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Friedrich M, Son HS, Hassel O, Teich L, Augustin VA, Khoramnia R, Auffarth GU, Yildirim TM. Early intraocular lens explantations: 10-year database analysis. BMC Ophthalmol 2024; 24:300. [PMID: 39039537 PMCID: PMC11265132 DOI: 10.1186/s12886-024-03570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The aim of this study was to analyze the causes and characteristics of IOL explantation within the first year after primary implantation. METHODS In this retrospective, cross sectional database study, a database consisting of over 2500 IOL explants sent from 199 national and international doctors over the past 10 years was analyzed. All IOLs explanted within the first year after implantation were included in this analysis. Explants with insufficient information as well as phakic and Add-on IOLs were excluded. Main outcome measures were the reason for explantation, the time between implantation and explantation, as well as IOLs' and patients' characteristics. Additionally, the explanted IOLs were microscopically and histologically analyzed, as required. RESULTS Of all explanted IOLs from the database, 1.9% (n = 50) were explanted within the first year after implantation. The most frequent reasons for early IOL explantation were IOL dislocation (32%), visual intolerance (26%), opacification (20%), and intraoperative complications (16%). The time between implantation and explantation was the shortest in cases with intraoperative complications (1.5 ± 3.1 days), followed by IOL dislocation (90.9 ± 103.9 days), visual intolerance (98.3 ± 86.5 days), opacifications (253.5 ± 124.0 days) and other indications (249.7 ± 124.0 days). Calcification of hydrophilic IOLs was the main type of opacification (80%). Notably, seven IOLs required immediate intraoperative exchange due to an intraoperative crack in the optic or a torn off haptic. CONCLUSION Indications for early IOL explantation were IOL dislocation, visual intolerance, opacification, and intraoperative complications. Especially intraoperative damages to the IOL and early calcification show a potential for improvement of affected IOLs and implantation systems.
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Affiliation(s)
- Maximilian Friedrich
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hyeck-Soo Son
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Oliver Hassel
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Lilly Teich
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Victor Aristide Augustin
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur Mert Yildirim
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Mao Y, Liang X, Zhao J, Jiang L, Liang Q, Ngai T, Gong X, Wu M. 3D monitoring of the microphase separations inside the intraocular lens. Acta Biomater 2024; 177:178-188. [PMID: 38307480 DOI: 10.1016/j.actbio.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
Glistenings often occur after implanting the intraocular lens (IOL) due to the formation of numerous microvacuoles (MVs) and may lead to deterioration of vision quality. Previous studies showed the formation of MVs was associated with the hydrophobicity of IOL materials. Yet, the mechanism remains an open question due to the complexity of IOL polymer networks. In this study, two commercialized IOLs with similar hydrophobicity are found distinct in the formation of MVs. The 3D growth kinetics of MVs during cooling processes are captured for the first time by digital holographic microscopy (DHM) and the components of MVs are measured by DHM and Raman spectroscopy. The results reveal that the growth of MVs stems from the microphase separation of water and surrounding IOL polymers. A polymer swelling model is thus proposed to describe the microphase separation process which is found dependent on the elasticity of IOL polymer networks. The total volume of MVs is determined by the IOL hydrophobicity, while the elastic force of IOL polymer networks determines the number density and size of MVs. This study demonstrates an approach for characterizing the phase separation of crosslinked polymeric materials in biosystems and sheds lights on the refinement of IOL materials. STATEMENT OF SIGNIFICANCE: Glistenings due to the formation of numerous microvacuoles (MVs) in intraocular lens (IOL) can occur after IOL implantation, which may induce poor quality of vision. However, the underlying mechanism of MVs formation is still an open question. This study establishes an in-situ 3D imaging platform to monitor growth kinetics of the MVs in IOLs, which allows to uncover the mechanism of glistenings formation resulting from the microphase separation. The findings imply the material hydrophobicity influences the total volume of MVs, while the local elasticity of IOL polymer networks determines the number density and the size of MVs. This study offers a new approach for characterizing phase separation in crosslinking biosystems and sheds lights on the refinement of IOL materials.
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Affiliation(s)
- Yan Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, PR China
| | - Xiao Liang
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China
| | - Junpeng Zhao
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China
| | - Lingxiang Jiang
- South China Advanced Institute for Soft Matter Science and Technology (AISMST), School of Emergent Soft Matter, South China University of Technology, Guangzhou 510640, PR China
| | - Qingyou Liang
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China; Analytical and Testing Center, South China University of Technology, Guangzhou 510640, PR China
| | - To Ngai
- Department of Chemistry, The Chinese University of Hong Kong, Hong Kong 999077, PR China
| | - Xiangjun Gong
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China; Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, South China University of Technology, Guangzhou 510640, PR China.
| | - Mingxing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, PR China.
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Fernández-Vigo JI, Macarro-Merino A, De Moura-Ramos JJ, Alvarez-Rodriguez L, Burgos-Blasco B, Novo-Bujan J, Ortega-Hortas M, Fernández-Vigo JÁ. Comparative study of the glistening between four intraocular lens models assessed by OCT and deep learning. J Cataract Refract Surg 2024; 50:37-42. [PMID: 37702457 DOI: 10.1097/j.jcrs.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To evaluate the glistening in 4 different models of intraocular lenses (IOLs) using optical coherence tomography (OCT) and deep learning (DL). SETTING Centro Internacional de Oftalmología Avanzada (Madrid, Spain). DESIGN Cross-sectional study. METHODS 325 eyes were assessed for the presence and severity of glistening in 4 IOL models: ReSTOR+3 SN6AD1 (n = 41), SN60WF (n = 110), PanOptix TFNT (n = 128) and Vivity DFT015 (n = 46). The presence of glistening was analyzed using OCT, identifying the presence of hyperreflective foci (HRF) in the central area of the IOL. A manual and an original DL-based quantification algorithm designed for this purpose was applied. RESULTS Glistening was detected in 22 (53.7%) ReSTOR SN6AD1, 44 (40%) SN60WF, 49 (38.3%) PanOptix TFNT, and 4 (8.7%) Vivity DFT015 IOLs, when any grade was considered. In the comparison of the different types of IOLs, global glistening measured as total HRF was 17.3 ± 25.9 for the ReSTOR+3; 9.3 ± 15.7 for the SN60WF; 6.9 ± 10.5 for the PanOptix; and 1.2 ± 2.6 for the Vivity ( P < .05). There was excellent agreement between manual and DL-based quantification (≥0.829). CONCLUSIONS It is possible to quantify, classify and compare the glistening severity in different IOL models using OCT images in a simple and objective manner with a DL algorithm. In the comparative study, the Vivity presented the lowest severity of glistening.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- From the Centro Internacional de Oftalmología Avanzada, Madrid, Spain (J.I. Fernández-Vigo, Macarro-Merino, J.Á. Fernández-Vigo); Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain (J.I. Fernández-Vigo, Burgos-Blasco); Department of Computational, Centro de Investigacion CITIC, Universidade da Coruña, A Coruña, Spain (De Moura-Ramos, Alvarez-Rodriguez, Novo-Bujan, Ortega-Hortas); Department of Computational, VARPA Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain (De Moura-Ramos, Alvarez-Rodriguez, Novo-Bujan, Ortega-Hortas); Department of Ophthalmology, Universidad de Extremadura, Badajoz, Spain (J.Á. Fernández-Vigo)
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Itoh K. Stainability of Acrylic Intraocular Lens With Brilliant Blue G: An In Vitro Study. Am J Ophthalmol 2023; 254:104-113. [PMID: 37406844 DOI: 10.1016/j.ajo.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To evaluate the stainability of several acrylic intraocular lens (IOLs) with Brilliant Blue G (BBG) in vitro. DESIGN Clinically relevant, laboratory, experimental study. METHODS LS313MF15 as a hydrophilic acrylic IOL and X-70, W60R, CP2.2R, YP2.2R, XC1, and XY1 as hydrophobic acrylic IOLs were included in this study. Prepared acrylic IOLs were evaluated for staining via immersion for different periods in BBG solution with adjusted concentrations. In cases where IOLs were stained blue, the sustained release of BBG and IOL cross-sectional images were evaluated, as well as changes in the optical properties of the IOLs via spectrophotometry. RESULTS All acrylic IOLs were stained with BBG in a BBG concentration- and staining time-dependent manner, with almost no sustained release of BBG observed. Lenses with a higher water content exhibited more pronounced staining, and BBG penetrated into the IOLs. A decrease in light transmittance with a peak wavelength of 610 to 620 nm was observed in blue-stained IOLs. LS313MF15 was markedly blue stained even with a short period of staining. CONCLUSIONS Any acrylic IOL can be stained with BBG, but hydrophilic IOLs are particularly susceptible to blue staining. Precautions should be taken in surgeries requiring the use of BBG staining, and efforts should be made to ensure that BBG components are sufficiently washed out intraoperatively.
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Affiliation(s)
- Kaku Itoh
- From the Departments of Ophthalmology, Muroran City General Hospital, Muroran City, Hokkaido, Japan (K.I.).
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Fernández-Vigo JI, Serrano González-Peramato MT, Nunila Gómez-de-Liaño C, Sánchez-Guillén I, Fernández-Vigo JÁ, Macarro-Merino A. Glistening on intraocular lenses: A review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:493-506. [PMID: 37369324 DOI: 10.1016/j.oftale.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
The glistening in intraocular lenses (IOLs) is a phenomenon in which tiny water-filled microvacuoles (MVs) form within the IOL material, causing light to scatter and create a sparkling or shimmering effect. The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence, risk factors, evolution, and possible clinical relevance. Classically, it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp, but these were techniques that required either specific technology or an expert explorer, complex image processing, and required a lot of time. In recent years, proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs. It has been described that the manufacturing process, the hydrophobic acrylic material, or the time since surgery are risk factors for the appearance of glistening. In addition, many issues related to this phenomenon are still unknown, such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs.
