Comparison of posterior capsule opacification and glistenings with 2 hydrophobic acrylic intraocular lenses: 5- to 7-year follow-up

Influence of the CleaRing intraocular open capsule device on refractive predictability in cataract surgery

BACKGROUND

The marked improvement in cataract surgery and intraocular lens (IOL) quality has led to a decline in posterior capsular opacification (PCO) incidence; however, PCO remains a common complication of cataract surgery. The CleaRing intraocular capsule open device (IOCD) decreases PCO incidence. We aimed to investigate the influence of the CleaRing IOCD on refractive predictability in cataract surgery.

METHODS

We conducted this prospective pilot study at the Wolfson Medical Center, Holon, Israel. Ten eyes of patients who underwent cataract surgery and insertion of an IOL after IOCD implantation into the capsular bag were included. All patients completed 12 months of follow-up, including refraction, measurement of uncorrected (UDVA) and best-corrected distance visual acuity (CDVA), slit-lamp biomicroscopy, and ultrasound biomicroscopy.

RESULTS

All the surgeries were uneventful, with no postoperative complications. The IOL was centred in the device and bag in all cases. The mean prediction error at 1 and 12 months postoperatively was +0.28 ± 0.32 D and +0.50 ± 0.32 D, respectively. The mean UDVA was 0.17 ± 0.13 and 0.15 ± 0.11 logMAR, and the mean CDVA was 0.04 ± 0.10 and 0.04 ± 0.06 logMAR, respectively. The manifest refractive cylinders at 12 months postoperatively were compatible with corneal astigmatism.

CONCLUSIONS

Implantation of the IOCD resulted in a slight, predicted, and stable hyperopic shift with a low standard deviation. The standard deviation of the prediction error demonstrated excellent refractive accuracy and predictability using the IOCD, which was as low as 0.32 D at the 12-month follow-up.

Light scattering in intraocular lenses explanted 15 to 40 years after surgery

The optical quality of intraocular lenses (IOLs) of different materials that have been implanted from 16 to 44 years in human eyes was studied. The IOLs were explanted due to other causes than loss of transparency. The scattered light from the IOLs was assessed in two angular regimes by using dark field images (for wide angles) and the optical integration method (for narrower angles). No evident differences were found in the scattering intensities processed from the dark images. The explanted lenses presented slightly increased amounts of straylight between 1 and 5.1° when compared to a reference new unused lens.

A review of late intraocular lens opacifications

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

SUMMARY

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

Altered stress field of the human lens capsule after cataract surgery

The lens capsule of the eye is important in focusing light onto the retina during the process of accommodation and, in later life, housing a prosthetic lens implanted during cataract surgery. Though considerable modeling work has characterized the mechanics of accommodation, little has been done to understand the mechanics of the lens capsule after cataract surgery. As such, we present the first 3-D finite element model of the post-surgical human lens capsule with an implanted tension ring and, separately, an intraocular lens to characterize the altered stress field compared to that in a model of the native lens capsule. All finite element models employed a Holzapfel hyperelastic constitutive model with regional variations in anisotropy. The post-surgical lens capsule demonstrated a dramatic perturbation to the stress field with mostly large reductions in stresses (except at the equator where the implant contacts the capsule) compared to native, wherein maximal changes in Cauchy stress were -100% and -145% for the tension ring and intraocular lens, respectively. However, implantation of the tension ring produced a more uniform stress field compared to the IOL. The magnitudes and distribution of the perturbed stress field may be an important driver of the fibrotic response of inhabiting lens epithelial cells and associated lens capsule remodeling after cataract surgery. Thus, the mechanical effects of an implant on the lens capsule could be an essential consideration in the design of intraocular lenses, particularly those with an accommodative feature.

A narrative review of intraocular lens opacifications: update 2020

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.

