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Belda JI, Placeres J, Elvira JC, Puig X, Pérez-Vives C, Zou M, Yu J, Sun S, O’Boyle D. Five-Year Incidence of Nd:YAG Capsulotomy After Cataract Surgery with Different Single-Piece Monofocal Intraocular Lenses: A Follow-Up Study of 3955 Eyes. Clin Ophthalmol 2024; 18:1599-1605. [PMID: 38855011 PMCID: PMC11162221 DOI: 10.2147/opth.s441012] [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: 09/19/2023] [Accepted: 04/18/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose To estimate the incidence of neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy up to five years after cataract surgery with different single-piece acrylic monofocal IOLs in a Spanish cohort. Patients and Methods Data were extracted from electronic medical records. Eligible participants were aged ≥65, had cataract surgery with one of five different acrylic monofocal IOLs (Alcon AcrySof, AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag and Zeiss Asphina), and more than six months baseline data. Participants were followed up to five years from surgery and up to six months from Nd:YAG. The incidence of Nd:YAG was compared between the IOLs and multivariate analyses were conducted to identify predictors of Nd:YAG incidence at five-years after cataract surgery. Results The initial cohort included 9545 patients with 14,519 eyes (53% female, average age 75 years). Of those, 3955 eyes were available for analysis five years after cataract surgery. Throughout the five years post-surgery, Nd:YAG incidence was consistently lower with Alcon Acrysof IOLs than the other IOLs. At five years the Nd:YAG incidence rate for Alcon Acrysof was 8.8%. In comparison, the incidence was 47.4% for AJL LLASY60 (OR = 9.54, 95% CI [6.57, 13.84]), 44.3% for Zeiss Asphina (OR = 8.35, 95% CI [5.85, 11.94]) and 44.0% for IOL Tech Stabibag (OR = 8.02, 95% CI [4.60, 13.84]). Conclusion Alcon AcrySof IOLs have a consistently lower risk of Nd:YAG incidence over a long follow-up period after cataract surgery, highlighting the importance of IOL choice for patients' long-term outcomes.
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Affiliation(s)
- José I Belda
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Alicante, Spain
| | - Javier Placeres
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Alicante, Spain
| | - Juan C Elvira
- Department of Ophthalmology, Hospital Universitario del Vinalopó, Alicante, Spain
| | | | | | - Ming Zou
- IQVIA Real World Solutions, Basel, Switzerland
| | - Jing Yu
- IQVIA Real World Solutions, Basel, Switzerland
| | - Shaohui Sun
- IQVIA Real World Solutions, Basel, Switzerland
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Nanavaty MA. Hydrophobic versus hydrophilic acrylic intraocular lenses within public sector based on the type of funding contacts: the debate continues. Eye (Lond) 2023; 37:3712-3713. [PMID: 37542172 PMCID: PMC10697948 DOI: 10.1038/s41433-023-02684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Mayank A Nanavaty
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, UK.
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK.
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Ting DSJ, Tatham AJ, Donachie PHJ, Buchan JC. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 16, influence of remuneration model on choice of intraocular lens in the UK. Eye (Lond) 2023; 37:3854-3860. [PMID: 37563427 PMCID: PMC10698051 DOI: 10.1038/s41433-023-02665-y] [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: 04/05/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND/OBJECTIVES Cataract surgery with intraocular lens (IOL) implantation is one of the most commonly performed surgeries worldwide. Within the UK, publicly funded cataract surgery is remunerated by two models: (1) "block contract" (BC), which commissions organisations to deliver whole service pathways without considering specific activity items; or (2) "payment by results" (PbR), which pays a tariff price for each procedure. This study aimed to examine the association between remuneration model and the cost and types of IOL used. SUBJECTS/METHODS Cataract operations recorded on the Royal College of Ophthalmologists' National Ophthalmology Database were included, with additional data collected for remuneration model from NHS England and cost of IOL from the NHS Spend Comparison Service. RESULTS We included 907,052 cataract operations from 87 centres. The majority of operations were performed in PbR centres (456 198, 50.3%), followed by BC centres (240 641, 26.5%) and mixed models centres (210 213, 23.2%). The mean price of hydrophobic (n = 7) and hydrophilic IOLs (n = 5) were £45.72 and £42.86, respectively. Hydrophobic IOLs were predominantly used (650 633, 71.7%) and were significantly more commonly used in centres remunerated by BC (96.5% vs. 3.5%) than those by PbR (65.7% vs. 34.3%) when compared to hydrophilic IOLs (p < 0.001). CONCLUSIONS This study demonstrated that the IOL choice may be perversely incentivised by the IOL cost and remuneration model. Although hydrophobic IOLs are more expensive at the point of surgery, their potential longer-term cost-effectiveness due to reduced requirement for YAG capsulotomy should be considered.