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Affiliation(s)
- J I Fernández-Vigo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | | | - C Nunila Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - I Sánchez-Guillén
- Servicio de Oftalmología, Hospital Perpetuo Socorro, Badajoz, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain
| | - J Á Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain; Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - A Macarro-Merino
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain
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Vacalebre M, Frison R, Corsaro C, Neri F, Santoro A, Conoci S, Anastasi E, Curatolo MC, Fazio E. Current State of the Art and Next Generation of Materials for a Customized IntraOcular Lens according to a Patient-Specific Eye Power. Polymers (Basel) 2023; 15:polym15061590. [PMID: 36987370 PMCID: PMC10054364 DOI: 10.3390/polym15061590] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
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.
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Affiliation(s)
- Martina Vacalebre
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Renato Frison
- Optical Consultant SIFI SpA, 95025 Aci Sant'Antonio (CT), Italy
| | - Carmelo Corsaro
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Fortunato Neri
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Antonio Santoro
- Dipartimento di Scienze Chimiche, Biologiche, Farmacologiche ed Ambientali (CHIBIOFARAM), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Sabrina Conoci
- Dipartimento di Scienze Chimiche, Biologiche, Farmacologiche ed Ambientali (CHIBIOFARAM), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Elena Anastasi
- Innovation and Medical Science, SIFI SpA, 95025 Aci Sant'Antonio (CT), Italy
| | | | - Enza Fazio
- Dipartimento di Scienze Matematiche ed Informatiche, Scienze Fisiche e Scienze della Terra (MIFT), Università di Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
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Objective Classification of Glistening in Implanted Intraocular Lenses Using Optical Coherence Tomography: Proposal for a New Classification and Grading System. J Clin Med 2023; 12:jcm12062351. [PMID: 36983351 PMCID: PMC10057385 DOI: 10.3390/jcm12062351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Purpose: To propose a classification of the glistening in intraocular lenses (IOL) using swept-source optical coherence tomography (SS-OCT) by means of a simple, objective and reproducible method that allows the quantification of the presence and severity of glistening. Methods: A cross-sectional study on a sample of 150 eyes of 150 patients who underwent cataract surgery in at least 600 days before the exam and attended a routine examination. Each subject was examined by SS-OCT after pupil dilation, identifying the presence of glistening or hyperreflective foci (HRF) in the central area of the IOL. The degree of glistening was classified into four categories: 0: ≤5 HRF; 1: 6 to 15 HRF; 2: 16 to 30 HRF; and 3: >30 HRF. The intra and interobserver reproducibility (intraclass correlation coefficient, ICC) in the quantification and classification of the glistening were calculated. The correlation between the horizontal and vertical scan of the IOL was also assessed. Results: Glistening was present in the IOL in 42.7% of the patients. The mean number of HRF or glistening microvacuoles was 10.4 ± 26.2 (range 0 to 239). In total, 63.3% of the IOLs had a grade 0, 20% grade a 1, 6.7% grade a 2 and 10% a grade 3. The intraobserver and interobserver reproducibility were very high, both for the absolute quantification of the glistening (ICC ≥ 0.994) and for the severity scale (ICC ≥ 0.967). There was an excellent correlation in the quantification of the IOL glistening between the horizontal and vertical scans (R ≥ 0.834; p < 0.001). Conclusions: The use of SS-OCT makes it possible to identify, quantify and classify IOL glistening in a simple, objective and reproducible way. This technique could provide relevant information for the study of the glistening on IOLs.
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Randomized multicenter trial to assess posterior capsule opacification and glistenings in two hydrophobic acrylic intraocular lenses. Sci Rep 2023; 13:2822. [PMID: 36805494 PMCID: PMC9938215 DOI: 10.1038/s41598-023-29855-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof (p = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups (p < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof (p < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.
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9
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Specifying Risk of Intraocular Lens Opacification After Endothelial Keratoplasty for Different Intraocular Lens Models: A Retrospective Monocentric Cohort Study. Cornea 2022:00003226-990000000-00119. [PMID: 36633939 DOI: 10.1097/ico.0000000000003087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE The aims of this study were to calculate the specific risk of opacification for different intraocular lens (IOL) models and to determine whether differences exist, even between lenses made of similar acrylic materials. METHODS This is a retrospective cohort study of all patients who underwent endothelial keratoplasty (EK), either after or in conjunction with cataract surgery, from June 2009 to October 2020 at Fundación Jiménez Díaz Hospital. RESULTS Three hundred seventy-two eyes of 308 patients with a median follow-up of 856 days [interquartile range (IQR): 384-1570] were included, of which 128 IOLs were hydrophobic, 120 hydrophilic, and 124 unknown. 12.9% of IOLs opacified after a median of 466 days (IQR: 255-743). Visual acuity (VA) was significantly lower in the opacified IOL group [0.51 (IQR: 0.36-1.13)] compared with the nonopacified group [0.22 (IQR: 0.11-0.65)] ( P < 0.001). IOL explantation and exchange was performed in 10 eyes, in which VA improved markedly, from 1.75 (IQR: 0.99-3.00) to 0.60 (IQR: 0.36-0.86) ( P = 0.004). IOL material and opacification events were not independent ( P < 0.001). Significant differences were found between the Akreos ADAPT AO and MI60P models and the Asphina 409M model ( P = 0.022). No significant differences were found in the opacification ratio for hydrophilic IOLs in the clinical diagnosis ( P = 0.11), the type of EK ( P = 0.25), the rebubbling rate ( P = 0.44), or the tamponade used ( P = 0.36). CONCLUSIONS Hydrophilic lenses should be avoided in patients at risk of requiring EK. It is important to know the probability of opacification of each IOL model to balance risk and benefits when planning an EK procedure because not all lenses opacify equally. Opacification is an unwanted event with a negative impact on VA, making IOL explantation and exchange the only viable treatment, although one that is not without risks.
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Lee YW, Choi CY, Moon K, Jeong YJ, An SI, Lee JM, Lee JH, Seong MC. Clinical outcomes of new multifocal intraocular lenses with hydroxyethyl methacrylate and comparative results of contrast sensitivity, objective scatter, and subjective photic phenomena. BMC Ophthalmol 2022; 22:379. [PMID: 36131264 PMCID: PMC9494844 DOI: 10.1186/s12886-022-02600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background We investigate the performance of new hydrophobic diffractive multifocal intraocular lenses (IOL) with hydroxyethyl methacrylate (HEMA) and compare their optical quality, contrast sensitivity, and subjective photic phenomena. Methods Medical records of patients who underwent routine simple cataract surgery and insertion of an existing multifocal IOL (TFNT, TF group) or a new multifocal IOL (CNWT, CN group) were retrospectively reviewed. Clinical data was collected 2 months postoperatively and included optical quality analysis system (OQAS) indices, contrast sensitivity, and subjective degrees of photic phenomena. Results One hundred thirty-five eyes of 135 patients were included (CN group, 71; TF group, 64). There was no significant difference between the two groups in the visual acuity and defocus curve. The indices of OQAS did not show a significant difference between groups. Contrast sensitivity was significantly better in the CN group at all degrees, including the area under the log contrast sensitivity function (p = 0.01). The subjective photic phenomena survey showed better results for the CN group, with the proportion of patients reporting no photic phenomena as 9.9% and 3.1% in the CN and TF groups, respectively. The proportion of patients who reported severe photic phenomena was 11.3% in the CN group and 25.0% in the TF group. Although the follow-up period was only 2 months, glistening, surface scattering, and posterior capsule opacity were not observed in any patient. Conclusions The new multifocal IOL with HEMA is safe, and provides stable visual acuity as well as superior contrast sensitivity and lower subjective photic phenomena, over the prior IOL.
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Affiliation(s)
- Yong Woo Lee
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.,Hanyang University School of Medicine, Seoul, Republic of Korea.,Seoulbalgeunsesang Eye Clinic, Seoul, Republic of Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kun Moon
- Seoulbalgeunsesang Eye Clinic, Seoul, Republic of Korea
| | | | - Sang Il An
- Seoulbalgeunsesang Eye Clinic, Seoul, Republic of Korea
| | - Je Myung Lee
- Seoulbalgeunsesang Eye Clinic, Seoul, Republic of Korea
| | - Jong Ho Lee
- Seoulbalgeunsesang Eye Clinic, Seoul, Republic of Korea
| | - Min Cheol Seong
- Hanyang University School of Medicine, Seoul, Republic of Korea. .,Department of Ophthalmology, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, 11923, Republic of Korea.
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11
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Tortolano L, Mrad O, Manerlax K, Khalfoun C, Yousfi R, Saunier J, Secretan P, Yagoubi N. Comparative stability of intraocular lenses during 2–20 years of artificial aging, potential effects in terms of biocompatibility. J Appl Polym Sci 2022. [DOI: 10.1002/app.52752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lionel Tortolano
- EA Matériaux et Santé Université Paris‐Saclay Châtenay‐Malabry France
- Department of Pharmacy Assistance Publique‐Hôpitaux de Paris, Groupe Hospitalier Henri Mondor Créteil France
| | - Omar Mrad
- EA Matériaux et Santé Université Paris‐Saclay Châtenay‐Malabry France
| | - Katia Manerlax
- EA Matériaux et Santé Université Paris‐Saclay Châtenay‐Malabry France
| | - Chaineze Khalfoun
- EA Matériaux et Santé Université Paris‐Saclay Châtenay‐Malabry France
| | - Rayane Yousfi
- EA Matériaux et Santé Université Paris‐Saclay Châtenay‐Malabry France
| | - Johanna Saunier
- EA Matériaux et Santé Université Paris‐Saclay Châtenay‐Malabry France
| | | | - Najet Yagoubi
- EA Matériaux et Santé Université Paris‐Saclay Châtenay‐Malabry France
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12
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Marmo AC, Rodriguez Cruz JJ, Pickett JH, Lott LR, Theibert DS, Chandler HL, Grunlan MA. Amphiphilic silicones to mitigate lens epithelial cell growth on intraocular lenses. J Mater Chem B 2022; 10:3064-3072. [PMID: 35332909 DOI: 10.1039/d2tb00213b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Silicone intraocular lenses (IOLs) that resist lens epithelial cell (LEC) growth would greatly improve patient outcomes. Herein, amphiphilic surface modifying additives (SMAs) were incorporated into an IOL-type diphenyl silicone to reduce LEC growth without compromising opto-mechanical properties. The SMAs were poly(ethylene oxide)-silane amphiphiles (PEO-SAs) [H-Si-ODMSm-block-PEO8-OCH3], comprised of a PEO segment and siloxane tether of varying lengths (m = 0, 13, and 30). These three SMAs were each blended into the addition cure diphenyl silicone at varying concentrations (5, 10, 15, 20, and 25 μmol g-1) wherein the wt% of PEO was maintained for all SMAs at a given molar concentration. The chemical crosslinking and subsequent retention of SMAs in modified silicones was confirmed. Key material properties were assessed following equilibration in both air and aqueous environments. Silicones modified with SMAs having longer tethers (m = 13 and 30) underwent rapid and substantial water-driven restructuring of PEO to the surface to form highly hydrophilic surfaces, especially as SMA concentration increased. The % transmittance was also maintained for silicones modified with these particular SMAs. The moduli of the modified silicones were largely unchanged by the SMA and remained in the typical range for silicone IOLs. When the three SMAs were introduced at the highest concentration, modified silicones remained non-cytotoxic and LEC count and associated alpha-smooth muscle actin (α-SMA) expression decreased with increasing tether length. These results demonstrate the potential of silicones modified with PEO-SA SMAs to produce LEC-resistant IOLs.