Visual and refractive outcomes and glistenings occurrence after implantation of 2 hydrophobic acrylic aspheric monofocal IOLs

PURPOSE

To compare the Clareon IOL with the Tecnis PCB00 IOL in terms of visual performance, refractive outcomes, glistenings occurrence, and quality-of-life outcomes.

SETTING

Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

DESIGN

Single-center, single-masked, prospective, randomized controlled trial.

METHODS

One hundred thirty-nine patients with bilateral cataracts were randomized to receive the Clareon (C IOL) or Tecnis (T IOL) IOL. Visual acuity, refraction, central corneal thickness (CCT), endothelial cell loss, contrast sensitivity, mesopic gap acuity, evaluation of glistenings, and rates of perioperative and postoperative complications were recorded. Quality-of-life outcomes were measured with the EuroQOL-5 dimensions questionnaire and the patient-reported outcome measures (PROMs) questionnaire. Optimized A-constants were available for the T IOL but not for the C IOL.

RESULTS

Seventy-one patients (140 eyes) received the C IOLs and 68 patients (134 eyes) received the T IOLs. Data were analyzed for the first implanted eye. At 12 months, mean uncorrected distance visual acuity (logarithm of the minimum angle of resolution) was 0.02 ± 0.10 and 0.01 ± 0.08 (mean ± SD; P = .49; 95% CI, -0.02 to 0.04) in the C IOL and T IOL groups, respectively. Corrected distance visual acuity was -0.02 ± 0.09 and -0.03 ± 0.06, respectively (P = .45; 95% CI, -0.02 to 0.04). The increase in CCT was 14 ± 19 and 16 ± 28 μm, respectively (P = .63; 95% CI, -10.16 to 6.16). Mean absolute refraction spherical equivalent error from target refraction was 0.41 ± 0.28 for the C IOL and 0.25 ± 0.2 for the T IOL groups (P = .002; 95% CI, 0.08 to 0.24). Glistenings were minimal (median grade 0), with no difference in grades between groups (P = .2). PROMs improved postoperatively and were similar in both groups.

CONCLUSIONS

There were no differences in visual outcomes between the Clareon IOL and Tecnis PCB00 IOL. Glistenings were rarely observed in either IOL with no difference in grades. There was no difference in perioperative or postoperative complications. Surgeon optimization of the A-constant for the Clareon IOL is recommended.

Comparison of glistenings formation and their effect on forward light scatter between the Acrysof SN60WF and Eternity Natural Uni NW-60 intraocular lenses

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.

Comparison of posterior capsule opacification development with 2 single-piece intraocular lens types

PURPOSE

To evaluate the differences in the incidence of posterior capsule opacification (PCO) and visual and optical performance between 2 hydrophobic acrylic single-piece sharp-edged intraocular lenses (IOLs) over 3 years.

SETTING

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

DESIGN

Prospective randomized case series.

METHODS

Patients with bilateral cataract were prospectively randomized to receive an Eyecee One IOL (IOL A) or an Acrysof SN60WF IOL (IOL B) and were followed for 36 months. The corrected distance visual acuity (CDVA) and IOL decentration and tilt were measured. The PCO was quantified by analysis of standardized retroillumination images.

RESULTS

The study comprised 160 eyes of 80 patients. The PCO incidence was low for both IOLs at all follow-up visits. Three years postoperatively, the median objective PCO score was 1.4 (range 0 to 5.6) for IOL A and 1.5 (range 0 to 5.0) for IOL B (P = .67). The neodymium:YAG (Nd:YAG) capsulotomy rate 3 years after surgery was 16.4% and 6.0% (P = .06), respectively. Visual acuity and contrast sensitivity outcomes were also comparable at all follow-up visits.

CONCLUSIONS

Both IOLs showed good capsular bag performance and low PCO rates 3 years after surgery. Both IOLs also showed comparable results for visual acuity, contrast sensitivity, decentration and tilt, PCO score, slitlamp examination, and Nd:YAG capsulotomy rates.