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Affiliation(s)
- Darren S J Ting
- Birmingham and Midland Eye Centre, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK
| | - John C Buchan
- The Royal College of Ophthalmologists' National Ophthalmology Audit, London, UK.
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Agarwal S, Thornell E. YAG Capsulotomy Rates in Patients Following Cataract Surgery and Implantation of New Hydrophobic Preloaded Intraocular Lens in an Australian Cohort: 3-Year Results. Clin Ophthalmol 2023; 17:3637-3643. [PMID: 38026609 PMCID: PMC10680474 DOI: 10.2147/opth.s437537] [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: 09/22/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To assess the risk of posterior capsular opacification (PCO) following implantation of the Clareon lens. Materials and Methods Retrospective analysis was performed for 484 consecutive eyes that had undergone phacoemulsification and implantation of a monofocal lens (CNA0T) between April 2018 and February 2020. Eyes with other ocular pathology that may affect outcomes, previous refractive surgery or eyes corrected for a near target were excluded. Incidence of PCO and YAG capsulotomy was recorded and regression analysis was performed to determine risk factors associated with PCO formation. Results Overall incidence of PCO following implantation of the CNA0T monofocal lens was 3.7% (18 eyes) at 1 year with 1.9% (9 eyes) undergoing YAG capsulotomy. At 3 years, 8.7% (42 eyes) had developed PCO and 4.1% (20 eyes) had undergone YAG capsulotomy cumulatively. Primary open angle glaucoma (POAG; OR = 6.53; 95% CI = 18.68, 2.28; P = 0.0005), age-related macular degeneration (AMD; OR = 2.35; 95% CI = 5.21, 1.06; P = 0.036), vitreomacular traction (VMT; OR = 7.32; 95% CI = 45.08, 1.19; P = 0.032), retinal vein occlusion (RVO; OR = 8.42; 95% CI = 38.99, 1.82; P = 0.006) and history of anti-VEGF therapy (OR = 3.22; 95% CI = 10.26, 1.01; P = 0.048) were positively associated with an increased risk of PCO. Conclusions Incidence of PCO requiring YAG capsulotomy was relatively low. However, certain co-morbidities were found to increase the risk of PCO development, most significantly POAG and RVO.
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Affiliation(s)
- Smita Agarwal
- Wollongong Eye Specialists, Wollongong, NSW, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Erin Thornell
- Wollongong Eye Specialists, Wollongong, NSW, Australia
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Schallhorn SC, Teenan D, Venter JA, Schallhorn JM, Hannan SJ. Early Clinical Experience with a New Hydrophobic Acrylic Single-Piece Monofocal Intraocular Lens. Clin Ophthalmol 2023; 17:3419-3427. [PMID: 38026603 PMCID: PMC10655610 DOI: 10.2147/opth.s433530] [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: 08/02/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To evaluate early clinical outcomes and adverse events (AEs) in cataract patients following implantation of a monofocal hydrophobic acrylic IOL with a new optimized non-constant aberration-correcting design (CT LUCIA 621P). Methods This retrospective study included patients with visually significant cataracts who underwent implantation of the CT LUCIA 621P IOL. Refraction, corrected (CDVA) and uncorrected (UDVA) visual acuity of the last available visit were used in the analysis. Intraoperative and postoperative AEs of the cohort were reviewed. Results A total of 191 eyes of 133 patients with the mean age of 70.2±11.2 years were included in this study. The mean follow-up time of the last available visit was 1.7±1.3 months. The mean postoperative monocular UDVA was 0.09±0.16 logMAR (≈20/25), and 74.9% (143/191) eyes achieved ≥20/25 UDVA. The percentage of eyes with manifest spherical equivalent (MSE) within ±0.50D and ±1.00D of emmetropia was 84.8% (162/191) and 98.4% (188/191), respectively. Linear regression of attempted vs achieved MSE showed a tight relationship, with the coefficient of determination close to 1 (R2=0.99), indicating a very predictable refractive correction. The reported AEs were those typically expected after cataract surgery. There were no AEs related to intraoperative manipulation with the IOL/injector or to postoperative stability of the IOL in the capsular bag. No eye lost ≥2 lines of CDVA. Conclusion The implantation of CT LUCIA 621P resulted in good refractive predictability and visual outcomes. No IOL-related adverse events were reported.
