Evaluation of teflon-coated intraocular lenses in an organ culture method

Current State of the Art and Next Generation of Materials for a Customized IntraOcular Lens according to a Patient-Specific Eye Power

Intraocular lenses (IOLs) are commonly implanted after surgical removal of a cataractous lens. A variety of IOL materials are currently available, including collamer, hydrophobic acrylic, hydrophilic acrylic, PHEMA copolymer, polymethylmethacrylate (PMMA), and silicone. High-quality polymers with distinct physical and optical properties for IOL manufacturing and in line with the highest quality standards on the market have evolved to encompass medical needs. Each of them and their packaging show unique advantages and disadvantages. Here, we highlight the evolution of polymeric materials and mainly the current state of the art of the unique properties of some polymeric systems used for IOL design, identifying current limitations for future improvements. We investigate the characteristics of the next generation of IOL materials, which must satisfy biocompatibility requirements and have tuneable refractive index to create patient-specific eye power, preventing formation of posterior capsular opacification.

Analysis of the biocompatibility of perfluoropolyether dimethacrylate network using an organotypic method

In this work, we have investigated the potential of perfluoropolyether (PFPE) polymers for use in biomaterial applications, especially in cell culture and tissue engineering. PFPE substrates were synthesized by the photocuring of liquid PFPE urethane dimethacrylate. These surfaces were then modified by ECM protein coatings and microstructuration, to promote cell adhesion and migration. The surface properties of PFPE and PDMS (used as a reference) samples were studied by static contact angle measurements and AFM imaging. Both polymer surfaces were hydrophobic, having sessile air-water contact angles superior to 100°. Collagen and fibronectin coatings were found to change the wettability of PFPE and PDMS samples. The biological testing of substrates was done using a liver organotypic culture to evaluate the migration and density of liver cells. The results over seven days of culture demonstrated that the migration and density of cells cultured under untreated PFPE were higher than the migration and density of cells cultured under PDMS. ECM protein coatings enhanced cell migration from liver explants cultured on PFPE or PDMS. Furthermore, these coatings were more efficient in the case of a PFPE sample. From a second series of tests, in which the PFPE was microstructured, it was found that microstructures promoted the formation of a 3D cell layer. These results indicate that PFPE polymers have a potential for use in the development of biomaterials for tissue engineering and cell culture.

Avaliação histopatológica da cápsula posterior associada ao implante de lente intraocular com superfície modificada com plasma de flúor e polietilenoglicol em coelhos

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.

RGD surface functionalization of the hydrophilic acrylic intraocular lens material to control posterior capsular opacification

Posterior Capsular Opacification (PCO) is the capsule fibrosis developed on implanted IntraOcular Lens (IOL) by the de-differentiation of Lens Epithelial Cells (LECs) undergoing Epithelial Mesenchymal Transition (EMT). Literature has shown that the incidence of PCO is multifactorial including the patient's age or disease, surgical technique, and IOL design and material. Reports comparing hydrophilic and hydrophobic acrylic IOLs have shown that the former has more severe PCO. On the other hand, we have previously demonstrated that the adhesion of LECs is favored on hydrophobic compared to hydrophilic materials. By combining these two facts and contemporary knowledge in PCO development via the EMT pathway, we propose a biomimetically inspired strategy to promote LEC adhesion without de-differentiation to reduce the risk of PCO development. By surface grafting of a cell adhesion molecule (RGD peptide) onto the conventional hydrophilic acrylic IOL material, the surface-functionalized IOL can be used to reconstitute a capsule-LEC-IOL sandwich structure, which has been considered to prevent PCO formation in literature. Our results show that the innovative biomaterial improves LEC adhesion, while also exhibiting similar optical (light transmittance, optical bench) and mechanical (haptic compression force, IOL injection force) properties compared to the starting material. In addition, compared to the hydrophobic IOL material, our bioactive biomaterial exhibits similar abilities in LEC adhesion, morphology maintenance, and EMT biomarker expression, which is the crucial pathway to induce PCO. The in vitro assays suggest that this biomaterial has the potential to reduce the risk factor of PCO development.