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Affiliation(s)
- Alec C Marmo
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - J Jesus Rodriguez Cruz
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Jackson H Pickett
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Lucas R Lott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Dustin S Theibert
- College of Optometry, The Ohio State University, Columbus, OH 43210, USA
| | - Heather L Chandler
- College of Optometry, The Ohio State University, Columbus, OH 43210, USA
| | - Melissa A Grunlan
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843, USA. .,Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA.,Department of Chemistry, Texas A&M University, College Station, TX 77843, USA
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13
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Xie J, Sun J, Liu T, Mao S, Dai Y. Comparison Between L-312 Hydrophobic-Hydrophilic Acrylate and US-860 UV Hydrophilic Acrylate IOL Opacification Characteristic. Front Med (Lausanne) 2022; 9:873684. [PMID: 35463016 PMCID: PMC9024102 DOI: 10.3389/fmed.2022.873684] [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: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To compare opacity characteristics of US-860 UV and L-312 IOL, and report the phenomenon of glistenings in hydrophobic-hydrophilic acrylic IOLs. Setting Qingdao Eye Hospital. Design Experimental study. Methods Four medical records (4 eyes) of patients with L-312 or US-860 UV IOL opacification reporting decreased or lost vision who underwent IOL explanation between 2019 and 2021 were reviewed. Explanted IOLs were analyzed by slit-lamp examination, confocal microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) at Qingdao Eye Hospital and Qingdao university of science and technology. Results The 4 explanted IOLs were represented by 2 hydrophilic acrylic designs. The preoperative mean corrected distance visual acuity changed from 1.84 ± 1.09 logarithm of the minimum angle of resolution (log MAR) to 0.20 ± 0.03 log MAR postoperatively except case 3. The mean interval of the L-312 IOL was 56.67 ± 14.19 months (range 44 to 72 months), and the interval of the US-860 UV IOL was 27 months. Morphological findings were surface, subsurface calcifications of the US-860 UV IOL material, and the optical region of L-312 IOLs are teeming with a great number of vacuoles by light microscope, scanning electron microscope and Energy Dispersive X-ray Spectral. Conclusion The cause of US-860 UV opacification was primary calcification, and vacuoles resulted in L-312 IOL opacification.
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Affiliation(s)
- Jin Xie
- Department of Ophthalmology, Graduate College of Shandong First Medical University, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Jie Sun
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- People's Hospital of Yinan, Linyi, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Shilan Mao
- Department of Ophthalmology, Graduate College of Shandong First Medical University, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Yunhai Dai
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- *Correspondence: Yunhai Dai
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Oshika T, Sasaki N. One-year multicenter evaluation of a new hydrophobic acrylic intraocular lens with hydroxyethyl methacrylate in an automated preloaded delivery system. J Cataract Refract Surg 2022; 48:275-279. [PMID: 34261986 PMCID: PMC8865199 DOI: 10.1097/j.jcrs.0000000000000746] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess a single-piece monofocal hydrophobic acrylic intraocular lens (IOL) with hydroxyethyl methacrylate (HEMA) (Clareon) contained in automated preloaded delivery system (AutonoMe). SETTING 18 surgical sites in Japan. DESIGN Observational study. METHODS In patients undergoing phacoemulsification and IOL implantation of a new hydrophobic acrylic IOL using an automated injector, clinical data were collected preoperatively and at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively. The degree of glistenings was graded on a 4-point scale. The surgeons rated usability and performance of the IOL delivery system on a 5-point scale. RESULTS The study enrolled 384 eyes of 384 patients, ranging in age from 41 to 93 (73.8 ± 8.2, mean ± SD) years. The percentage of eyes with corrected distance visual acuity of 20/25 or better at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively was 82.6%, 91.9%, 92.8%, 96.6%, and 95.2%, respectively. Refractive error was within 1.0 diopter in approximately 90% of cases. No glistenings were found in all cases throughout the study period. The rate of Nd:YAG laser posterior capsulotomy was 0.9% at 1 year. The IOL delivery system received high ratings on its usability and performance by the surgeons. CONCLUSIONS The new hydrophobic acrylic IOL with HEMA showed excellent visual and refractive outcomes without developing glistenings throughout the 1-year study period. The surgeons gave high marks for usability and performance of the automated preloaded delivery system.
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15
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Mao Y, Liu H, Long Gu F, Wu MX, Wang Y. The molecular design of performance-enhanced intraocular lens composites. Biomater Sci 2022; 10:1515-1522. [PMID: 35171153 DOI: 10.1039/d1bm01919h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Intraocular lens (IOL) implantation surgery is quite effective in the treatment of blindness caused by cataracts. However, in clinical applications, IOLs readily form glistening. This phenomenon usually occurs for a period after IOL implantation ranging from a few months to several years. The molecular mechanism of the formation of glistening in IOLs is still inconclusive. Failure to understand and explain the molecular mechanism of glistening formation greatly hinders the design and application of new glistening-free IOL materials. Here, in this study, we use molecular dynamics simulation methods to conduct in-depth research on the molecular mechanism of the glistening formation of IOLs, aiming to provide a possible molecular mechanism of glistening. Furthermore, based on this molecular mechanism, we propose a novel strategy of a glistening-free material based on a composite design method to reasonably copolymerize several types of molecules or functional groups, so that the glistening phenomenon can be effectively eliminated. The possible molecular mechanism of glistening formation proposed in this research can offer a solid theoretical basis and guidance for the subsequent construction of glistening-free IOL materials.
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Affiliation(s)
- Yan Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China.
| | - Hong Liu
- Key Laboratory of Theoretical Chemistry of Environment Ministry of Education, School of Chemistry, South China Normal University, Guangzhou, Guangdong 510006, People's Republic of China.
| | - Feng Long Gu
- Key Laboratory of Theoretical Chemistry of Environment Ministry of Education, School of Chemistry, South China Normal University, Guangzhou, Guangdong 510006, People's Republic of China.
| | - Ming-Xing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China.
| | - Yan Wang
- Key Laboratory of Theoretical Chemistry of Environment Ministry of Education, School of Chemistry, South China Normal University, Guangzhou, Guangdong 510006, People's Republic of China.
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16
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Jain M, Kekunnaya R. Spoke-Wheel-Shaped Deposits Over Intraocular Lens. JAMA Ophthalmol 2022; 140:e214687. [PMID: 35050377 DOI: 10.1001/jamaophthalmol.2021.4687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mayank Jain
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
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17
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Ullrich M, Ruiss M, Hienert J, Pilwachs C, Fisus AD, Georgiev S, Hirnschall N, Findl O. Anterior chamber depth variability between 2 hydrophobic acrylic 1-piece intraocular lenses: randomized trial. J Cataract Refract Surg 2021; 47:1460-1465. [PMID: 33929807 DOI: 10.1097/j.jcrs.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the difference in anterior chamber depth (ACD) after uneventful cataract surgery between 2 hydrophobic acrylic 1-piece intraocular lenses (IOLs) with different material properties. SETTING Hanusch Hospital, Vienna, Austria. DESIGN Single-center, bilateral randomized paired-eye controlled study. METHODS Patients scheduled for bilateral cataract surgery were randomized to receive the Clareon IOL in 1 eye and the AcrySof IQ IOL (both Alcon Laboratories, Inc.) in the contralateral eye. Preoperatively, a slitlamp examination, optical biometry (IOLMaster 700, Carl Zeiss Meditec AG), refraction, and visual acuity measurements were performed. ACD was assessed 1 hour and 1 week postoperatively and with additional measurement of uncorrected (UDVA) and corrected distance visual acuity (CDVA) 6 months postoperatively. RESULTS 80 eyes of 40 patients were analyzed in this study. ACD at the 6-month follow-up was 3.94 ± 0.30 mm for the Clareon IOL and 3.91 ± 0.32 mm for the AcrySof IQ IOL (P = .08). Statistically significant differences in the ACD shift between both IOLs were detected between 1 week and 6 months (P = .04) and 1 hour and 6 months (P = .04). There were no statistically significant differences between both IOLs in UDVA (P = .78), CDVA (P = .59), and spherical equivalent (SE, P = .39) at the 6-month visit. The mean absolute error between the measured and the aimed SE was not significant (P = .97). CONCLUSIONS There was no clinically relevant difference in ACD between the Clareon IOL and the AcrySof IQ IOL in patients after uneventful cataract surgery. Both IOLs yielded good refraction and visual acuity outcomes.