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Affiliation(s)
- Steven C Schallhorn
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Optical Express, Glasgow, UK
- Carl Zeiss Meditec, Inc, Dublin, CA, USA
| | | | | | - Julie M Schallhorn
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California, San Francisco, CA, USA
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Nuijts RM, Bhatt U, Nanavaty MA, Roberts TV, Peterson R, Teus MA. Three-year multinational clinical study on an aspheric hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2023; 49:672-678. [PMID: 36848238 PMCID: PMC10284131 DOI: 10.1097/j.jcrs.0000000000001173] [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: 09/06/2022] [Revised: 01/23/2023] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To present the results of a study investigating the 3-year effectiveness and safety of the Clareon single-piece intraocular lens (IOL). SETTING 19 multinational sites. DESIGN Prospective multicenter single-arm study. METHODS Patients were bilaterally implanted with Clareon IOLs. Assessments included uncorrected distance visual acuity, corrected distance visual acuity (CDVA), manifest refraction, tilt, decentration, applanation tonometry, and fundus examination, including glistenings and posterior capsule opacification (PCO) evaluation. The primary outcomes for effectiveness and safety were evaluated at 1 year and compared with ISO historical safety and performance endpoint (SPE) rates. Patients were followed for up to 3 years after implantation. RESULTS 424 eyes of 215 patients were implanted (n = 215 first eye, n = 209 second eye), and 183 patients completed the trial at 3 years (with 364 binocular and 1 monocular patient). At 1 year, the cumulative and persistent adverse event rates were below SPE targets, and 99.5% of eyes achieved a monocular CDVA of ≤0.3 logMAR (vs the SPE target of 92.5%). At 3 years, the mean monocular CDVA was -0.032, with 93.4% (341/365) of eyes achieving a CDVA of 0.1 logMAR or better, 100% of eyes presented with grade 0 glistenings ≤25 MV/mm 2 , and 92.9% of eyes (394/424) had either no PCO or clinically nonsignificant PCO. CONCLUSIONS This study supports the long-term safety and effectiveness of the Clareon IOL. The visual outcomes were excellent and stable over the 3-year study period, PCO rates were very low, and 100% of IOLs had grade 0 glistenings.
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Affiliation(s)
- Rudy M.M.A. Nuijts
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Uday Bhatt
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Mayank A. Nanavaty
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Timothy V. Roberts
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Rachael Peterson
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Miguel A. Teus
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
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Hong Y, Fang Q, Bai T, Zhao P, Han Y, Lin Q. Cascade reaction triggering and photothermal AuNPs@MIL MOFs doped intraocular lens for enhanced posterior capsular opacification prevention. J Nanobiotechnology 2023; 21:134. [PMID: 37095517 PMCID: PMC10127092 DOI: 10.1186/s12951-023-01897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023] Open
Abstract
Posterior capsular opacification (PCO) is the most common complication after cataract surgery. Present strategies can't meet the clinical needs of long-term prevention. This research reports a novel intraocular lens (IOL) bulk material with high biocompatibility and synergistic therapy. Gold nanoparticles (AuNPs) doped MIL-101-NH2 metal-organic frameworks (MOFs) (AuNPs@MIL) was firstly fabricated via in situ reductions. Then the functionalized MOFs were uniformly mixed with glycidyl methacrylate (GMA) and 2-(2-ethoxyethoxy) ethyl acrylate (EA) to form the nanoparticle doped polymer (AuNPs@MIL-PGE), and which was used to fabricate IOL bulk materials. The materials' optical and mechanical properties with different mass contents of nanoparticles are investigated. Such bulk functionalized IOL material could efficiently remove residual human lens epithelial cells (HLECs) in the capsular bag in the short term, and can prevent PCO on demand in the long run by near-infrared illumination (NIR) action. In vivo and in vitro experiments demonstrate the biosafety of the material. The AuNPs@MIL-PGE exhibits excellent photothermal effects, which could inhibit cell proliferation under NIR and doesn't cause pathological effects on the surrounding tissues. Such functionalized IOL can not only avoid the side effects of the antiproliferative drugs but also realize the enhanced PCO prevention in clinical practice.