Clinical and material degradations of intraocular lenses: A review

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.

Effects of intraocular lens glistenings on visual function: a prospective study and presentation of a new glistenings grading methodology

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 (r_s=0.533–0.895, p≤0.001). There was no association between CDVA or MGA and glistenings grade (r_s=− 0.098, p=0.583 and r_s=0.171, p=0.359, respectively). There was no association between FCS at mesopic light levels and glistenings grade (r_s=−0.032, p=0.864), or the straylight parameter and glistenings grade (r_s=0.021, p=0.916). No association was found between the integrated straylight parameter and glistenings grade (r_s=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.

Long-term effectiveness and safety of a three-piece acrylic hydrophobic intraocular lens modified with hydroxyethyl-methacrylate: an open-label, 3-year follow-up study

Background

Clareon^® is a new hydrophobic acrylic optic biomaterial designed for enhanced clarity and greater resistance to glistening. The present study evaluated the effectiveness and safety of a three-piece hydrophobic, monofocal intraocular lens (IOL) Model MA60NM, made of this new optic material.

Methods

In this prospective, multicenter, open-label study, eligible patients aged ≥60 years, underwent a unilateral implantation with IOL Model MA60NM following phacoemulsification. Patients were followed-up for up to 3 years after implantation. Visual outcome and serious adverse events (SAEs, cumulative and persistent) were compared to ISO grid rates (BS EN ISO 11979-7:2006). The primary effectiveness variable was Best Spectacle-Corrected Visual Acuity (BSCVA) at 1-year postoperative follow-up. In addition, posterior capsular opacification (PCO) was assessed qualitatively and graded by slit lamp exam on a 5-point scale at all visits.

Results

Overall, 179 and 138 patients completed the 1-year and 3-year postoperative follow-up, respectively. The BSCVA outcomes were better with IOL Model MA60NM than the ISO grid rates with 95.5% of patients at 1 year and 94.2% of patients at 3 years having achieved a BSCVA of 20/40 or better vs 92.5% in ISO grid. The incidence of cumulative or persistent SAEs was lower after Model MA60NM implantation than the ISO grid reference. The incidence of clinically significant PCO was 1.1% at the 1-year and 2.2% at the 3-year visit. Posterior capsulotomy rate was 1.1% at 1 year and 1.4% at 3 years.

Conclusion

The three-piece hydrophobic, monofocal IOL Model MA60NM was effective for the visual correction of aphakia and successfully met all the safety parameters as defined by the ISO criteria. PCO and posterior capsulotomy rates were low over the 3-year follow-up period. This study provides evidence and supports the long-term safety and effectiveness of the new optic biomaterial Clareon^®.

Long-term clinical results and scanning electron microscopic analysis of the aspheric, hydrophobic, acrylic intraocular lens CT LUCIA 611P(Y)

Purpose

The aim of this study was to evaluate the clinical outcomes of a novel designed hydrophobic, acrylic, monofocal, fully preloaded intraocular lens (IOL; CT LUCIA 611P) 1 year after implantation. Scanning electron microscopic analysis regarding the optic-haptic junction and sharp edges of the IOL was performed.

Patients and methods

This is a noninterventional, observational prospective study of cataract patients who underwent implantation of the CT LUCIA 611P. Ninety-six eyes of 54 subjects were enrolled. Follow-up included visual acuity assessment, slit lamp examination with special focus on appearance of glistenings and evaluation of posterior capsule opacification (PCO). Scanning electron microscopic analysis of the new designed optic-haptic junction and edges of the IOL was performed.

