver eyes from the posterior (Miyake-Apple) view, complemented by microscopic analyses, proved useful in the evaluation of IOL-capsular bag interaction. These studies are more important in cases of newly introduced lens designs.

Single-piece hydrophobic acrylic intraocular lens explanted within the capsular bag

A 74-year-old woman had uneventful phacoemulsification with implantation of a single-piece hydrophobic acrylic intraocular lens (IOL) (SA30AL) in her left eye. Two weeks after the surgery, the patient presented for ophthalmological consultation reporting pseudophakic dysphotopsia, which she had subjectively noted since surgery. Explantation/exchange of the IOL was performed 3 months after the surgery. The IOL was strongly attached to the capsule, which was fibrotic and contracted; explantation of the capsular bag complex in toto was done. To our knowledge, this is the first case of explantation of this IOL design with clinicopathological correlation.

Posterior capsule opacification: a review of the aetiopathogenesis, experimental and clinical studies and factors for prevention

Posterior capsule opacification (PCO, secondary cataract, after cataract) is a nagging postsurgical complication following extracapsular cataract surgery (ECCE) and intraocular lens (IOL) implantation. PCO should be eliminated since it has deleterious sequelae and Neodynium: Yttrium Aluminium Garnet (Nd: YAG) laser treatment often is an unnecessary financial burden on the health care system. PCO following cataract surgery could be a major problem, since patient follow-up is difficult and the Nd:YAG laser is not always available. Advances in surgical techniques, IOL designs/biomaterials have been instrumental in bringing about a gradual and unnoticed decrease in the incidence of PCO. We strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing - from 50% in the 1980s and early 1990s to less than 10% currently. Superior tools, surgical procedures, skills and appropriate IOL designs have all helped to significantly reduce this complication. In this article, we review the aetio pathogenesis, experimental and clinical studies and propose surgical and implant-related factors for PCO prevention. Careful application and utilisation of these factors by surgeons could lead to a significant reduction is secondary cataract, the second most common cause of visual loss worldwide.

Capsular bag opacification after experimental implantation of a new accommodating intraocular lens in rabbit eyes

PURPOSE

To evaluate the development of capsular bag opacification in rabbit eyes after implantation of an intraocular lens (IOL) designed to minimize contact between the anterior capsule and the IOL and ensure expansion of the capsular bag.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

Ten New Zealand white rabbits had a study IOL (new accommodating silicone IOL [Synchrony, Visiogen, Inc.]) implanted in 1 eye and a control IOL (1-piece plate silicone IOL with large fixation holes) implanted in the other eye. Intraocular lens position, anterior capsule opacification (ACO), and posterior capsule opacification (PCO) were qualitatively assessed using slitlamp retroillumination photographs of the dilated eyes. Anterior capsule opacification and PCO were graded on a 0 to 4 scale after the eyes were enucleated (Miyake-Apple posterior and anterior views after excision of the cornea and iris). The eyes were also evaluated histopathologically.

RESULTS

The rate of ACO and PCO was significantly higher in the control group. Fibrosis and ACO were almost absent in the study group; the control group exhibited extensive capsulorhexis contraction, including capsulorhexis occlusion. Postoperative IOL dislocation into the anterior chamber and pupillary block syndrome were observed in some eyes in the study group.

CONCLUSIONS

The special design features associated with the study IOL appeared to help prevent PCO. Complications in the study group were probably caused by the increased posterior vitreous pressure in rabbit eyes compared to human eyes and the relatively large size of the study IOL relative to the anterior segment of rabbit eyes.

Anatomical variations in termination of the axillary artery and its clinical implications

Variations in the termination of the axillary artery (AA) were observed in 51 out of 356 axilla during routine dissections. The incidence of variation was higher on the right axilla in 17.42% cases (CI: 11.60-22.51) than the left axilla 11.24% cases (CI: 6.46-15.55) and was found to be 12.33% in male and 40.63% in female cadavers. The variations were divided into four groups. The first group showed that the terminal end of the AA divided into lateral and medial divisions in 6.16% (CI: 2.21-9.82) male and in 15.63% (CI: 2.76-25.25) female cadavers. The second group variation showed that the terminal end of the axillary artery divided into deep and superficial divisions in 2.74% (CI: 0.10-5.27) male and in 6.25% (CI: -1.87-13.13) female cadavers. The third group showed that the terminal end of the AA divided into three branches in 2.74% (CI: 0.10-5.27) male and in 6.25% (CI: -1.87-13.13) female cadavers. The fourth group showed the tapering of the terminal end of AA in 0.68% (CI: -0.63-1.99) male and 12.50% (CI: 0.97-21.46) female cadavers. The variable origin of the circumflex humeral, subscapular and profunda brachii arteries was also observed. These variations in the terminal end of the axillary artery are not only of significant clinical importance to orthopaedic and reconstructive surgeons but also have very significant medico-legal implications.

Functionalization of OEP-Based Benzochlorins To Develop Carbohydrate-Conjugated Photosensitizers. Attempt To Target β-Galactoside-Recognized Proteins

meso-(2-Formylvinyl)octaethylporphyrin on reaction with cyanotrimethylsilane in the presence of various catalysts [copper triflate [Cu(OTf)(2)], indium triflate [In(OTf)(3)], or magnesium bromide diethyl etherate (MgBr(2).Et(2)O)] produced a mixture of the intermediate 3-hydroxy-3-cyanopropenoporphyrin, the corresponding trimethylsilyl ether derivative, and the unexpected propenochlorins. The yields of the reaction products were found to depend on the reaction conditions and the catalysts used. The intermediate porphyrins on treatment with concentrated sulfuric acid yielded the free-base cyanobenzochlorins in major quantity along with several other novel benzochlorins as minor products. Reduction of ethyl-3-hydroxy-1-pentenoate-porphyrin with DIBAL-H/NaBH(4) and subsequent acid treatment provided the corresponding free-base 10(3)-(2-hydroxyethyl)benzochlorin, which upon a sequence of reactions gave a free-base benzochlorin bearing a carboxylic acid functionality in good yield. It was then condensed with a variety of carbohydrates (glucosamine, galactosamine, and lactosamine), and the related conjugates were screened using the galectin-binding-ability assay. Among the carbohydrate conjugates investigated, the lactose and galactose analogues displayed the galectin-binding ability with an enhancement of about 300-400-fold compared to lactose. In preliminary studies, all photosensitizers (with or without carbohydrate moieties) were found to be active in vitro [radiation-induced fibrosarcoma (RIF) tumor cells]. However, the cells incubated with lactose (known to bind to beta-galactoside-recognized proteins) prior to the addition of the photosensitizers containing the beta-galactose moiety (e.g., galactose and lactose) produced a 100% decrease in their photosensitizing efficacy. Under similar experimental conditions, benzochlorin without a beta-galactoside moiety or the related glucose conjugate did not show any inhibition in its photosensitizing efficacy. These results in combination with the galectin-binding data indicate a possible beta-galactoside-recognized protein specificity of the galactose- and lactose-benzochlorin conjugates.