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Affiliation(s)
- Yueze Hong
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Qiuna Fang
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ting Bai
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Peiyi Zhao
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yuemei Han
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Quankui Lin
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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8
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van Vught L, Que I, Luyten GPM, Beenakker JWM. Effect of anatomical differences and intraocular lens design on negative dysphotopsia. J Cataract Refract Surg 2022; 48:1446-1452. [PMID: 36449675 DOI: 10.1097/j.jcrs.0000000000001054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/30/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To assess the effect of ocular anatomy and intraocular lens (IOL) design on negative dysphotopsia (ND). SETTING Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. DESIGN Ray-tracing study based on clinical data. METHODS Ray-tracing simulations were performed to assess the effect of anatomical differences and differences in IOL design on the peripheral retinal illumination. To that end, eye models that incorporate clinically measured anatomical differences between eyes of patients with ND and eyes of pseudophakic controls were created. The anatomical differences included pupil size, pupil centration, and iris tilt. The simulations were performed with different IOL designs, including a simple biconvex IOL design and a more complex clinical IOL design with a convex-concave anterior surface. Both IOL designs were analyzed using a clear edge and a frosted edge. As ND is generally considered to be caused by a discontinuity in peripheral retinal illumination, this illumination profile was determined for each eye model and the severity of the discontinuity was compared between eye models. RESULTS The peripheral retinal illumination consistently showed a more severe discontinuity in illumination with ND-specific anatomy. This difference was the least pronounced, 8%, with the frosted edge clinical IOL and the most pronounced, 18%, with the clear edge biconvex IOL. CONCLUSIONS These results show that small differences in the ocular anatomy or IOL design affect the peripheral retinal illumination. Therewith, they can increase the severity of ND by up to 18%.
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Affiliation(s)
- Luc van Vught
- From the Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands (van Vught, Luyten, Beenakker); C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (van Vught, Beenakker); Translational Nanobiomaterials and Imaging Group, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (Que); Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands (Beenakker)
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Xia Y. The management of cataract surgery in diabetic patients. J Perioper Pract 2022; 32:361-367. [PMID: 35445624 DOI: 10.1177/17504589221091063] [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: 01/12/2023]
Abstract
A cataract in the eye is a major cause of vision loss in diabetic patients, which occurs earlier and develops faster than non-diabetic patients, and often requires surgery for treatment. However, diabetic patients undergoing cataract surgery have a higher risk of intraoperative and postoperative complications than non-diabetic patients. For diabetic patients undergoing any surgery, careful perioperative assessment and management are required to reduce postoperative complications and improve surgical outcomes. Better understanding of their needs may guide perioperative practitioners to manage their care appropriately. This article presents recent evidence and guidance associated with the preoperative, intraoperative and postoperative management of diabetic patients undergoing cataract surgery and to inform perioperative practitioners of the challenges and potential complications to provide the best care and improve sight.
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Affiliation(s)
- Yu Xia
- Beijing Aerospace General Hospital, Beijing, China
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10
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Hong Y, Zou H, Hu Y, Fei F, Liang L, Liu D, Han Y, Lin Q. Design of foldable, responsively drug-eluting polyacrylic intraocular lens bulk materials for prevention of postoperative complications. J Mater Chem B 2022; 10:8398-8406. [PMID: 36250493 DOI: 10.1039/d2tb01974d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Posterior capsular opacification (PCO), resulting from undesired intracapsular cell proliferation, is the most common complication of intraocular lens (IOL) implantation after cataract surgery. In recent years, IOLs have been developed into a drug delivery platform. Compared with traditional eye drops, drug-loaded IOLs have the characteristics of independent patient compliance and no other operation except surgical implantation. In this work, a series of poly(glycidyl methacrylate-co-2-(2-ethoxyethoxy)ethyl acrylate) (PGE) acrylic intraocular lens materials were synthesized as drug delivery platforms. The PGE synthesized with 10% crosslinking agent has excellent optical, foldable, and thermomechanical properties. An aldehyde group was subsequently introduced into the PGE chains, and an antiproliferative drug (doxorubicin) was immobilized onto the PGE chains via an H+-sensitive imine bond. The IOL exhibits H+-dependent Dox release behavior in a simulated pathological environment. The in vitro and in vivo systematical evaluations indicate that such a responsively drug-eluting PGE IOL can effectively prevent PCO.