Results

Best-corrected distance visual acuity increased from mean 0.48 logMAR (range 0.86-0.34) preoperatively to mean 0.02 logMAR (range 0.14 to -0.10) 1 year after surgery. Thirty-eight of 42 subjects' eyes (90.5%), which underwent bilateral surgery with implantation of the IOL, never required glasses for distance again, while 4 (9.5%) required glasses only in rare cases (eg, driving at night). The spherical equivalent was within ±0.50 D in 88 of 96 subjects (91.7%) and within ±0.75 D in 96.9% of cases. Target refraction ±1.00 D was achieved in 100% of subject eyes. No glistenings were reported in any case. From the surgeons' perspective, the wider, thicker optic-haptic transition of the IOL resulted in significantly increased stiffness, which enabled improved centering of the IOL and enhanced rotational stability and refractive predictability and stability and PCO prevention.

Conclusion

The results of this long-term observational study demonstrate the safety and efficacy of the IOL. Because of the completely new designed thicker and stiffer optic-haptic junction regarding improved characteristics of the IOL (stability in the capsular bag), some special attention has to be addressed to the slightly different behavior of the lens during implantation and unfolding process.

[Posterior capsule opacification, glistenings and visual outcomes: 3 years after implantation of a new hydrophobic IOL]

PURPOSE

To evaluate the visual outcomes, the incidence of glistenings and posterior capsule opacification in a series of consecutive eyes with a new blue light-filtering hydrophobic acrylic intraocular lens (IOL) SETTING: Service d'ophtalmologie, clinique Beausoleil, avenue de Lodève, Montpellier.

DESIGN

Retrospective, cross-sectional study.

METHODS

This study included a series of 66 eyes that underwent routine cataract surgery with PODEye (PhysIOL SA, Liège, Belgium) monofocal IOL implantation between May 2011 and November 2011. These eyes were compared for glistenings with patients implanted with Acrysof material IOL (Alcon, Fort Worth, USA) who had a routine postoperative examination between January 2015 and August 2015. The safety of the IOL was assessed by visual acuity outcomes, as well as rotational stability, centration and postoperative medication. The incidence and severity of glistenings were evaluated with the slit lamp. Glistenings and PCO were graded subjectively (0=absent; 1=moderate; 2=dense). Follow-up was 3 years.

RESULTS

The mean visual acuity after PODEye implantation was 0.98±0.05 (n=50) in decimal notation at 1 year, 0.98±0.06 at 1 week, (n=66), 1.00±0.01 at 3 weeks (n=64) and 0.99±0.02 at 3 months (n=59). The IOL displayed stable positioning in all axes. Glistenings of grade 2 were absent in the G-Free/PODEye group, whereas they were significantly present in the Acrysof group. One out of 43 eyes at 3-year follow-up underwent YAG capulotomy at 37 months. Sixty-six percent of eyes had no PCO (grade 0) at 3 years.

CONCLUSIONS

The PODEye IOL was safe and stable. Glistenings grade 2 or more were not found with this blue light-filtering hydrophobic acrylic IOL. PCO occurrence was low at three years.

A meta-analysis of Nd:YAG capsulotomy rates for two hydrophobic intraocular lens materials

Purpose

The purpose of this study is to estimate and compare neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates for AcrySof ^® and Clareon^® intraocular lens (IOL) materials using historical data from the medical literature and Alcon-sponsored clinical studies.

Methods

Clinical trials that involved the implantation of AcrySof or Clareon monofocal IOLs in subjects with cataract or presbyopia were extracted from the literature and a company repository of clinical studies. The study duration, number of eyes, and cumulative percent of Nd:YAGs for posterior capsule opacification were extracted. Bayesian random effects meta-analyses were conducted to estimate and compare outcomes for the 2 different IOL materials.

