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Khoramnia R, Naujokaitis T, Baur ID, Hassel O, Henningsen N, Reitemeyer E, Chychko L, Łabuz G, Auffarth GU. Functional outcomes after refractive lens exchange with implantation of a glistening-free diffractive trifocal intraocular lens. Am J Ophthalmol 2024:S0002-9394(24)00351-9. [PMID: 39117256 DOI: 10.1016/j.ajo.2024.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE To evaluate visual outcomes and patient-reported results after bilateral femtosecond-laser assisted refractive lens exchange (RLE) with the implantation of a diffractive trifocal intraocular lens (IOL). DESIGN Prospective interventional case series METHODS: A study of 27 patients (54 eyes) implanted with the Clareon PanOptix (Alcon) multifocal IOL during femtosecond laser assisted RLE in a university hospital setting. The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 60cm, uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 40cm and 33cm were evaluated at three months postoperatively and compared with the preoperative values. In addition, we assessed the postoperative defocus curve, mesopic and photopic contrast sensitivity, and patient-reported spectacle independence. RESULTS The mean postoperative binocular UDVA was -0.02±0.06 logMAR and CDVA was -0.11±0.05 logMAR. The UIVA was -0.07±0.05 logMAR and DCIVA was -0.07±0.07 logMAR. The UNVA at 40cm was 0.03±0.09 logMAR and DCNVA was -0.02±0.06 logMAR; and, at 33cm UNVA was 0.14±0.10 logMAR and DCNVA was 0.11±0.08 logMAR. In comparison to the preoperative binocular CDVA (-0.12±0.08 logMAR), no statistically significant change was observed (p=1.0), while all the other binocular visual acuities improved (p<0.01). In the mean binocular defocus curve, the visual acuity was better than 0.10 logMAR in the range between +0.5 D and -3.0 D. The mean contrast sensitivity was within the normal range, and most patients reported complete spectacle independence. CONCLUSION The RLE surgery improved uncorrected visual acuity at far, intermediate and near distances without negatively affecting the CDVA. Patients achieved a high level of spectacle independence.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany.
| | - Tadas Naujokaitis
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Isabella D Baur
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Oliver Hassel
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Nikola Henningsen
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Emanuel Reitemeyer
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Lizaveta Chychko
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Grzegorz Łabuz
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
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Friedrich M, Son HS, Hassel O, Teich L, Augustin VA, Khoramnia R, Auffarth GU, Yildirim TM. Early intraocular lens explantations: 10-year database analysis. BMC Ophthalmol 2024; 24:300. [PMID: 39039537 PMCID: PMC11265132 DOI: 10.1186/s12886-024-03570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The aim of this study was to analyze the causes and characteristics of IOL explantation within the first year after primary implantation. METHODS In this retrospective, cross sectional database study, a database consisting of over 2500 IOL explants sent from 199 national and international doctors over the past 10 years was analyzed. All IOLs explanted within the first year after implantation were included in this analysis. Explants with insufficient information as well as phakic and Add-on IOLs were excluded. Main outcome measures were the reason for explantation, the time between implantation and explantation, as well as IOLs' and patients' characteristics. Additionally, the explanted IOLs were microscopically and histologically analyzed, as required. RESULTS Of all explanted IOLs from the database, 1.9% (n = 50) were explanted within the first year after implantation. The most frequent reasons for early IOL explantation were IOL dislocation (32%), visual intolerance (26%), opacification (20%), and intraoperative complications (16%). The time between implantation and explantation was the shortest in cases with intraoperative complications (1.5 ± 3.1 days), followed by IOL dislocation (90.9 ± 103.9 days), visual intolerance (98.3 ± 86.5 days), opacifications (253.5 ± 124.0 days) and other indications (249.7 ± 124.0 days). Calcification of hydrophilic IOLs was the main type of opacification (80%). Notably, seven IOLs required immediate intraoperative exchange due to an intraoperative crack in the optic or a torn off haptic. CONCLUSION Indications for early IOL explantation were IOL dislocation, visual intolerance, opacification, and intraoperative complications. Especially intraoperative damages to the IOL and early calcification show a potential for improvement of affected IOLs and implantation systems.