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Affiliation(s)
- Marlies Ullrich
- From the VIROS-Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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Tandogan T, Auffarth GU, Choi CY, Son HS, Khoramnia R. Comparative analysis of in vitro accelerated glistening formation in foldable hydrophobic intraocular lenses. Int Ophthalmol 2021; 41:3073-3080. [PMID: 34013467 PMCID: PMC8364527 DOI: 10.1007/s10792-021-01870-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/15/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE To analyse and compare the propensity to form glistenings in 4 different types of hydrophobic acrylic intraocular lenses (IOLs): Alcon AcrySof ® MA60AC, HOYA iSert® PC-60AD, Bausch&Lomb enVista, and Kowa Avansee™ PU6A. METHODS We used an accelerated laboratory method to create glistenings. IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h. Microvacuole (MV) density and size were documented and calculated using an image analysis program. RESULTS Median density of glistenings [MV/mm2] for Alcon AcrySof ® MA60AC was 623 (range 507-804), for HOYA iSert® PC-60AD 1358 (range 684-2699), for Bausch&Lomb enVista 2 (range 1-2), and for Kowa Avansee™ PU6A 1 (range 1-4). The prevailing MV size was: 0-5 µm for Hoya IOLs, 5-10 µm for Alcon IOLs, 20-50 µm for Bausch&Lomb IOLs, and 5-50 µm for Kowa IOLs. CONCLUSIONS Glistenings could be induced in all studied IOLs using the accelerated laboratory method. The Alcon AcrySof ® MA60AC and HOYA iSert® PC-60AD IOLs showed MV of high density, while the glistenings in the Hoya IOLs were smaller in size compared to the Alcon IOLs. The MV density was minimal in the Bausch&Lomb enVista and Kowa Avansee™ PU6A IOLs. The propensity of the Alcon AcrySof ® MA60AC IOLs to form glistenings in vitro correlated with the findings of clinical results that are already published.
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Affiliation(s)
- Tamer Tandogan
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Gerd U. Auffarth
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
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Kanclerz P, Yildirim TM, Khoramnia R. Microscopic Characteristics of Late Intraocular Lens Opacifications. Arch Pathol Lab Med 2021; 145:759-767. [PMID: 33091924 DOI: 10.5858/arpa.2019-0626-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The increases in overall life expectancy and in lens surgeries performed on younger patients have resulted in a significant increase in the anticipated duration of artificial intraocular lenses (IOLs) in the eye. Thus, the physicochemical properties of the IOL become a critical issue, and several types of postoperative IOL opacifications have been reported. OBJECTIVE.— To describe the microscopic characteristics of opacified IOLs. Glistenings and subsurface nanoglistenings are fluid-related phenomena developing mainly in hydrophobic acrylic IOLs and are associated with aqueous influx into the IOL matrix. Calcification presents in hydrophilic acrylic or silicone IOLs as deposits of hydroxyapatite or other phases of calcium. Snowflake degeneration is less common, and it manifests in older polymethyl methacrylate IOLs. DATA SOURCES.— PubMed and ScienceDirect databases were searched for the following keywords: intraocular lens, IOL, cataract surgery, phacoemulsification, opacification, glistening, subsurface nanoglistenings, calcification, snowflake degeneration. English-language articles published up to October 15, 2019 were included in the study. The manuscript contains mainly a literature review; however, it was supplemented with original investigations from the David J. Apple International Laboratory for Ocular Pathology. CONCLUSIONS.— Glistenings and subsurface nanoglistenings should be evaluated in a hydrated state and at room temperature; they manifest as microvacuoles sized from 1.0 to greater than 25.0 μm and less than 200 nm, respectively. Calcification deposits are situated on or underneath the surface of the IOL and can be stained with a 1% alizarin red solution or with the von Kossa method. Snowflake degeneration manifests as "particles" or "crystals," causing whitish IOL discoloration. Scanning electron microscopy or energy dispersive X-ray spectroscopy may improve the diagnostic accuracy.
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Affiliation(s)
- Piotr Kanclerz
- From the Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland (Kanclerz)
| | - Timur Mert Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany (Yildirim, Khoramnia)
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany (Yildirim, Khoramnia)
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20
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Surface light scattering from 1-piece hydrophobic acrylic intraocular lenses with hydroxyethyl methacrylate: contralateral observation for 7 years. J Cataract Refract Surg 2021; 47:702-705. [PMID: 33769764 DOI: 10.1097/j.jcrs.0000000000000621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantitatively and intraindividually compare surface light scattering for 7 years after implantation of Clareon and AcrySof intraocular lenses (IOLs). SETTING Miyata Eye Hospital, Miyazaki, Japan. DESIGN Retrospective comparative case series. METHODS Clinical records of eyes that had contralateral implantation of SN60WF and SY60WF IOLs were reviewed. Light scattering on the anterior surface of IOLs, corrected distance visual acuity (CDVA), and mesopic and photopic contrast sensitivities were examined at 1 year, 3 years, and 7 years postoperatively, and they were intraindividually compared. RESULTS 34, 19, and 16 patients visited at 1 year, 3 years, and 7 years postoperatively, respectively. Surface light scattering in eyes with SY60WF IOL was significantly reduced, and the rate of increase was 2.74 computer compatible tapes per year. Although there were prominent increases in eyes with SN60WF IOL, no statistically significant difference was found in their CDVA and contrast sensitivities. CONCLUSIONS In eyes with Clareon IOLs, the development of surface light scattering was suppressed up to 7 years. The increase rate demonstrated that the visual acuity would be least deteriorated up to 12 years postoperatively, whereas the influence of straylight induced should be investigated.
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21
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In vitro glistening formation in IOLs: automated method for assessing the volumetric density and depth distribution of microvacuoles. J Cataract Refract Surg 2021; 46:1178-1183. [PMID: 32511108 DOI: 10.1097/j.jcrs.0000000000000272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a method to measure the depth profile of microvacuoles (MVs) in intraocular lenses (IOLs) and to characterize, after accelerated aging, the glistening of an acrylic hydrophobic IOL. SETTING University of Milano-Bicocca, Milan, Italy. DESIGN In vitro study. METHODS A heat treatment was applied in vitro to Basis V IOLs exposed to deionized water (24 hours at 45 ± 1°C, rapid cooling, and 24 hours at 24 ± 1°C). Thirty images (area 1.2 mm) of each IOL were acquired by a microscope, focusing on sequential planes every 23 ± 2 μm. By tracking the traces of each MV in consecutive images, the coordinates of the MV centroids along the IOL thickness were construed by an automated procedure, and in the generated single-focus stacked image, MVs were counted by an automated method. RESULTS MV density was found normally distributed along the IOL depth profile (Jarque-Bera test). In focus-stacked images, the MV automated counting was found accurate within 5% vs manual counting, and MV volume density of the order of 10 mm was estimated. It was observed that stacks of 15 images provided a 4% lower MV volume density compared with the stacking of 30 images. CONCLUSIONS The assessment of the number of MVs by the acquisition of a single image of an IOL was influenced by the distance of the selected plane from the IOL surface. The decrease in MV density approaching the IOL edges can be explained as a consequence of the diffusion of water toward the external environment after accelerated aging.
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22
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Xiang Y, Jin R, Zhang Y, Li K, Liu G, Song X, Wang Y, Nie Y. Foldable Glistening-Free Acrylic Intraocular Lens Biomaterials with Dual-Side Heterogeneous Surface Modification for Postoperative Endophthalmitis and Posterior Capsule Opacification Prophylaxis. Biomacromolecules 2021; 22:3510-3521. [PMID: 34288655 DOI: 10.1021/acs.biomac.1c00582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Yang Xiang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China
| | - Rongrong Jin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China
| | - Ying Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Kaijun Li
- The Key Laboratory of Leather Chemistry and Engineering of Ministry of Education, College of Biomass Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Gongyan Liu
- The Key Laboratory of Leather Chemistry and Engineering of Ministry of Education, College of Biomass Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Xu Song
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.,NMPA Key Laboratory for Quality Research and Control of Tissue Regenerative Biomaterial & Institute of Regulatory Science for Medical Devices & NMPA Research Base of Regulatory Science for Medical Devices, Sichuan University, Chengdu 610065, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China
| | - Yu Nie
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China
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Yildirim TM, Schickhardt SK, Wang Q, Friedmann E, Khoramnia R, Auffarth GU. Quantitative evaluation of microvacuole formation in five intraocular lens models made of different hydrophobic materials. PLoS One 2021; 16:e0250860. [PMID: 33930084 PMCID: PMC8087009 DOI: 10.1371/journal.pone.0250860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
In this laboratory study, we assessed the resistance to microvacuole (glistening) formation in hydrophobic intraocular lenses (IOLs). Glistenings were induced in five lenses each of five different hydrophobic acrylic IOL models, using an established in vitro laboratory model: 800C (Rayner, Worthing, UK), AcrySof SN60WF (Alcon, Fort Worth, USA), Tecnis ZCB00 (Johnson & Johnson Vision, Santa Ana, USA), Vivinex XY1 (Hoya, Tokyo, Japan) and CT Lucia 611P (Zeiss, Oberkochen, Germany). We evaluated the number of microvacuoles per square millimeter (MV/mm2) in the central part of each IOL. Results were analyzed statistically, and mean glistening numbers were ranked, with the highest in the SN60WF which had 66.0 (±45.5) MVs/mm, followed by the 611P with 30.7 (±8.4) MVs/mm2. The 800C and XY1 showed comparable values of 2.0 (±3.6) and 2.7 (±2.4) MVs/mm2, respectively. ZCB00 had the lowest number with 0.9 (±0.6) MVs/mm2. This study shows that the resistance to glistening formation differs depending on the hydrophobic acrylic copolymer composition of the IOL material. Some IOLs from current clinical use are still prone to develop glistenings whereas others, including the ZCB00, 800C and XY1 show high resistance to microvacuole formation.
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Affiliation(s)
- Timur M. Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Sonja K. Schickhardt
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Qiang Wang
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
- Department of Ophthalmology, The Third Affiliated Hospital of Wenzhou Medical University, Rui’an, Zhejiang, China
| | - Elfriede Friedmann
- Faculty of Mathematics and Natural Sciences, University of Kassel, Kassel, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Gerd U. Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Abstract
The spectrum of complications in the use of intraocular lenses (IOL) is different today from at the time of their introduction. Opacities in the IOL material are increasingly described in the literature as a reason for IOL explantation. This paper provides an overview of the different forms of IOL material opacities. Currently relevant forms of IOL material opacities and their effects on optical quality are summarized. The main reason for opacification in hydrophilic IOLs is calcification, whereas in hydrophobic IOLs it is mainly the formation of so-called glistenings that is reported. Most material opacities affect various optical parameters and lead to increased intraocular straylight. In case of a disturbing material opacification, the only therapeutic option is to replace the opacified IOL.