Polymer coating of paramagnetic particulates for in vivo oxygen-sensing applications

Crystalline lithium phthalocyanine (LiPc) can be used to sense oxygen. To enhance biocompatibility/stability of LiPc, we encapsulated LiPc in Teflon AF (TAF), cellulose acetate (CA), and polyvinyl acetate (PVAc) (TAF, previously used to encapsulate LiPc, was a comparator). We identified water-miscible solvents that don't dissolve LiPc crystals, but are solvents for the polymers, and encapsulated crystals by solvent evaporation. Oxygen sensitivity of films was characterized in vitro and in vivo. Encapsulation did not change LiPc oximetry properties in vitro at anoxic conditions or varying partial pressures of oxygen (pO2). EPR linewidth of encapsulated particles was linear with pO2, responding to pO2 changes quickly and reproducibly for dynamic measurements. Encapsulated LiPc was unaffected by biological oxidoreductants, stable in vivo for four weeks. Oximetry, stability and biocompatibility properties of LiPc films were comparable, but both CA and PVAc films are cheaper, and easier to fabricate and handle than TAF films, making them superior.

Biocompatibility of intraocular lens materials

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.

Improved Performances of Intraocular Lenses by Poly(ethylene glycol) Chemical Coatings

Cataract surgery is a routine ophthalmologic intervention resulting in replacement of the opacified natural lens by a polymeric intraocular lens (IOL). A main postoperative complication, as a result of protein adsorption and lens epithelial cell (LEC) adhesion, growth, and proliferation, is the secondary cataract, referred to as posterior capsular opacification (PCO). To avoid PCO formation, a poly(ethylene glycol) (PEG) chemical coating was created on the surface of hydrogel IOLs. Attenuated total reflectance Fourier transform infrared spectroscopy, "captive bubble" and "water droplet" contact angle measurements, and atomic force microscopy analyses proved the covalent grafting of the PEG chains on the IOL surface while keeping unchanged the optical properties of the initial material. A strong decrease of protein adsorption and cell adhesion depending on the molar mass of the grafted PEG (1100, 2000, and 5000 g/mol) was observed by performing the relevant in vitro tests with green fluorescent protein and LECs, respectively. Thus, the study provides a facile method for developing materials with nonfouling properties, particularly IOLs.

Influence of gradual introduction of hydrophobic groups (stearic acid) in denatured atelocollagen on fibroblasts behaviorin vitro

To prepare new biocompatible hydrophobic collagen films for medical devices, innovative collagen derivatives were synthesized by reaction of the lysyl amino groups of the alpha-chains with activated stearic acid. Different collagens having different substitution degrees were obtained and used to prepare films crosslinked with oxidized glycogen. Their physicochemical surface properties were evaluated, and in vitro assays were performed to analyze the behavior of fibroblasts in contact with the materials. The assays were performed with cells in adhesion and growth phases. The hydrophobic properties increased with the number of stearic acid introduced in the collagen but only in the range of 1-12 stearic acids per molecule. For higher modifications a decrease of hydrophoby was observed. All the films induced a decrease of cells growth and adhesion but without cytotoxicity. These effects were more pronounced for the collagen containing about eight stearic acid residues. Cells behavior on modified collagens films seems to be related to the chemical groups exposed on the surface of the films. Indeed, the surface chemistry directly influences the adsorption of adhesion proteins and modulates their conformation therefore modifying the cell adhesion.

Guidance of liver and kidney organotypic cultures inside rectangular silicone microchannels

We have studied the effect of rectangular polydimethylsiloxane (PDMS) microchannels on the behavior of embryonic liver and kidney explants maintained in contact with these microchannels. The microchannel widths were varied from 35 to 300 microm and depth from 45 to 135 microm. The growth of these tissue types were compared to the development on flat silicone and plastic control material. At seeding, due to the viscoelastic properties of both organs, "capillary-like filling" was observed inside the narrowest microchannels. In those cases, the tissues grew to a confluent layer joining the microchannels with no cell migration and proliferation inside the microchannels. In the largest microchannels, only a weak migration was observed and the cellular behavior appears quite similar to that of PDMS flat culture conditions. In intermediate geometries, we observed different tissue growth progressed inside those microchannels with an average growth properties inside the microchannels when compared to other sizes. The liver tissues velocity of up to 72 microm/day resulting to form a dense three-dimensional multicellular 'liver-like tissue'. Scanning electron microscopy (SEM) observations demonstrated that the tissue was organized like an epithelial layer with round cells embedded in an extracellular matrix. Liver cell mobility may result primarily from the activity of the marginal cells, whereas the sub-marginal cells appeared passively dragged. Parenchymal organization demonstrating differentiated states was also observed. Kidney grew mainly on the microchannel walls and the tissues never appeared dense and organized as the liver ones.