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Affiliation(s)
- Yueze Hong
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
| | - Haoyu Zou
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
| | - Yulin Hu
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
| | - Fan Fei
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
| | - Lin Liang
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
| | - Dong Liu
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
| | - Yuemei Han
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
| | - Quankui Lin
- Department of Biomaterials, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, P. R. China.
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11
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Schallhorn SC, Bonilla M, Pantanelli SM. Outcomes of a multicenter U.S. clinical trial of a new monofocal single-piece hydrophobic acrylic IOL. J Cataract Refract Surg 2022; 48:1126-1133. [PMID: 35333839 PMCID: PMC9514744 DOI: 10.1097/j.jcrs.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of the CT LUCIA 611P intraocular lens (IOL) in patients with cataracts. SETTING 23 surgeons at 15 different clinical sites. DESIGN Prospective single-arm clinical trial. METHODS The study was conducted under an Investigational Device Exemption for premarket approval of a new hydrophobic acrylic IOL in the United States. Patients were followed for 12 months, and the main measured variables included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and adverse events. RESULTS In total, 339 eyes of 339 patients were implanted with the study device, of which 310 (91.4%) reached the 12-month visit. The percentage of eyes within ±0.50 diopter (D) and ±1.00 D of emmetropia was 85.8% (266/310) and 96.8% (300/310), respectively. Manifest refraction spherical equivalent (MRSE) remained stable over the first year with the mean 12-month MRSE of -0.03 ± 0.45 D. The mean 12-month UDVA and CDVA were 0.09 ± 0.15 (≈20/25) and -0.02 ± 0.09 (≈20/19) logMAR, respectively. Of all patients, 99.4% (308/310) achieved postoperative CDVA ≥20/40. The incidence of Nd:YAG capsulotomy within the first year was 3.5% (11/310). Only 2 eyes had IOL tilt present at the 12-month postoperative visit with no associated visual symptoms. There were 2 cases of IOL decentration; one required removal of the IOL, whereas the other had no visual side effects related to decentration. There were no findings of glistening at any visit. CONCLUSIONS The CT LUCIA 611P IOL demonstrated excellent safety, efficacy, and stability of refractive outcomes. No significant issues related to the biocompatibility of the IOL material were observed.
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Grzybowski A, Zemaitiene R, Markeviciute A, Tuuminen R. Should We Abandon Hydrophilic Intraocular Lenses? Am J Ophthalmol 2022; 237:139-145. [PMID: 34843687 DOI: 10.1016/j.ajo.2021.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize the features of hydrophilic intraocular lenses (IOLs) important in the clinical context of expected prolonged duration time of the IOL within the eye. DESIGN Perspective. METHODS Discussion includes possible factors and mechanisms associated with hydrophilic IOLs' susceptibility to calcification and posterior capsule opacification (PCO) formation. RESULTS Results of recently reported studies show that particular surgeries, such as pars plana vitrectomy, Descemet stripping (automated) endothelial keratoplasty, and Descemet membrane endothelial keratoplasty with intraocular gas or air injection, might predispose the calcification process of hydrophilic IOLs, leading to a significant decrease in visual quality and possibly explantation of the IOL. Hydrophilic IOLs are more susceptible than hydrophobic IOLs to PCO formation, which is the most common of late postoperative complications that are associated with significant side effects. CONCLUSIONS We believe that all patients should be informed about the higher risk of calcification and PCO associated with hydrophilic IOLs. We also recommend limiting the use of hydrophilic acrylic IOLs during cataract surgery, especially when it is combined with pars plana vitrectomy or endothelial keratoplasty, and in patients with endothelial diseases who will probably require operation on it in the future.
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Affiliation(s)
- Andrzej Grzybowski
- From the Department of Ophthalmology, University of Warmia and Mazury, (A.G.), Olsztyn; Institute for Research in Ophthalmology (A.G.), Poznan, Poland.