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25
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Khoramnia R. Eintrübung von Intraokularlinsen. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1250-3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas Spektrum an Komplikationen und die Explantationsgründe bei der Verwendung von
Intraokularlinsen (IOL) haben sich durch die Weiterentwicklung der
Kataraktchirurgie verändert. Eintrübungen des Materials beeinflussen dabei
unterschiedlich stark die optische Qualität. Im Fall einer störenden Eintrübung
des Materials ist auch heute noch – trotz aller Fortschritte auf dem Gebiet der
IOL-Materialien – ein Austausch der IOL die einzige Behandlungsoption.
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Tandogan T, Auffarth GU, Son HS, Merz P, Choi CY, Khoramnia R. In-vitro glistening formation in six different foldable hydrophobic intraocular lenses. BMC Ophthalmol 2021; 21:126. [PMID: 33685428 PMCID: PMC7938589 DOI: 10.1186/s12886-021-01879-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Glistenings describe small, refractile microvacuoles that may arise within the intraocular lens (IOL) material and reduce the patients’ quality of vision. Lenses composed of hydrophobic acrylic material are particularly affected by glistening formation. In this study, we compared the tendency of glistening formation in six different types of hydrophobic acrylic intraocular lenses (IOLs). Methods We used a well-established accelerated laboratory method to develop glistenings in the following IOLs: Vivinex XY1 (Hoya), AcrySof SN60WF (Alcon), Tecnis ZCB00 (AMO), Avansee PN6A (Kowa), Aktis SP NS-60YG (Nidek), and CT Lucia 601P (Zeiss). IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h in a water bath. Microvacuole (MV) density and size (Miyata grading) were documented and calculated using an image analysis program. Results The mean glistening density [MV/mm2] and mean Miyata grading (in brackets) were: Vivinex: 11.6 ± 5.7 (0), SN60WF: 264.4 ± 110.3 (2.6), Tecnis: 6.0 ± 2.8 (0), Avansee: 2.2 ± 0.7 (0), Aktis: 851.4 ± 59.4 (3+) and CT Lucia: 71.0 ± 71.6 (1). Conclusions While all tested IOLs showed glistenings with the accelerated laboratory method, the Aktis and SN60WF showed the highest microvacuole density, followed by the CT Lucia. In comparison, the Vivinex, Tecnis, and Avansee IOLs showed far fewer number of glistenings.
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Affiliation(s)
- Tamer Tandogan
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
| | - Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Patrick Merz
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
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27
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Wang Q, Yildirim TM, Schickhardt SK, Łabuz G, Khoramnia R, Merz PR, Son HS, Munro DJ, Friedmann E, Auffarth GU. Quantification of the In Vitro Predisposition to Glistening Formation in One Manufacturer's Acrylic Intraocular Lenses Made in Different Decades. Ophthalmol Ther 2021; 10:165-174. [PMID: 33544374 PMCID: PMC7886932 DOI: 10.1007/s40123-020-00329-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Foldable hydrophobic acrylic intraocular lenses (IOLs) are prone to develop a long-term postoperative material change called glistenings. The aim of this study was to investigate the changes in the predisposition for glistening formation in one type of hydrophobic acrylic IOL material from its introduction to the present day. Methods In a laboratory setup, an in vitro model was used to induce glistenings in hydrophobic acrylic IOLs manufactured by one company (Alcon, Fort Worth, TX, USA) in different years: 23 1990s-manufacture hydrophobic acrylic three-piece IOLs (MA30BA/MA60AC) that were explanted in 1996 and 1997, and five of each of the newer AcrySof IOL models (MA60AC, SA60AT, TFNT00 and SN60WF) from 2014 to 2017. Furthermore, five Clareon (SY60WF) IOLs were put through the same accelerated aging procedure. The number of microvacuoles per square millimeter (MV/mm2) was determined in the central part of each IOL optic and compared between the groups. Results The mean number of MV was highest in the 1990s-manufacture Alcon acrylic IOLs, with 1289 (± 738) MV/mm2. The number decreased to 650 (± 101), 192 (± 105), 175 (± 112) and 47 (± 26) for MA60AC, SA60AT, TFNT00 and SN60WF, respectively. The lowest count was obtained in the Clareon group, with 1 (± 1) MV/mm2.
Conclusions A high number of glistenings was induced in the explanted IOLs from the 1990s. The propensity for glistening formation decreased considerably after that decade and now in current use. Even though in vitro glistening formation in today’s AcrySof material was low, the Clareon material was essentially glistenings-free.
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Affiliation(s)
- Qiang Wang
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.,Department of Ophthalmology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Timur M Yildirim
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Sonja K Schickhardt
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Grzegorz Łabuz
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Patrick R Merz
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Hyeck-Soo Son
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Donald J Munro
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Elfriede Friedmann
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.,Numerics and Mathematical Modeling, Institute of Mathematics, Faculty of Mathematics and Natural Sciences (FB10), University of Kassel, Kassel, Germany
| | - Gerd U Auffarth
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
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28
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Cases of intraocular lens opacification in pseudophakic eyes: analysis of the results of microstructural studies. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov41836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Relevance. Currently, all over the world, during cataract surgeries, a huge number of intraocular lenses (IOLs) made of different materials are implanted. Alongside with the development of modern IOL materials and designs, publications about their opacities appear. The nature and the localization of IOL opacities mainly depend on the properties of the material out of which the lens is made. Polymethyl methacrylate (PMMA) currently rarely used to manufacture IOLs, tends to cloud in the optical center due to structural breakdown, forming snowflake-like cracks. Opacities of acrylic IOLs depend on the degree of hydrophilic properties of the material. The deposition of crystalline deposits in the optical zone of hydrophilic acrylic lenses leads to a significant decrease in visual acuity and requires IOL explantation. There is a definite dependence of the occurrence of opacities in hydrophilic acryl on the patients concomitant diseases. In hydrophobic acrylic IOLs, vacuoles form, and glistenings occurs. Herewith, visual functions, as a rule, do not suffer.
Purpose: to find out what structural changes in the IOL led to the need to remove them from pseudophakic eyes due to a decrease in visual acuity.
Materials and methods. Four clouded IOLs made from different materials were examined. The lenses were studied using a SUPRA 55VP scanning electron microscope (Carl Zeiss, Germany) using a secondary electron detector. Element distribution maps on the surface and inside the lenses were collected using an X-max 80 mm2 energy dispersive X-ray analysis detector (Oxford Instruments, UK).
Results. A hydrophilic lens with hydrophobic coating became cloudy 5 years after implantation. Hydroxyapatite crystals were found on all parts of the IOL along its surface. In a hydrophobic acrylic IOL, microvacuoles and cavities in the optical center were found using scanning electron microscopy. Two PMMA IOLs underwent self-destruction within 8 years after implantation. Chemical analysis of PMMA lenses did not reveal any inorganic compounds.
Conclusion. One of the complications of IOL implantation is an impairment of their transparency. Factors associated with IOL material and manufacturing, as well as the patients comorbidities, can lead to lens opacification at various terms after surgery.
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29
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Abstract
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.
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Affiliation(s)
- Piotr Kanclerz
- Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland
| | - Timur M Yildirim
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Khoramnia R, Yildirim TM, Łabuz G, Mayer CS, Auffarth GU. [Opacification of intraocular lenses: laboratory and clinical findings]. Ophthalmologe 2020; 118:633-642. [PMID: 33188443 PMCID: PMC8260513 DOI: 10.1007/s00347-020-01259-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
Hintergrund Das Spektrum der Komplikationen beim Einsatz von Intraokularlinsen (IOL) ist heute ein anderes als zur Zeit ihrer Einführung. Trübungen im IOL-Material werden vermehrt als Explantationsgrund in der Literatur beschrieben. Ziel der Arbeit Diese Arbeit soll einen Überblick über die verschiedenen Formen von IOL-Materialeintrübungen geben. Material und Methoden Die heute relevanten Formen von IOL-Materialeintrübungen und deren Auswirkungen auf die optische Abbildungsqualität wurden zusammengestellt. Ergebnisse und Diskussion Als Grund für eine Eintrübung steht bei hydrophilen IOL die Kalzifikation im Vordergrund, während bei hydrophoben IOL v. a. über die Entstehung sog. „Glistenings“ berichtet wird. Die meisten Materialeintrübungen beeinflussen verschiedene optische Parameter und führen zu einem erhöhten intraokularen Streulicht. Im Falle einer störenden Materialeintrübung besteht die einzige Therapieoption in einem Austausch der eingetrübten IOL.
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Affiliation(s)
- Ramin Khoramnia
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Timur M Yildirim
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Grzegorz Łabuz
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Christian S Mayer
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Gerd U Auffarth
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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31
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Nakamura T, Isogai N, Kojima T, Yoshida Y, Sugiyama Y, Tanaka Y, Ichikawa K. Long-term In Vivo Stability of Posterior Chamber Phakic Intraocular Lens: Properties and Light Transmission Characteristics of Explants. Am J Ophthalmol 2020; 219:295-302. [PMID: 32622670 DOI: 10.1016/j.ajo.2020.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the in vivo durability of the surface and optical properties of the implantable Collamer lens (ICL). DESIGN Retrospective case series. METHODS We included patients who developed cataracts after having undergone ICL implantation from March 2003 to May 2014 and underwent ICL explantation followed by cataract surgery from March 2017 to December 2019 at the Nagoya Eye Clinic. ICL explants were submitted to Chukyo Medical Co, Ltd (Nagoya City, Japan) for laboratory analysis using ultraviolet-visible light spectroscopy, light microscopy (LM), and scanning electron microscopy. Patients' demographic and clinical data were collected and reviewed. RESULTS Thirteen eyes from 10 patients were studied. The average age at ICL explantation was 50.5 ± 8.5 years (range, 34.5-66.3 years). The average length of ICL stay in the eye (from implantation to explantation) was 10.5 ± 2.7 years (range, 4.4-13.7 years). No opacification or coloring of the ICL explants was observed by LM. The ICL explants showed almost the same light transmittance as that of unused ICLs. Scanning electron microscopy revealed no irregularities at the surface of the center and periphery of the optic and haptic footplate. The positioning holes did not show any deposition. CONCLUSION The ICLs remained in-eye for >10 years without any deterioration in the surface and optical properties of the ICL, despite their contact with the ciliary body and iris tissues and the continuous interaction with the aqueous humor components. The present study shows long-term in vivo stability of the ICL.