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Affiliation(s)
- Maximilian Friedrich
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hyeck-Soo Son
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Oliver Hassel
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Lilly Teich
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Victor Aristide Augustin
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur Mert Yildirim
- Department of Ophthalmology, The David J Apple Center for Vision Research, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Hammer M, Muuss M, Herbster L, Herth J, Scheuerle A, Khoramnia R, Labuz G, Uhl P, Auffarth GU. Viscoelastic, Optical, and Surgical Properties of Vitreous Body Replacement Hydrogels After Aging Compared to Porcine Vitreous Bodies And Silicone Oils. Transl Vis Sci Technol 2024; 13:5. [PMID: 38967936 PMCID: PMC11232910 DOI: 10.1167/tvst.13.7.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Purpose First- (monomers), second- (pre-gelated), and third- (in situ gelating after injection) generation hydrogels were previously introduced to replace the vitreous body after vitrectomy surgery. In this study, we evaluated the surgical, optical, and viscoelastic properties of vitreous body replacement hydrogels before and after an accelerated aging protocol previously applied to intraocular implants. Methods Measurements of injection force, removal speed using a clinically established vitrectomy setup, as well as evaluation of forward light scattering and viscoelastic properties before and after an accelerated aging protocol were conducted. Results were compared to porcine and human vitreous bodies, as well as currently clinically applied lighter- and heavier-than-water silicone oils. Results Removal speed of all tested hydrogels is substantially lower than the removal speed of porcine vitreous body (0.2 g/min vs. 2.7 g/min for the best performing hydrogel and porcine vitreous body, respectively). Forward light scattering in second-generation vitreous body replacement hydrogels was higher after the aging process than the straylight of the average 70-year-old vitreous body (9.4 vs. 5.5 deg2/sr, respectively). The viscoelastic properties of all hydrogels did not change in a clinically meaningful manner; however, trends toward greater stiffness and greater elasticity after aging were apparent. Conclusions This study demonstrates surgical weaknesses of the hydrogels that need to be addressed before clinical use, especially low removal speed. Pre-linked hydrogels (second-generation) showed inferior performance regarding surgical properties compared to in situ gelating hydrogels (third-generation). Translational Relevance This study highlights possible pitfalls regarding surgical and optical properties when applying vitreous replacement hydrogels clinically.
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Affiliation(s)
- Maximilian Hammer
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Marcel Muuss
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Lorenz Herbster
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Jonathan Herth
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | | | - Ramin Khoramnia
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Grzegorz Labuz
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Philipp Uhl
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
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Khoramnia R, Naujokaitis T, Łabuz G, Auffarth GU. Are There Patient-Relevant Differences in the Material Properties of Intraocular Lenses? Klin Monbl Augenheilkd 2024; 241:602-604. [PMID: 38776928 DOI: 10.1055/a-2261-1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
- Ramin Khoramnia
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
| | - Tadas Naujokaitis
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
| | - Grzegorz Łabuz
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
| | - Gerd U Auffarth
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
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Baur ID, Łabuz G, Chychko L, Yildirim TM, Naujokaitis T, Auffarth GU, Khoramnia R. In vivo comparison of implantation behavior and laboratory analysis of two preloaded intraocular lens injectors. Eur J Ophthalmol 2024; 34:766-773. [PMID: 37750504 PMCID: PMC11082425 DOI: 10.1177/11206721231204382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE We evaluated implantation behavior and injector damage of two different IOL injector systems, the Multisert and the AutonoMe. DESIGN Prospective, randomized, comparative study with laboratory investigation. METHODS We examined used injectors from 48 bilateral cataract cases and assessed video recordings of each Implantation. All eyes were intraindividually randomized for treatment with one of the two IOL injectors. Implantation videos were reviewed for inadvertent events and the time for different implantation steps was determined. The injector nozzle tips were examined using light and scanning electron microscopy (SEM). Damage was graded using the Heidelberg Score for IOL injector damage (HeiScore). Three months postoperatively, IOLs were assessed for material changes. RESULTS Implantation was without critical events in 96 of 96 eyes. Mean implantation time was 41.90 ± 7.11 s with the Multisert and 52.22 ± 12.06 s with the AutonoMe. In the AutonoMe group, we observed 4 eyes (8.3%) with a failed docking attempt, 28 eyes (58.3%) with a haptic adherence, one case (2.1%) of straight leading haptic and 2 cases (4.2%) of intrawound IOL manipulation. There were no events observed in the Multisert group. The mean HeiScore values were 0.87 ± 0.61 and 3.68 ± 0.47 for the AutonoMe and Multisert. 3 months postoperatively, IOL material changes were absent. CONCLUSIONS Both injectors allowed safe and controlled implantation. Using Multisert, implantation behavior was more consistent. The injectors showed different damage profiles with a higher damage score for the Multisert.The study is registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien; reference number: DRKS00007837).