Improvement of the surface biocompatibility of silicone intraocular lens by the plasma‐induced tethering of phospholipid moieties

To improve the surface biocompatibility of the silicone intraocular lens (IOL), 2-methacryloyloxyethyl phosphorylcholine (MPC) was tethered onto the IOL through air plasma treatment. Chemical changes on the IOL surface were characterized by X-ray photoelectron spectroscopy (XPS) to confirm the covalent binding of MPC. Morphologies of the IOL surfaces were observed by scanning electron microscopy (SEM) to optimize the plasma treatment process. The hydrophilicity and biocompatibility of the control and modified IOLs were compared by the measurements of water contact angle, platelet adhesion, macrophage cell culture, and lens epithelial cell (LEC) attachment. It was found that, after the tethering of MPC, the hydrophilicity of the IOL can be improved significantly and permanently, and the platelet, macrophage, and LEC adhesion on the IOL surface are obviously suppressed, which indicated the enhancement of surface biocompatibility.

Development and evaluation of biocompatible films of polytetrafluoroethylene polymers holding lithium phthalocyanine crystals for their use in EPR oximetry

Electron paramagnetic resonance (EPR) oximetry is a powerful technology that allows the monitoring of oxygenation in tissues. The measurement of tissue oxygenation can be achieved using lithium phthalocyanine (LiPc) crystals as oxygen reporters. In order to have biocompatibility for the sensing system and to assure long-term stability in the responsiveness of the system, we developed films of Teflon AF 2400 with embedded LiPc crystals. These systems can be used as retrievable inserts or parts of an implantable resonator or catheter. Atomic force microscopy studies revealed that the surface of the films was regular and planar. The response to oxygen of the sensor (EPR linewidth as a function of pO(2)) remained unchanged after implantation in mice, and was not affected by sterilization or irradiation. The use of resonators, holding LiPc embedded in Teflon AF 2400, implanted in the gastrocnemius muscle of rabbits allowed the monitoring of oxygen during several weeks. Several assays also demonstrated the biocompatibility of the system: (1) no hemolytic effect was noted; (2) no toxicity was found using the systemic injection test of extracts; (3) histological analysis in rabbit muscle in which the films were implanted for 1 week or 3 months was similar to standard polyethylene biocompatible devices. These advanced oxygen sensors are promising tools for future pre-clinical and clinical developments of EPR oximetry. These developments can be applied for other applications of biosensors where there is a need for oxygen permeable membranes.

Surface modification of silicone intraocular implants to inhibit cell proliferation

Photo-cross-linkable polymers bearing cinnamic, sulfonate, and carboxylate groups were synthesized by radical polymerization leading to randomly distributed copolymers. These polymers were used to coat silicone intraocular lenses in order to reduce posterior capsule opacification, also named "secondary cataract". We previously demonstrated that polymers containing both carboxylate and sulfonate groups inhibit cell proliferation, and formulations with the ratio R = COO-/(COO- + SO3-) equal to 0.64 provided the highest inhibitory effect. Ionic polymers with this formulation were synthesized to contain a monomer with pendant siloxane groups in order to get compatibility with the silicone matrix of the intraocular lenses. Anchorage of the ionic polymer at the surface of the silicone implant was achieved by a cycloaddition reaction of the photosensitive groups according to two options. These modified silicone surfaces grafted onto intraocular lenses were shown to inhibit cell proliferation to 60%.

Radio-frequency plasma treatment improves the growth and attachment of endothelial cells on poly(methyl methacrylate) substrates: implications in tissue engineering

The aim of this study was to improve the biocompatibility of poly(methyl methacrylate) (PMMA) substrates for possible applications in corneal prostheses or in micro-carrier cell culture systems. PMMA substrates were exposed to radio-frequency (RF) argon and nitrogen plasmas for 5 and 10 min each. The PMMA films were examined by Fourier transform infrared (FT-IR) spectroscopy, to characterize the surface changes after plasma exposure. Plasma treatment in general was found to decrease the water contact angle of PMMA, thus increasing its hydrophilicity. There was also an associated increase in the work of adhesion of plasma-treated PMMA substrates. PMMA substrates exhibited differential properties towards endothelial cell (CPA-47) growth. The untreated PMMA surface did not support endothelial growth, compared with both polystyrene (TCPS) and plasma-treated PMMA, while plasma (PL): PMMA exhibited growth rates slightly lower than the TCPS control, as assessed by [3H]thymidine incorporation profiles. The compatibility and growth supportive properties of PL : PMMA were further confirmed by an MTT assay, which showed preserved cellular viability and mitochondrial activity of the cells. Confocal microscopic visualization of cells with fluorescence-labeled vimentin showed normal organization of the cytoskeletal fibers, indicating appropriate attachment to the substrate. Cells growing on PL: PMMA maintained their functionality, as seen from Factor VIII expression. Taken collectively, the findings of this study point out the suitability of RF plasma treatment in inducing desirable changes in PMMA substrates, so as to improve their ability to support the growth and attachment of endothelial cells.