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32
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Grzybowski A, Markeviciute A, Zemaitiene R. A narrative review of intraocular lens opacifications: update 2020. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1547. [PMID: 33313292 PMCID: PMC7729367 DOI: 10.21037/atm-20-4207] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The opacifications of intraocular lenses (IOLs) can significantly impact patients visual quality. Despite the identification of specific risk factors, manufacturing changes, opacifications are not eliminated. Likewise, more attention in recent studies was paid to possible new risk factors, however one of the most important purposes of the studies remains opacifications effect on visual performance, which could be disturbed in different aspects. The aim of this review is to discuss the main risk factors of IOLs opacification in particular IOL types, and its impact on vision quality. Different risk factors were discussed in the study, including the material of IOLs, the impact of the breakdown of blood-aqueous barrier (BAB), and certain surgeries that can be associated with opacification formation. Glistenings occur more often in a hydrophobic material, however, the changes in water content of the IOLs can significantly reduce the formation of glistenings. The studies showed a significant effect of intraocular injection of exogenous air or gas during Descemet-stripping endothelial keratoplasty, Descemet-stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, and pars plana vitrectomy on calcification formation. It raises a concern, as the incidence of these surgeries is increasing. Visual acuity decreases significantly after the calcification in IOLs occurs, and it usually causes IOLs exchange. However, disability glare seems to be more affected in patients with IOLs, which were affected by glistenings than visual acuity. Disability glare is associated with increased levels of straylight, which was widely evaluated in recent studies and it was reported to be a susceptible measurement to detect the presence of IOLs pathology. For future researches, it should be noticed that disability glare and straylight are more appropriate in evaluating IOLs opacification effect on visual quality than visual acuity. While reviewing the main risk factors of IOLs opacifications particular attention must be paid on calcification occurrence in hydrophilic acrylic IOLs after surgeries with intraocular injection of exogenous air or gas.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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33
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Argay A, Vamosi P. The assessment of the impact of glistening on visual performance in relation to tear film quality. PLoS One 2020; 15:e0240440. [PMID: 33044979 PMCID: PMC7549795 DOI: 10.1371/journal.pone.0240440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background The aim of our case control study was to evaluate the impact of glistening and tear film quality on visual performance after implantation of two different hydrophobic acrylic intraocular lenses (IOLs). Materials and methods In our retrospective study we included cataract patients operated between January 1, 2011 and December 31, 2012, with follow-up controls between January 2016 and December 2019. Z-Flex 860FAB (Medicontur) and AcrySof IQ SN60WF (Alcon) monofocal IOLs were implanted during standard phacoemulsification. Best corrected distance visual acuity (BCDVA) and contrast sensitivity were monitored over the post-operative period of up to 6 years. Glistening was evaluated semi-quantitatively with slit-lamp biomicroscopy and quantitatively using Pentacam HR (Oculus). Using HD Analyzer OQAS (Visiometrics), total intraocular light diffusion was interpreted with the objective scatter index (OSI) and tear film quality was evaluated with the tear film related objective scatter index (TF-OSI). Results 26 eyes implanted with the Z-Flex and 25 eyes with the AcrySof IQ IOLs were included in the analysis. The slit-lamp evaluation of patients with the Z-Flex IOL (0.57 ± 0.60) revealed significantly less glistening (p<0.0001), compared to the AcrySof IQ group (1.82 ± 0.90), and these observations were confirmed by the Pentacam HR analyses, as well (Z-Flex group: 35.1 ± 1.63, Acrysof IQ: 39.6 ± 3.69, p<0.0001). TF-OSI differed between the two sets of patients remarkably (1.53 ± 1.03 vs. 2.51 ± 1.76 for AcrySof IQ and Z-Flex groups, respectively, p = 0.043). Both groups of patients provided similar results of BCDVA and contrast sensitivity. Conclusion Glistening and tear film quality both contribute to visual performance outcomes after cataract surgery. In our study the advantage of less glistening in the Z-Flex IOL might have been masked by the adverse effects of the more pronounced tear film insufficiency of these patients, compared to the AcrySof IQ group. Among other factors, tear film quality should also be taken into consideration when comparing the impact of glistening on visual quality of patients implanted with different IOLs.
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Affiliation(s)
- Amanda Argay
- Department of Ophthalmology, Péterfy Sándor Hospital and Traumatology Center, Budapest, Hungary
| | - Peter Vamosi
- Department of Ophthalmology, Péterfy Sándor Hospital and Traumatology Center, Budapest, Hungary
- * E-mail:
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34
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Fișuș AD, Hirnschall ND, Maedel S, Fichtenbaum M, Draschl P, Findl O. Capsular bag performance of a novel hydrophobic acrylic single-piece intraocular lens: Two-year results of a randomised controlled trial. Eur J Ophthalmol 2020; 31:2377-2382. [PMID: 32993380 DOI: 10.1177/1120672120960591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the visual outcome, intraocular lens (IOL) stability and posterior capsule opacification (PCO) rate of a hydrophobic acrylic intraocular lens. SETTING Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN This double-masked randomised study included patients who underwent standard cataract surgery. METHOD Patients received either the hydrophobic acrylic IOL (iPure, PhysIOL) or the hydrophobic acrylic control IOL (Tecnis ZCB00, Johnson&Johnson). Subjective refraction, uncorrected and corrected distance visual acuity (UDVA, CDVA), IOL tilt and decentration (Purkinje meter) and PCO intensity using retroillumination images with automated image analysis (automated quantification of after-cataract, AQUA), were evaluated for both groups 2 years after surgery. RESULTS A total number of 31 patients completed the 2-year follow-up, 16 in the study group and 15 in the control group. The CDVA was 0.0 logMAR (standard deviation - SD: 0.1) for the study IOL and 0.1 logMAR (SD: 0.2) for the control IOL, p = 0.001. The AQUA PCO score for the study group was 2.1 and 1.4 for the control group, p = 0.44. Mean IOL tilt was 2.9° (SD: 1.8) in the study group and 5.0° (SD: 4.5) in the control group, whilst the mean decentration was 0.37 mm (SD: 0.18) and 0.45 mm (SD: 0.3), p = 0.610. CONCLUSION The studied parameters revealed a good performance for both IOLs. Both IOLs had good CDVA, a small amount of tilt and decentration and none of the patients required laser capsulotomies during the follow-up time of 2 years after surgery.Presented at the 37th ESCRS Congress Paris, France, September 2019.
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Affiliation(s)
- Andreea D Fișuș
- Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery - Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Nino D Hirnschall
- Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery - Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Sophie Maedel
- Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery - Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Maria Fichtenbaum
- Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery - Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Petra Draschl
- Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery - Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Oliver Findl
- Department of Ophthalmology, Vienna Institute for Research in Ocular Surgery - Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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Durr GM, Ahmed IIK. Intraocular Lens Complications: Decentration, Uveitis-Glaucoma-Hyphema Syndrome, Opacification, and Refractive Surprises. Ophthalmology 2020; 128:e186-e194. [PMID: 32652203 DOI: 10.1016/j.ophtha.2020.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
As cataract surgery has evolved, intraocular lens (IOL) complications are rare. The purpose of this review was to report the incidence, diagnosis, and management of IOL decentrations, uveitis-glaucoma-hyphema (UGH) syndrome, IOL opacifications, and refractive surprises. Literature review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Controlled Trial Database and the reference lists of original studies as well as reviews. Intraocular lens decentrations and dislocations can appear at any time, particularly in patients with predisposing factors such as pseudoexfoliation, prior vitreoretinal surgery, or trauma. Recognizing when they require surgical intervention for UGH or to improve visual function is critical in limiting long-term sequela. Intraocular lens opacifications such as glistenings rarely require intervention, but others, such as subsurface nanoglistenings, calcifications, or discolorations, may require IOL exchange. Finally, despite our best efforts to enhance measurements and IOL calculations, refractive surprises still occur. Intraocular lens complications are uncommon with modern cataract surgery. A number of these complications require proper identification and care to optimize patient outcomes.
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Affiliation(s)
- Georges M Durr
- Department of Ophthalmology, Université de Montréal, Montréal, Canada; Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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36
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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: 22] [Impact Index Per Article: 5.5] [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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Bhattacharjee H, Buragohain S, Javeri HJ, Das D. Scanning electron microscopic features of explanted degraded hydrophobic acrylic intraocular lenses which were in vivo for a prolonged period. Indian J Ophthalmol 2020; 68:1086-1089. [PMID: 32461435 PMCID: PMC7508145 DOI: 10.4103/ijo.ijo_2168_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: To study and document electron microscopic features in explanted hydrophobic microvacuoles affected acrylic intraocular lenses (IOL) which were in vivo for an average duration of 11 years. Methods: Scanning electron microscopic (SEM; Hitachi S 3000 N EXAX Genesis VP SEM) study of five explanted hydrophobic acrylic IOL which had clinically evident microvacuoles prior to explantation, was done. The IOLs were in vivo for a prolonged period and needed explantation for various indications. Only those hydrophobic acrylic IOLs which fulfilled the inclusion criteria were included. The findings were compared with control specimens. Results: The IOLs were in vivo for an average duration of 11.6 ± 4.21 years. The cause of explantation of IOL was subluxation in four cases and low visual acuity in one case. Bulk degradation and microvacuoles on cut sections throughout the IOL optics and undulating surface patterns over both the surfaces of the IOL has been documented in all the specimens. No such findings were noted in the control specimens where the surface and texture were homogenous. Conclusion: SEM findings of the structural changes in explanted IOL documented in the study demonstrate that hydrophobic acrylic IOL is degradable in vivo. Microvacuoles are a clinical manifestation of the structural changes that occur at a microscopic and molecular level. These changes are not seen in IOLs which have not undergone intraocular implantation. To our knowledge, a similar study of this kind has not been done.