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Affiliation(s)
- Isabella D Baur
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Grzegorz Łabuz
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Lizaveta Chychko
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Timur M Yildirim
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Tadas Naujokaitis
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Gerd U Auffarth
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Schickhardt SK, Łabuz G, Munro DJ, Lieberwirth I, Zhang L, Fang H, Auffarth GU. In-vitro assessment of a novel intraocular lens made of crosslinked polyisobutylene. J Mech Behav Biomed Mater 2024; 152:106368. [PMID: 38340476 DOI: 10.1016/j.jmbbm.2023.106368] [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: 08/24/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To describe and analyse the particularities of the material and the optical quality of the first intraocular lens (IOL) (Eyedeal® lens) made of crosslinked polyisobutylene (xPIB). METHODS We assessed the material quality using an accelerated ageing process (to provoke glistenings) and compared values with a control, AcrySof® lens. Using the sessile drop method, the contact angle of the new IOL was measured. Images of the lens surface were recorded by scanning electron microscopy (SEM). Optical quality was assessed by measuring the labeled power and modulation transfer function (MTF) using standard metrology equipment (OptiSpheric IOL PRO2). RESULTS The Eyedeal® lens had an average glistening density result of 7.46 ± 3.78 MV/mm2 compared to the control AcrySof® whose glistenings number was 142.42 ± 72.47 MV/mm2. The contact angle was 97.2° whereas the angle of AcrySof material is between 73.3 ± 2.4° and 84.4 ± 0.1°. Using SEM, Eyedeal® lenses were examined and all appeared to be comparable to modern IOLs made of acrylic materials. The power and MTF values were normal and conformed to ISO standards. CONCLUSIONS In the laboratory, the new Eyedeal® lens showed equivalence to current hydrophobic- or hydrophilic-acrylic lens models. It showed superiority in its glistening density result compared to the control lens.
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Affiliation(s)
- Sonja K Schickhardt
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Grzegorz Łabuz
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Donald J Munro
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany.
| | | | - Lu Zhang
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Hui Fang
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Gerd U Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany.
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Fernández-Vigo JI, Macarro-Merino A, De Moura-Ramos JJ, Alvarez-Rodriguez L, Burgos-Blasco B, Novo-Bujan J, Ortega-Hortas M, Fernández-Vigo JÁ. Comparative study of the glistening between four intraocular lens models assessed by OCT and deep learning. J Cataract Refract Surg 2024; 50:37-42. [PMID: 37702457 DOI: 10.1097/j.jcrs.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To evaluate the glistening in 4 different models of intraocular lenses (IOLs) using optical coherence tomography (OCT) and deep learning (DL). SETTING Centro Internacional de Oftalmología Avanzada (Madrid, Spain). DESIGN Cross-sectional study. METHODS 325 eyes were assessed for the presence and severity of glistening in 4 IOL models: ReSTOR+3 SN6AD1 (n = 41), SN60WF (n = 110), PanOptix TFNT (n = 128) and Vivity DFT015 (n = 46). The presence of glistening was analyzed using OCT, identifying the presence of hyperreflective foci (HRF) in the central area of the IOL. A manual and an original DL-based quantification algorithm designed for this purpose was applied. RESULTS Glistening was detected in 22 (53.7%) ReSTOR SN6AD1, 44 (40%) SN60WF, 49 (38.3%) PanOptix TFNT, and 4 (8.7%) Vivity DFT015 IOLs, when any grade was considered. In the comparison of the different types of IOLs, global glistening measured as total HRF was 17.3 ± 25.9 for the ReSTOR+3; 9.3 ± 15.7 for the SN60WF; 6.9 ± 10.5 for the PanOptix; and 1.2 ± 2.6 for the Vivity ( P < .05). There was excellent agreement between manual and DL-based quantification (≥0.829). CONCLUSIONS It is possible to quantify, classify and compare the glistening severity in different IOL models using OCT images in a simple and objective manner with a DL algorithm. In the comparative study, the Vivity presented the lowest severity of glistening.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- From the Centro Internacional de Oftalmología Avanzada, Madrid, Spain (J.I. Fernández-Vigo, Macarro-Merino, J.Á. Fernández-Vigo); Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain (J.I. Fernández-Vigo, Burgos-Blasco); Department of Computational, Centro de Investigacion CITIC, Universidade da Coruña, A Coruña, Spain (De Moura-Ramos, Alvarez-Rodriguez, Novo-Bujan, Ortega-Hortas); Department of Computational, VARPA Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain (De Moura-Ramos, Alvarez-Rodriguez, Novo-Bujan, Ortega-Hortas); Department of Ophthalmology, Universidad de Extremadura, Badajoz, Spain (J.Á. Fernández-Vigo)
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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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Fernández-Vigo JI, Serrano González-Peramato MT, Nunila Gómez-de-Liaño C, Sánchez-Guillén I, Fernández-Vigo JÁ, Macarro-Merino A. Glistening on intraocular lenses: A review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:493-506. [PMID: 37369324 DOI: 10.1016/j.oftale.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
The glistening in intraocular lenses (IOLs) is a phenomenon in which tiny water-filled microvacuoles (MVs) form within the IOL material, causing light to scatter and create a sparkling or shimmering effect. The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence, risk factors, evolution, and possible clinical relevance. Classically, it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp, but these were techniques that required either specific technology or an expert explorer, complex image processing, and required a lot of time. In recent years, proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs. It has been described that the manufacturing process, the hydrophobic acrylic material, or the time since surgery are risk factors for the appearance of glistening. In addition, many issues related to this phenomenon are still unknown, such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs.