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences (R.Z., A.M.), Kaunas, Lithuania
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences (R.Z., A.M.), Kaunas, Lithuania
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki (R.T.), Helsinki; Department of Ophthalmology, Kymenlaakso Central Hospital (R.T.), Kotka, Finland
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Agarwal S, Thornell E. Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim:
This study aimed to compare the performance of two monofocal Intraocular Lenses (IOL) platforms.
Background:
The Clareon® Intraocular Lens (IOL) is a relatively new monofocal lens platform designed to improve postoperative results compared to other monofocal platforms.
Objective:
This study aimed to assess and compare the visual and refractive outcomes, and incidence of YAG capsulotomy of the Clareon® IOL and a standard non-preloaded AcrySof® monofocal IOL following contralateral implantation in patients undergoing cataract surgery.
Methods:
A total of 20 patients (40 eyes; 12 female, average age 72.8±6.4 years) who had undergone contralateral implantation of an AcrySof® IQ monofocal lens (SN60WF or SN6AT; Alcon; Texas, USA) and a Clareon®monofocal lens (CNAOT0; Alcon; Texas, USA) were selected. Uncorrected Distance Visual Acuity (UDVA), Contrast Sensitivity (CS), kinetic perimetry, and refraction were measured 1 month following the second surgery and subjective vision was measured 6 months following the second surgery using a quality-of-life questionnaire.
Results:
There was no difference in postoperative UDVA (P=0.94), CS (P>0.05), or refraction (P=0.64) between eyes that received the Clareon® and AcrySof® IQ lenses. Clareon® eyes had a higher incidence of glare/haloes and positive dysphotopsia while AcrySof® IQ eyes had a higher incidence of negative dysphotopsia. Patient satisfaction was similar between the groups (P=0.86), although 25% of patients reported more clarity in the eye that received the Clareon® lens. The incidence of posterior capsular opacification was low for both groups.
Conclusion:
Clareon® and AcrySof® IQ lenses perform similarly, providing good refractive, visual, and subjective outcomes. Clareon® is available as a preloaded lens option and may reduce PCO and the need for Nd: YAG capsulotomy.
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Maedel S, Evans JR, Harrer-Seely A, Findl O. Intraocular lens optic edge design for the prevention of posterior capsule opacification after cataract surgery. Cochrane Database Syst Rev 2021; 8:CD012516. [PMID: 34398965 PMCID: PMC8406949 DOI: 10.1002/14651858.cd012516.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posterior capsule opacification (PCO) is a clouding of the posterior part of the lens capsule, a skin-like transparent structure, which surrounds the crystalline lens in the human eye. PCO is the most common postoperative complication following modern cataract surgery with implantation of a posterior chamber intraocular lens (IOL). The main symptoms of PCO are a decrease in visual acuity, 'cloudy', blurred vision and reduced contrast sensitivity. PCO is treated with a neodymium:YAG (Nd:YAG) laser to create a small opening in the opaque capsule and regain a clear central visual axis. This capsulotomy might cause further ocular complications, such as raised intraocular pressure or swelling of the central retina (macular oedema). This procedure is also a significant financial burden for health care systems worldwide. In recent decades, there have been advances in the selection of IOL materials and optimisation of IOL designs to help prevent PCO formation after cataract surgery. These include changes to the side structures holding the lens in the centre of the lens capsule bag, called IOL haptics, and IOL optic edge designs. OBJECTIVES To compare the effects of different IOL optic edge designs on PCO after cataract surgery. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE, Ovid Embase, Latin American and Caribbean Health Sciences Literature Database (LILACS), the ISRCTN registry, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 17 November 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared different types of IOL optic edge design. Our prespecified primary outcome was the proportion of eyes with Nd:YAG capsulotomy one year after surgery. Secondary outcomes included PCO score, best-corrected distance visual acuity (BCDVA) and quality of life score at one year. Due to availability of important long-term data, we also presented data at longer-term follow-up which is a post hoc change to our protocol. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane and the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 10 studies (1065 people, 1834 eyes) that compared sharp- and round-edged IOLs. Eight of these studies were within-person studies whereby one eye received a sharp-edged IOL and the fellow eye a round-edged IOL. The IOL materials were acrylic (2 studies), silicone (4 studies), polymethyl methacrylate (PMMA, 3 studies) and different materials (1 study). The studies were conducted in Austria, Germany, India, Japan, Sweden and the UK. Five studies were at high risk of bias in at least one domain. We judged two studies to be at low risk of bias in all domains. There were few cases of Nd:YAG capsulotomy at one year (primary outcome): 1/371 in sharp-edged and 4/371 in round-edged groups. The effect estimate was in favour of sharp-edged IOLs but the confidence intervals were very wide and compatible with higher or lower chance of Nd:YAG capsulotomy in sharp-edged compared with round-edged lenses (Peto odds ratio (OR) 0.30, 95% CI 0.05 to 1.74; I2 = 0%; 6 studies, 742 eyes). This corresponds to seven fewer cases of Nd:YAG capsulotomy per 1000 sharp-edged IOLs inserted compared with round-edged IOLs (95% CI 9 fewer to 7 more). We judged this as low-certainty evidence, downgrading for imprecision and risk of bias. A similar reduced risk of Nd:YAG capsulotomy in sharp-edge compared with round-edge IOLs was seen at two, three and five years but as the number of Nd:YAG capsulotomy events increased with longer follow-up this effect was more precisely measured at longer follow-up: two years, risk ratio (RR) 0.35 (0.16 to 0.80); 703 eyes (6 studies); 89 fewer cases per 1000; three years, RR 0.21 (0.11 to 0.41); 538 eyes (6 studies); 170 fewer cases per 1000; five years, RR 0.21 (0.10 to 0.45); 306 eyes (4 studies); 331 fewer cases per 1000. Data at 9 years and 12 years were only available from one study. All studies reported a PCO score. Four studies reported the AQUA (Automated Quantification of After-Cataract) score, four studies reported the EPCO (Evaluation of PCO) score and two studies reported another method of quantifying PCO. It was not possible to pool these data due to the way they were reported, but all studies consistently reported a statistically significant lower average PCO score (of the order of 0.5 to 3 units) with sharp-edged IOLs compared with round-edged IOLs. We judged this to be moderate-certainty evidence downgrading for risk of bias. The logMAR visual acuity score was lower (better) in eyes that received a sharp-edged IOL but the difference was small and likely to be clinically unimportant at one year (mean difference (MD) -0.06 logMAR, 95% CI -0.12 to 0; 2 studies, 153 eyes; low-certainty evidence). Similar effects were seen at longer follow-up periods but non-statistically significant data were less fully reported: two years MD -0.01 logMAR (-0.05 to 0.02); 2 studies, 311 eyes; three years MD -0.09 logMAR (-0.22 to 0.03); 2 studies, 117 eyes; data at five years only available from one study. None of the studies reported quality of life. Very low-certainty evidence on adverse events did not suggest any important differences between the groups. AUTHORS' CONCLUSIONS This review provides evidence that sharp-edged IOLs are likely to be associated with less PCO formation than round-edged IOLs, with less Nd:YAG capsulotomy. The effects on visual acuity were less certain. The impact of these lenses on quality of life has not been assessed and there are only very low-certainty comparative data on adverse events.
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Affiliation(s)
- Sophie Maedel
- Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Jennifer R Evans
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Oliver Findl
- Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
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Leydolt C, Schartmüller D, Schwarzenbacher L, Röggla V, Schriefl S, Menapace R. Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial. Am J Ophthalmol 2020; 217:224-231. [PMID: 32335056 DOI: 10.1016/j.ajo.2020.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years. DESIGN Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. PATIENT POPULATION Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye. OBSERVATION PROCEDURES Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA). MAIN OUTCOME MEASURE PCO score (scale, 0-10). RESULTS The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23). CONCLUSION The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.