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Affiliation(s)
| | | | - Henal J Javeri
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Dipankar Das
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl methacrylate. J Cataract Refract Surg 2020; 46:682-687. [DOI: 10.1097/j.jcrs.0000000000000142] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Philippaki E, O'Brart DP, Hull CC. Comparison of glistenings formation and their effect on forward light scatter between the Acrysof SN60WF and Eternity Natural Uni NW-60 intraocular lenses. BMJ Open Ophthalmol 2020; 5:e000399. [PMID: 32154371 PMCID: PMC7044831 DOI: 10.1136/bmjophth-2019-000399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 11/08/2022] Open
Abstract
Aims To compare the characteristics of glistenings and forward light scatter between the Alcon Acrysof SN60WF and Santen Eternity Natural Uni NW-60 intraocular lenses (IOLs). Methods Five Acrysof SN60WF and five Eternity Natural Uni NW-60 IOLs were studied. All IOLs were single piece blue blockers with the same dioptric power (20D) and optic diameter (6.0 mm). Glistenings were induced by a thermal accelerated ageing process. Glistenings were objectively quantified using bespoke image processing software. The angular distribution of forward light scatter was measured using an optical bench system and the straylight parameter calculated from the light scatter function. Results The median increase in the number of glistenings was 15 and 525 for the Eternity and Acrysof IOLs, respectively, which was statistically significantly different (p=0.012). Median glistenings diameter was 23.8 μm (Acrysof) and 32.8 μm (Eternity). Four (80%) of the Acrysof lenses had straylight values higher than a 20-year-old CIE standard glare observer and in two cases the straylight exceeded that of the 70-year-old CIE standard glare observer. None of the Eternity lenses had straylight values that exceeded the value for the 20-year-old CIE standard glare observer. Conclusions The Eternity Natural Uni NW-60 IOLs resisted the induction of glistenings more than the Acrysof SN60WF IOLs. Although the Acrysof IOLs developed smaller glistenings than the Eternity IOLs, there were sufficient numbers to produce a higher straylight parameter.
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Kawai K. An evaluation of glistening and stability of intraocular lens material manufactured by different methods. Eur J Ophthalmol 2020; 31:427-435. [PMID: 32000525 DOI: 10.1177/1120672120902038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate glistening and long-term stability of five commercially available intraocular lenses. METHODS This experimental study evaluated the SN60WF (Alcon), XY1 (Hoya), NS-60YG (NIDEK), ZCB00V (Johnson & Johnson Vision) and AN6KA (Kowa) intraocular lenses. To generate glistenings, intraocular lenses were immersed in physiological saline at 50°C for 2 h, then left in situ at 35°C and removed at regular intervals over 24 h. Stability of the intraocular lens material was assessed by immersing intraocular lenses into vials of purified water placed at 100°C for 115 days, which simulated 20-year ageing. Gas chromatography-mass spectrometry was used to detect leached compounds. RESULTS Almost no glistenings were observed for the AN6KA. Glistenings were observed in the remaining intraocular lenses after 3 h. The number of glistenings gradually disappeared by 6 h for all intraocular lenses except SN60WF (12 h). Only the NS-60YG and ZCB00V intraocular lenses had no changes in weight or dimensions. Gas chromatography-mass spectrometry detected phenethyl alcohol in XY1 and SN60WF, 2-phenoxyethanol in AN6K and no compounds in the remaining intraocular lenses. A peak shift due to the carbonyl group between 1600 and 1700 cm-1 was detected for the SN60WF and AN6K intraocular lenses only. CONCLUSION SN60WF had the most numerous glistenings that resolved over a longer duration. The long-term stability test confirmed elution of the intraocular lens material-derived compounds and signs of degradation for the XY1, SN60WF and AN6K intraocular lenses. NS-60YG and ZCB00V showed no signs of deterioration due to ageing. Differing manufacturing methods likely play a role in the stability of intraocular lenses.
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Affiliation(s)
- Kenji Kawai
- Department of Ophthalmology, School of Medicine, Tokai University, Oiso, Japan
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Łabuz G, Reus NJ, van den Berg TJTP. Light scattering levels from intraocular lenses extracted from donor eyes. J Cataract Refract Surg 2019; 43:1207-1212. [PMID: 28991619 DOI: 10.1016/j.jcrs.2017.06.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/23/2017] [Accepted: 06/24/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess light scatter levels of intraocular lenses (IOLs) extracted from donor eyes to understand straylight elevation documented earlier in pseudophakic population studies and identify potential sources of light scattering in IOLs. SETTING Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands. DESIGN Experimental study. METHODS Light scattering in 74 donor IOLs was measured with the C-Quant device adapted for in vitro analysis of IOLs. Straylight was assessed at a 2.5-degree and 7.0-degree scatter angle, and results were compared with the straylight of a 20-year-old crystalline lens, a 70-year-old crystalline lens, and a lens with cataract. To identify potential changes to the IOL material, the IOLs were examined with a light microscope and a slitlamp. RESULTS At 2.5 degrees and 7.0 degrees, the straylight parameter was 5.78 deg2/steradian (sr) ± 4.70 (SD) and 5.06 ± 4.01 deg2/sr, respectively. Forty-one percent of IOLs showed lower straylight than the 20-year-old lens. In 14%, the scattering intensity was higher than in the 70-year-old lens; none showed straylight comparable to that of the cataractous lens. Increased straylight was associated with surface deposits, snowflake-like degeneration, and glistenings. The incidence of IOL-related complications differed between the IOL groups. CONCLUSIONS Microscopic structural alterations of IOLs play a major role in straylight elevations in pseudophakic eyes. A clear correlation with degeneration and/or alteration of implanted IOLs was found. Although these IOL-related complications would likely not affect visual acuity, they give rise to straylight and thus can cause disability glare and other symptoms.
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Affiliation(s)
- Grzegorz Łabuz
- From the Rotterdam Ophthalmic Institute (Łabuz), Rotterdam, the Department of Ophthalmology (Reus), Amphia Hospital, Breda, and the Netherlands Institute for Neuroscience (van den Berg), Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
| | - Nicolaas J Reus
- From the Rotterdam Ophthalmic Institute (Łabuz), Rotterdam, the Department of Ophthalmology (Reus), Amphia Hospital, Breda, and the Netherlands Institute for Neuroscience (van den Berg), Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Thomas J T P van den Berg
- From the Rotterdam Ophthalmic Institute (Łabuz), Rotterdam, the Department of Ophthalmology (Reus), Amphia Hospital, Breda, and the Netherlands Institute for Neuroscience (van den Berg), Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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House P, Abdul Rahman A, Richards J, D'Souza B. Long-term clinical audit of glistenings in Alcon Acrysof intra-ocular lenses with and without yellow chromophore. Clin Exp Ophthalmol 2019; 48:251-252. [PMID: 31705782 DOI: 10.1111/ceo.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Philip House
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Anmar Abdul Rahman
- Department of Ophthalmology, Counties Manukau DHB, Auckland, New Zealand
| | | | - Blasco D'Souza
- Canning Eye Clinic, Cannington, Perth, Western Australia, Australia
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Grzybowski A, Kanclerz P, Beiko GHH. IOLs glistenings and quality of vision. Graefes Arch Clin Exp Ophthalmol 2019; 257:2795-2796. [PMID: 31630230 DOI: 10.1007/s00417-019-04496-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland. .,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 60-554 Gorczyczewskiego 2/3, Poznan, Poland.
| | | | - George H H Beiko
- Department of Surgery, McMaster University, Hamilton, Canada.,Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Canada
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5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes. Eye (Lond) 2019; 34:960-968. [PMID: 31616057 PMCID: PMC7182577 DOI: 10.1038/s41433-019-0630-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/07/2019] [Accepted: 09/03/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the 3- and 5-year incidence of posterior capsule opacification (PCO) and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy in patients following cataract surgery, comparing results for different single-piece acrylic hydrophilic and hydrophobic monofocal intraocular lens (IOL) models and other patient factors. PATIENTS AND METHODS Electronic medical record data collected from seven United Kingdom (UK) National Health Service (NHS) ophthalmology clinics for routine, age-related (≥65 years) cataract surgeries that implanted single-piece acrylic monofocal IOLs during 2010-2013 were used to calculate 3- and 5-year incidence of Nd:YAG and PCO. IOL models of Alcon Acrysof, AMO Tecnis, Bausch & Lomb (B & L) Akreos, LenStec Softec, and Rayner Flex were analyzed. Pairwise comparisons were conducted between AcrySof IOLs and other IOLs using Bonferroni adjustment for multiplicity. Multivariate analyses were conducted adjusting for known confounders. RESULTS The incidence of Nd:YAG capsulotomy ranged between 2.4-12.6% at 3 years and 5.8-19.3% at 5 years post-cataract surgery. Similarly, the incidence of PCO ranged between 4.7-18.6% at 3 years and 7.1-22.6% at 5 years. When comparing all of the single-piece IOLs, AcrySof demonstrated the lowest incidence rates for both PCO and Nd:YAG (P < 0.001 for each comparison). From adjusted logistic regression analysis, AcrySof were associated with lower 3- and 5-year odds of Nd:YAG and PCO incidence. CONCLUSIONS Following cataract surgery with single-piece monofocal IOLs different incidence rates of PCO were observed with different IOLs. AcrySof IOLs were associated with significantly lower incidence of PCO requiring Nd:YAG treatment over periods of 3 and 5 years.