Results

A Bayesian random effects, meta-analysis was performed that combined a literature review of published AcrySof Nd:YAG posterior capsulotomy rates and Nd:YAG rates observed in Alcon-sponsored clinical studies of AcrySof and Clareon. Sixteen Alcon studies contained Nd:YAG data suitable for meta-analysis. Three of these Alcon studies contained results for the Clareon material (2 one-year studies, and 1 three-year study). The literature review included 50 papers from 1998 to 2015. In combination, 30,891 eyes were available for analysis and 2040 Nd:YAG procedures were reported in studies with a follow-up duration ranging in length from 4 months to 10 years. The overall probability of performing a Nd:YAG capsulotomy within a year of implant for AcrySof was 1.44% (1.11% to 1.83%) and 0.62% (0.21% to 1.38%) for Clareon. There was small improvement in the probability of Nd:YAG within a year of implant for Clareon lenses of about 0.82% with a 95% credible interval of (0.07% to 1.36%) at 1 year. Results were similar for incidence rates per 100 surgeries in a year: 0.62 (0.21 to 1.40) for Clareon, 1.46 (1.12 to 1.87) for AcrySof, and the difference was 0.84 (0.07 to 1.39) favoring Clareon. At 3 years, the overall probability of performing a Nd:YAG capsulotomy for AcrySof was 4.19% (3.24% to 5.30%) compared with only 1.82% (0.63% to 4.02%) for Clareon.

Conclusion

A meta-analysis of Clareon multi-piece and single-piece clinical data predicts that the cumulative Clareon Nd:YAG probability will be ≤ AcrySof by 2.37% (0.18% to 3.91%) at 3 years. The results indicate that Clareon is likely to perform as well as, and possibly better than, AcrySof in terms of Nd:YAG capsulotomy rates.

Biomaterial Influence on Intraocular Lens Performance: An Overview

There is strong evidence that the IOL material is the factor having the greatest impact on posterior capsule opacification (PCO), anterior capsule opacification (ACO) development, and glistening formation after cataract surgery, even though there are other IOL features—such as haptic material and design and edge and optic design—that also have some influence. We reviewed the published literature describing the adverse events that are mainly related to the intraocular lens (IOL) material, such as PCO, ACO, and the subsequent capsule contraction, as well as glistening formation. The adverse events presented in this overview are the most common ones in clinical practice, and therefore, they are generally included in the clinical protocols for IOL evaluation.

Further Enhancement of Intraocular Open-Capsule Devices for Prevention of Posterior Capsule Opacification

Purpose

We improve the intraocular open-capsule devices (IOCD) for the prevention of posterior capsule opacification (PCO).

Methods

A total of 45 New Zealand rabbit eyes were divided into six similar groups after crystalline lens evacuation. Each group was implanted with a hydrophilic intraocular lens (IOL) and a hydrophilic IOCD of different designs. In the first experiment (Part A), a square design ring with and without large apertures was compared to a round design ring without apertures. In the second experiment (Part B), a square design ring with large apertures was compared to square design IOCDs with small apertures of high and low density. PCO and Soemmering's ring were evaluated clinically, by the Miyake Apple view, and histologically. The results were compared to a control group of eyes implanted with a hydrophilic IOL only.

Results

All devices showed significant prevention of PCO and Soemmering's ring compared to the control group. Part A: the square design with apertures had the lowest level of peripheral lens epithelial cells proliferation (protrusions). Part B: modifying the size and density of the apertures had no influence on those protrusions.

Conclusions

The IOCD significantly reduced the rate of PCO and its precursor, Soemmering's ring. The rings with the square edges and apertures produced the best results. The study was underpowered to determine the influence of the apertures design.

Translational Relevance

The IOCD has the potential to prevent up to 80% of the PCO cases; the most common complication after cataract surgery. The design of the ring is important for its success.

Long-term efficiency of cataract surgery with hydrophilic acrylic Ioflex intraocular lens

OBJECTIVE

To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns.

METHODS

Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated.

RESULTS

The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group.

CONCLUSIONS

The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.

Nd:YAG Capsulotomy Rates With Two Trifocal Intraocular Lenses

PURPOSE

To compare Nd:YAG capsulotomy rates following implantation of two diffractive trifocal intraocular lenses (IOLs).