Adsorption/desorption phenomena on pure and Teflon AF-coated titania surfaces studied by dynamic contact angle analysis

As a result of inflammatory processes, plaque formation on dental titanium implants often leads to clinically pathogenic situations. This special biofilm formation on (bio)materials in contact with saliva is initiated by ionic and protein interactions. In this interfacial process, albumin becomes a main constituent of dental pellicle. Interfacial reactions change the surface characteristics. They determine the following steps of macromolecular adsorption and bacterial adhesion. This work focuses on the dynamic contact angle analysis (DCA), which is a tool for online measurements of dynamic changes of wettability without disturbing the interface during detection. Repeatability of the DCA method has been assessed according to the Bland and Altman method. The kinetics and equilibrium data of shifts in the wetting tension hysteresis indicate ionic influences at the titanium/bovine serum albumin (BSA) interface: the Ca-mediated increase of the BSA adsorption on titanium and the adsorption maximum at the isoelectric point (IEP) of BSA. Ti was surface modified by Teflon AF polymeric coatings. The result of the assessment gives reason to consider Teflon AF as a reference material for DCA repeatability studies. This surface modification caused drastic changes in the dynamic interfacial reactions. Shifts in the wetting tensions during DCA adsorption-desorption experiments clearly demonstrated the partially irreversible adsorption of BSA on Teflon AF. In contrast, reversible adsorption behavior was detected on pure Ti surfaces. These findings strengthen the hypothesis that the analysis of dynamic changes in wetting tension and wetting tension hysteresis is a sensitive analytical method for the detection of dynamic interfacial changes at biomaterial/biosystem interfaces during the initial steps of biofilm formation.

Modulating fibroblast cell proliferation with functionalized poly(methyl methacrylate) based copolymers: chemical composition and monomer distribution effect

Poly(methyl methacrylate)-based terpolymers bearing sulfonate and carboxylate groups have been synthesized by radical copolymerization leading to polymers with random distributions of ionic monomer units. Fibroblast cells were seeded on terpolymers of various molar compositions of ionic groups. Kinetics of the cell proliferation were examined and systematically compared to the nonfunctionalized control polymer, poly(methyl methacrylate). Modulation of cell proliferation was observed on 15% ionic monomer content copolymers of various compositions (R = COO(-)/(COO(-) + SO(3)(-)) and varies from 0 to 1). The inhibition percentage of cell proliferation calculated for each polymer by comparison to the cell proliferation on the control was plotted against R and gave a maximum value for R close to 0.55. Copolymers with ionic group contents higher or lower than 15% exhibit inhibition percentages fitting with those previously observed for the same R values, showing that the hydrophilic properties are not sufficient to explain the modulation effect of this material toward cells. Moreover, for each polymer tested, cells, even if inhibited in growth, were shown to be viable, indicating that the synthesized terpolymers exhibit cytostatic properties excluding any cytotoxic effect. Such polymers may be used for the fabrication of biocompatible intraocular lenses and prevent secondary cataract.

Evaluation of interfacial properties of hyaluronan coated poly(methylmethacrylate) intraocular lenses

Polymethylmethacrylate intraocular lenses (IOLs) were surface-modified by the linking of a overlayer of hyaluronan. In vitro experiments show that the hydrophilic HA overlayer prevents fibroblasts adhesion and greatly reduces Staphyloccous epidermidis adhesion to the IOL surface. To gain insights into the interfacial properties of untreated and hyaluronan-coated PMMA IOLs, force-distance curves were obtained by atomic force microscopy, using standard and modified tips. These measurements allow clear appreciation of the marked difference between the mechanical and chemico-physical properties at the aqueous interface of the uncoated and hyaluronan-coated lenses.