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16
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Schartmüller D, Schriefl S, Schwarzenbacher L, Leydolt C, Kundi M, Pieh S, Menapace R, Kriechbaum K. Posterior capsule opacification and Nd:YAG laser rates with two hydrophobic acrylic single-piece IOLs. Eye (Lond) 2020; 34:857-863. [PMID: 31485039 PMCID: PMC7182578 DOI: 10.1038/s41433-019-0569-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/26/2019] [Accepted: 08/07/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To evaluate the development of posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates following implantation of two hydrophobic acrylic IOLs. METHODS In a randomized, controlled trial, 80 patients with bilateral senile cataract were implanted with the hydrophobic acrylic single-piece intraocular Lenses (IOLs) EyeCee One in one eye and iMics1 in the other. Outcomes of 39 patients (78 eyes) were evaluated after 3 years. Automated Quantification of After-Cataract (AQUA; for PCO occurrence), visual acuity, anterior fibrosis, capsule-optic edge interaction and distance between anterior and posterior capsule IOL surface were analysed. RESULTS After a mean follow-up of 38 ± 1.95 months, Nd:YAG capsulotomy occurred at a rate of 15.4% and 46.2% in the EyeCee One and iMics1 groups, respectively (p < 0.01). Respective mean PCO scores measured by AQUA were 1.57 ± 1.63 and 2.45 ± 1.44 (p = 0.019). A distinct gap between the anterior capsule and the IOL optic was present in 89% of eyes implanted with EyeCee One and 13% of iMics1 eyes. A gap between the posterior capsule and the posterior surface of the lens was observed in 76% of EyeCee One eyes and 35% of iMics1 eyes. CONCLUSIONS Study findings suggest that PCO and Nd:YAG capsulotomy rates are significantly lower in eyes implanted with the EyeCee One IOL compared to the iMics1 IOL. Optic sharpness and lens material seem to be the decisive factors, while the stepped edge beneath the haptic junction appeared to be ineffective.
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Affiliation(s)
- Daniel Schartmüller
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Sabine Schriefl
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christina Leydolt
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Stephan Pieh
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Katharina Kriechbaum
- Department of Ophthalmology and Optometry of the Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
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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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18
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Visual and refractive outcomes and glistenings occurrence after implantation of 2 hydrophobic acrylic aspheric monofocal IOLs. J Cataract Refract Surg 2020; 46:986-994. [PMID: 32271271 DOI: 10.1097/j.jcrs.0000000000000201] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Menapace R, Schriefl S, Lwowski C, Leydolt C. Impact of primary posterior capsulorhexis on regeneratory after-cataract and YAG laser rates with an acrylic micro-incision intraocular lens with plate haptics: 1-year and 3-year results. Acta Ophthalmol 2019; 97:e1130-e1135. [PMID: 31197967 PMCID: PMC6899841 DOI: 10.1111/aos.14156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022]
Abstract
Purpose To evaluate the posterior capsule opacification (PCO) and YAG laser capsulotomy (YAG‐LCT) rates with a plate‐haptic acrylic micro‐incision intraocular lens (IOL) and the impact of primary posterior capsulorhexis. Methods A total of 97 patients scheduled for immediate sequential bilateral cataract surgery underwent a randomized, prospective intraindividual comparison with the ZEISS Asphina 409MV plate‐haptic acrylic IOL with the eyes receiving an additional primary posterior capsulorhexis (PPCR) or not. YAG‐LCT and PCO rates were evaluated at 1 and 3 years. Three‐year PCO rates were calculated with a 3‐scenario method for eyes that underwent YAG‐LCT between 1 and 3 years. Results A total of 56 patients were seen at 1 year, and 57 at 3 years. For the eyes without and with PPCR, YAG‐LCT rates were 14.3% and 0% at 1 year, and 59.7% and 3.5% at 3 years, respectively. Opacification rates at 1 year were 0.55 ± 0.99 and 0.05 ± 0.21 for the central 2‐mm optic zone. A total of 42 patients completed both the 1‐ and 3‐year follow‐up. Three‐year opacification rates for the group without PPCR were 1.99 ± 2.20, 2.26 ± 2.66 and 3.66 ± 3.61 for the central 2‐mm zone and 2.57 ± 2.07, 3.13 ± 3.03 and 4.09 ± 3.34 for the 4.5‐mm zone for the best, extrapolated and worst‐case scenarios, respectively. Conclusion The ZEISS Asphina 409MV plate‐haptic acrylic IOL exhibited unusually high YAG‐LCT and PCO rates with standard in‐the‐bag implantation. PPCR was safe and effective in preventing central opacification and the need for YAG laser treatment.
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Affiliation(s)
- Rupert Menapace
- Department of Ophthalmology Medical University of Vienna Vienna Austria
| | - Sabine Schriefl
- Department of Ophthalmology Medical University of Vienna Vienna Austria
| | - Christoph Lwowski
- Department of Ophthalmology Medical University of Vienna Vienna Austria
| | - Christina Leydolt
- Department of Ophthalmology Medical University of Vienna Vienna Austria
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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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