METHODS

This multi-center retrospective analysis included patients who underwent uncomplicated lens phacoemulsification and were implanted with a diffractive trifocal IOL: FineVision MicroF (PhysIOL, Liège, Belgium) or AT Lisa tri 839MP (Carl Zeiss Meditec, Jena, Germany). All surgeries were performed during the same period. The postoperative follow-up period was at least 1 year. Chi-square and Kaplan-Meier tests analyzed non-parametric estimates for survival/failure functions. The Wilcoxon (Breslow) test compared Nd:YAG capsulotomy rates between the two groups.

RESULTS

Of 5,130 eyes included, 3,387 were implanted with the FineVision MicroF IOL and 1,743 with the AT Lisa tri 839MP IOL. There were no statistical differences in age, axial length, or IOL power between groups. Nd:YAG capsulotomies were necessary in 330 eyes (9%) in the FineVision group and 408 eyes (23%) in the AT Lisa tri group (P < .001). The probability of having Nd:YAG capsulotomy up to 9 months postoperatively was equal for both lenses. Beyond 9 months, the Nd:YAG capsulotomy rate increased significantly more in the AT Lisa tri group, reaching a probability of 35% for eyes with a follow-up of 34 to 44 months, whereas in the FineVision group the probability was 14% after a follow-up of 37 to 47 months. The differences in survival (without Nd:YAG capsulotomy)/failure (with Nd:YAG capsulotomy) functions were significant (P < .001).

CONCLUSIONS

Eyes implanted with the FineVision MicroF IOL required significantly fewer Nd:YAG laser capsulotomies than those with the AT Lisa tri 839MP IOL during the first years after implantation. The design of the IOL platforms could account for these differences. [J Refract Surg. 2016;32(11):748-752.].

A pilot study to determine if intraocular lens choice at the time of cataract surgery has an impact on patient-reported driving habits

PURPOSE

To determine if intraocular lens (IOL) choice at the time of cataract surgery affects driving habits.

MATERIALS AND METHODS

Pseudophakes who were 28-35 months postbilateral cataract surgery with one of two contemporary one-piece hydrophobic acrylic IOLs (SN60WF or ZCB00) were asked to complete the Driving Habits Questionnaire, a validated instrument for determining self-reported driving status, frequency, and difficulty. To determine if there were any differences in driving habits between the two groups, t-tests and χ (2) tests were used.

RESULTS

Of 90 respondents, 72 (40 SN60WF and 32 ZCB00) were still active drivers. The SN60WF-implanted subjects were less likely to drive at the same speed or faster than the general flow of traffic, less likely to rate their quality of driving as average/above average, less likely to have traveled beyond their immediate neighborhood, less likely to drive at night, more likely to have moderate-to-severe difficulty driving at night, and more likely to have self-reported road traffic accidents. The differences did not reach statistical significance.

CONCLUSION

Changes in patients' driving habits 2-3 years after cataract surgery may be associated with the type of IOL implanted. A larger study, powered to demonstrate statistical significance, is needed to verify the trends identified in this pilot study and discover possible contributing factors.

Comparison of posterior capsule opacification at 360-degree square edge hydrophilic and sharp edge hydrophobic acrylic intraocular lens in diabetic patients

AIM

To compare posterior capsule opacification (PCO) degree and visual functions after phacoemulsification in eyes implanted with 360-degree square edge hydrophilic acrylic intraocular lens (IOL) (570C C-flex, Rayner) and sharp edge hydrophobic acrylic IOL (Sensar AR40e, AMO) in diabetic patients.

METHODS

Sixty diabetic patients underwent uneventful phacoemulsification and randomly implanted one of the two IOLs. The PCO value was measured by retroillumination photographs and Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software at 1, 6, 12, and 24mo after surgery. Visual acuity, and contrast sensitivity in photopic and mesopic conditions were also examined at each follow up time point. The incidence of eye that required Nd:YAG laser posterior capsulotomy were also compared.