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Werner L, Thatthamla I, Ong M, Schatz H, Garcia-Gonzalez M, Gros-Otero J, Cañones-Zafra R, Teus MA. Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in comparison to commercially available IOLs. J Cataract Refract Surg 2019; 45:1490-1497. [PMID: 31399323 DOI: 10.1016/j.jcrs.2019.05.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/26/2019] [Accepted: 05/11/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To perform in vitro assessments of surface haze and roughness, subsurface nanoglistenings (SSNGs), and glistenings of a new hydrophobic acrylic intraocular lens (IOL) in comparison to commercially available IOLs. SETTING Universities of Utah and Alcalá, and Alcon Vision, LLC. DESIGN Experimental study. METHODS The IOLs used were Clareon CNA0T0, Tecnis ZCB00 and Tecnis OptiBlue ZCB00V, Eternity W-60, enVista MX60, and Vivinex XY1. Surface haze was assessed by the pixel intensity units (PIU) from cross-sectional slitlamp images, and it was correlated to atomic force microscopy roughness. For SSNGs, the IOLs were artificially aged up to 10 years, followed by Scheimpflug densitometry (computer-compatible tape unit [CCTU]) measurements. For glistenings, the IOLs were immersed in a water bath and subjected to temperature changes before analysis. RESULTS The surface haze (n = 10, PIU) was 4.25 ± 0.87 (SD) (CNA0T0), 9.50 ± 1.66 (ZCB00), 39.48 ± 1.97 (ZCB00V), 46.68 ± 3.16 (W-60), 44.70 ± 4.00 (MX60), and 4.42 ± 0.71 (XY1) (P < .001), which showed a strong correlation with surface roughness measurements (R = 0.94, P = .006). The densitometry (n = 10, CCTU at 10 years) was 7.30 ± 1.36 (CNA0T0), 11.88 ± 3.10 (ZCB00), 38.12 ± 2.24 (ZCB00V), 48.13 ± 9.44 (W-60), 20.20 ± 3.84 (MX60), and 6.75 ± 6.66 (XY1) (P < .001), with no significant differences between CNA0T0 vs. ZCB00 and XY1. The glistenings density (n = 30) was the lowest for the CNA0T0, W-60, and MX60 IOLs. CONCLUSIONS The new Clareon CNA0T0, which is manufactured from a hydrophobic acrylic material, exhibited among the lowest levels of surface haze and roughness, SSNGs, and glistenings compared with other commercially available hydrophobic acrylic IOLs.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
| | | | - Marcia Ong
- Alcon Vision, LLC, Fort Worth, Texas, USA
| | | | | | | | | | - Miguel A Teus
- Clinica Novovisión, Madrid, Spain; Universidad de Alcalá, Madrid, Spain
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Stanojcic N, Hull C, O'Brart DP. Clinical and material degradations of intraocular lenses: A review. Eur J Ophthalmol 2019; 30:823-839. [PMID: 31387387 DOI: 10.1177/1120672119867818] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To review the published scientific literature concerning clinical and material degradations of intraocular lenses after implantation in cataract surgery. METHODS A search was undertaken using the following databases: CENTRAL (including Cochrane Eyes and Vision Trials Register; The Cochrane Library: Issue 2 of 12 February 2019), Ovid MEDLINE (R) without Revisions (1996 to February week 2, 2019), Ovid MEDLINE (R) (1946 to February week 2, 2019), Ovid MEDLINE (R) Daily Update 19 February 2019, MEDLINE and MEDLINE non-indexed items, Embase (1980-2019, week 7), Embase (1974-2019, 19 February), Ovid MEDLINE (R) and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to 19 February 2019), Web of Science (all years), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and the WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Only published articles in English were selected. Search terms/keywords included 'IOL' or 'intraocular lens', combined with 'opacification', degradation, glistenings, nanoglistenings, whitening, transmittance, light scatter, discolouration/discoloration, performance, quality, material, biocompatibility, calcification, explantation and ultraviolet/UV radiation. Relevant in-article references not returned in our searches were also considered. RESULTS After review of the available articles, the authors included 122 publications in this review, based on the quality of their methodology and their originality. The studies included in this review were randomized controlled trials, cohort studies, case-controlled studies, case series, case reports, laboratory studies and review papers. Differing material degradations of intraocular lenses have been described and their associated pathophysiology studied. Reported anomalies include photochemical alterations, water vacuoles, internal and surface calcific deposits, surface coatings and discolouration. The nature of such changes has been shown to depend on the type of intraocular lenses material used and/or manufacturing processes and storage conditions employed. Changes in the intraocular lens can also be influenced by surgical technique, coexisting ocular pathologies and topical and systemic medications. The clinical significance of these degradations is variable, with some resulting in significant visual disturbance and the need for intraocular lens explantation and others producing only minimal visual impairments. Failure to recognize the precise nature of the problem may lead to unnecessary laser capsulotomy procedures. CONCLUSION Clinical degradations of intraocular lenses are uncommon but have been reported following the implantation of intraocular lenses made of differing biomaterials. Their correct identification and thorough investigation to determine the underlying cause is necessary for optimal patient management and the prevention of such problems. Choosing a lens made of a particular material may be important in patients with certain ocular conditions.
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Affiliation(s)
- Nick Stanojcic
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London Frost Eye Research Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Hull
- Division of Optometry and Visual Sciences, School of Health Science, City, University of London, London, UK
| | - David Ps O'Brart
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London Frost Eye Research Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Weindler JN, Łabuz G, Yildirim TM, Tandogan T, Khoramnia R, Auffarth GU. The impact of glistenings on the optical quality of a hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2019; 45:1020-1025. [DOI: 10.1016/j.jcrs.2019.01.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/25/2022]
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Borkenstein AF, Borkenstein EM. Polarized glasses may help in symptomatic cases of intraocular lens glistenings. CLINICAL OPTOMETRY 2019; 11:57-62. [PMID: 31191065 PMCID: PMC6511652 DOI: 10.2147/opto.s202796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/16/2019] [Indexed: 05/30/2023]
Abstract
Intraocular lens (IOL) glistening is a relatively common phenomenon. Although most of the patients remain asymptomatic, a small percentage of patients can develop unwanted optical side effects. We report 6 symptomatic patients with IOL glistening. All patients underwent an implantation of a hydrophobic acrylic mononofocal, multifocal or toric IOL in external clinics for visually significant cataract at least 6 months prior. Patients had very reasonable corrected visual acuity (0.8-1.0 decimal), but significantly had reduced contrast sensitivity and modulation transfer function, complained of visual phenomena and expressed dissatisfaction with their visual status. Patients indicated the symptoms were not present immediately after surgery, but gradually developed postoperatively. Slit-lamp examination revealed moderate-to-severe glistening in all cases. No other pathology that would be responsible for the visual symptoms was present. Patients reported improvement in side effects with the use of edge filter (blue-light blocking) eyeglasses and polarized sunglasses with an increase in contrast sensitivity by aproximately 1 line on Pelli-Robson chart. The use of specific eyewear seems to be a promising alternative to avoid explant of an IOL in symptomatic patients with glistenings and very good visual acuity. In conclusion, we believe that long-term optical clarity is crucial for the choice of an IOL.
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Stanojcic N, O'Brart DPS, Maycock N, Hull CC. Effects of intraocular lens glistenings on visual function: a prospective study and presentation of a new glistenings grading methodology. BMJ Open Ophthalmol 2019; 4:e000266. [PMID: 31179397 PMCID: PMC6528773 DOI: 10.1136/bmjophth-2018-000266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective To investigate the effect of intraocular lens (IOL) glistenings on visual performance and evaluate a new glistenings grading methodology. Methods and Analysis Thirty-four patients (34 eyes) were recruited. Corrected distance visual acuity (CDVA), mesopic gap acuity (MGA), functional contrast sensitivity (FCS) and forward light scatter were measured (Advanced Vision and Optometric Tests, City Occupational, London, UK). The IOL centre was imaged and glistenings density graded by three observers using the Miyata scale and a new system. Inter-rater reliability, association between the two grading scales, and correlations between glistenings grades and visual performance parameters were evaluated. Results The intraclass correlation coefficient between graders for the new grading system was 0.769 (95% Confidence Interval [CI] 0.636 to 0.868). There was a significant association between the Miyata scale and the new grading system for all graders (rs=0.533–0.895, p≤0.001). There was no association between CDVA or MGA and glistenings grade (rs=− 0.098, p=0.583 and rs=0.171, p=0.359, respectively). There was no association between FCS at mesopic light levels and glistenings grade (rs=−0.032, p=0.864), or the straylight parameter and glistenings grade (rs=0.021, p=0.916). No association was found between the integrated straylight parameter and glistenings grade (rs=0.078, p=0.701). Conclusion The new glistenings grading scale was highly reproducible. In this cohort, glistenings in the same hydrophobic acrylic IOL after cataract surgery were not associated with changes in visual function, as assessed by a series of tests not previously used in glistenings research.
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Affiliation(s)
- Nick Stanojcic
- Department of Ophthalmology, St Thomas' Hospital, London, UK
| | | | - Nick Maycock
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - Chistopher C Hull
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, UK
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Otrošinová M, Novák J, Kvasnička J, Žídek O. Late postoperative opacification of a hydrophobic acrylic intraocular lens AcryNovaTMPC 610Y. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2019; 75:172-179. [PMID: 32397719 DOI: 10.31348/2019/4/1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report late postoperative opacification of a hydrophobic acrylic intraocular lens (IOL) AcryNovaTMPC 610Y as well as the clinical consequences in patients 10 years after uncomplicated cataract surgery. MATERIALS AND METHODS Medical records were reviewed of 23 patients (26 eyes) with AcryNovaTMPC 610Y implantated between years 2005 and 2007. Next clinical examination was performed 10 years after surgery. We assessed best corrected distance visual acuity (BCDVA), contrast sensitivity (CSV-1000E) and relative opacity of IOL material, (OCULUS Pentacam HR). Results of BCDVA and Pentacam were analysed statistically. One explanted IOL was analysed using anterior segment OCT in vitro and spectroscopic method EDX (Energy-dispersive X-ray spectroscopy). RESULTS Opacification led to a statistically significant reduction in the best corrected distance visual acuity (BCDVA) = (0,95 ± 0,10) versus (0,87 ± 0,20) and to increase of IOL opacity only in some lenses but statistically significant in the average (6,37 ± 2,16)% versus value of (14,22 ± 5,87)%. In the explanted IOL we have documented structural changes of primarily hydrophobic raw material leading to property of hydrophilic one. CONCLUSION Some batches of AcryNovaTMPC 610Y were produced from raw material of poor quality which is the cause of its structural changes and its progressive opacification.
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