RESULTS

There was not any statistically significant difference in PCO scores between Rayner C-flex 570C group and Sensar AR40e group at each follow up time point. Visual acuity, Nd:YAG capsulotomy incidence and contrast sensitivity also had no significant difference during the 24mo follow-up.

CONCLUSION

For diabetic patients, Rayner 570C C-flex and Sensar AR40e IOLs are same effective for prevent PCO. The 360-degree square edge design maybe is a good alternative technique to improve PCO prevention.

Glistenings 9 years after phacoemulsification in hydrophobic and hydrophilic acrylic intraocular lenses

PURPOSE

To compare the development of glistenings after implantation of a hydrophobic acrylic intraocular lens (IOL) (AcrySof SA60AT) and a hydrophilic IOL (BL27) and evaluate the effect on corrected distance visual acuity (CDVA) and contrast sensitivity 9 years postoperatively.

SETTING

St. Erik Eye Hospital, Stockholm, Sweden.

DESIGN

Prospective randomized clinical trial.

METHODS

One of 3 experienced cataract surgeons performed standard phacoemulsification in 1 eye of each patient. The patients were randomized to implantation of a hydrophobic acrylic IOL or a hydrophilic acrylic IOL. Both IOLs had sharp posterior edges. The CDVA and contrast sensitivity were measured 9 years postoperatively. Scheimpflug images of the IOLs were obtained to analyze glistenings, which were graded subjectively at the slitlamp and quantified objectively with digital image analysis using computer software.

RESULTS

Seventy-eight of the 120 patients were available for the 9-year follow-up examination. Patients with the hydrophilic IOL had statistically significantly fewer glistenings (P < .001). The development of glistenings was not correlated with IOL power, CDVA, or contrast sensitivity.

CONCLUSIONS

After 9 years, the hydrophobic IOL developed more glistenings than the hydrophilic IOL. Glistenings did not affect CDVA or contrast sensitivity.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Five-year incidence of Nd:YAG laser capsulotomy and association with in vitro proliferation of lens epithelial cells from individual specimens: a case control study

Background

The aims of this study were to determine the 5-year incidence of posterior capsule opacification (PCO) requiring Nd:YAG laser capsulotomy in a representative mixed cohort of cataract patients, to determine risk factors for PCO and to investigate possible association with growth of human lens epithelial cells (HLEC) in vitro.

Methods

Pieces of the anterior lens capsule and adhering HLEC were obtained at cataract surgery and cultured individually. After one and two weeks respectively, cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent cell layer. The 5-year incidence of Nd:YAG laser capsulotomy in this cohort was determined through medical records and by mail or telephone interviews. For statistic analyses Mann–Whitney U-test, Fisher’s exact test and binary logistic regression were used.

Results

Data on treatment/no treatment for PCO was obtained from 270 patients with a median follow-up time of 57 months (range 50–64 months). The three-year cumulative incidence of PCO was 5.2% and the cumulative 5-year incidence was 11.9%. Patients who had undergone Nd:YAG laser capsulotomy were significantly younger (median 71 years) than patients who did not receive treatment for PCO (median 75 years, p = 0.022). Logistic regression demonstrated that apart from younger age, follow-up time and type of intraocular lens (IOL) were associated with risk of PCO, with hydrophilic 1-piece IOLs conferring a higher risk than hydrophobic acrylic 1-piece or 3-piece IOLs (adjusted OR = 9.4, 95% CI 2.5-35.7, p = 0.001). Of the 270 patients from whom information could be retrieved regarding PCO treatment, in vitro cell culture could be established and quantified from 185 patients. No significant difference in cell growth in vitro was shown between patients subsequently requiring/not requiring Nd:YAG laser capsulotomy.

Conclusions

The cumulative 5-year incidence of 11.9% is comparable or slightly higher than reported in other recent studies. The type of IOL was the most important risk factor for PCO in this study, whereas intrinsic proliferative capacity of the individual’s lens epithelial cells seems to be less important for subsequent PCO development.