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Affiliation(s)
- J I Fernández-Vigo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | | | - C Nunila Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - I Sánchez-Guillén
- Servicio de Oftalmología, Hospital Perpetuo Socorro, Badajoz, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain
| | - J Á Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain; Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - A Macarro-Merino
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain
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Yildirim TM, Auffarth GU, Henningsen N, Łabuz G, Augustin VA, Son HS, Mackenbrock LHB, Khoramnia R. Differential Diagnosis of Changes in Intraocular Lenses. Klin Monbl Augenheilkd 2023; 240:952-959. [PMID: 37567234 DOI: 10.1055/a-2130-6944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Differentiating between various intraocular lens (IOL) changes can be a challenge. In particular, certain IOL models carry the risk of late postoperative calcification. A major cause of IOL exchange surgery could be avoided if appropriate modifications were made during the IOL manufacturing process. The use of a hydrophilic acrylate carries the risk of IOL calcification, especially when a secondary procedure, such as a pars plana vitrectomy or other procedures using gas or air, is performed. In secondary IOL calcification, there is a wide range of opacification patterns, which are usually located in the centre on the anterior surface of the IOL or sometimes elsewhere. Often, granular deposits accumulate just below or on the surface of the IOL, leading to significant deterioration in visual quality and eventually requiring IOL exchange surgery. Therefore, in the case of eyes requiring secondary surgical intraocular intervention in the future, the use of hydrophilic IOLs should be critically evaluated. With regard to hydrophobic IOL materials, there are clear differences in the susceptibility to the formation of glistenings. Over time, there has been a significant decrease in glistening formation over the past 30 years due to optimisation of the material. With hydrophobic IOLs, special care should also be taken to avoid mechanical damage. In general, the only treatment option for functionally-impairing IOL opacification is surgical lens exchange, which carries potential risks of complications. In cases with a low degree of functional impairment, and especially in eyes with additional ocular diseases, it may be difficult to weigh the risk of additional surgery against the potential benefit. In some cases, it may be more appropriate not to perform an IOL exchange despite the IOL opacification. Recent visualisation methods that allow high-resolution analysis of the opacities in vivo and in vitro may be used in the future to estimate the functional effects of various IOL material changes on the optical quality.
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Affiliation(s)
| | | | | | - Grzegorz Łabuz
- Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
| | | | - Hyeck-Soo Son
- Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
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Objective Classification of Glistening in Implanted Intraocular Lenses Using Optical Coherence Tomography: Proposal for a New Classification and Grading System. J Clin Med 2023; 12:jcm12062351. [PMID: 36983351 PMCID: PMC10057385 DOI: 10.3390/jcm12062351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Purpose: To propose a classification of the glistening in intraocular lenses (IOL) using swept-source optical coherence tomography (SS-OCT) by means of a simple, objective and reproducible method that allows the quantification of the presence and severity of glistening. Methods: A cross-sectional study on a sample of 150 eyes of 150 patients who underwent cataract surgery in at least 600 days before the exam and attended a routine examination. Each subject was examined by SS-OCT after pupil dilation, identifying the presence of glistening or hyperreflective foci (HRF) in the central area of the IOL. The degree of glistening was classified into four categories: 0: ≤5 HRF; 1: 6 to 15 HRF; 2: 16 to 30 HRF; and 3: >30 HRF. The intra and interobserver reproducibility (intraclass correlation coefficient, ICC) in the quantification and classification of the glistening were calculated. The correlation between the horizontal and vertical scan of the IOL was also assessed. Results: Glistening was present in the IOL in 42.7% of the patients. The mean number of HRF or glistening microvacuoles was 10.4 ± 26.2 (range 0 to 239). In total, 63.3% of the IOLs had a grade 0, 20% grade a 1, 6.7% grade a 2 and 10% a grade 3. The intraobserver and interobserver reproducibility were very high, both for the absolute quantification of the glistening (ICC ≥ 0.994) and for the severity scale (ICC ≥ 0.967). There was an excellent correlation in the quantification of the IOL glistening between the horizontal and vertical scans (R ≥ 0.834; p < 0.001). Conclusions: The use of SS-OCT makes it possible to identify, quantify and classify IOL glistening in a simple, objective and reproducible way. This technique could provide relevant information for the study of the glistening on IOLs.
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Randomized multicenter trial to assess posterior capsule opacification and glistenings in two hydrophobic acrylic intraocular lenses. Sci Rep 2023; 13:2822. [PMID: 36805494 PMCID: PMC9938215 DOI: 10.1038/s41598-023-29855-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof (p = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups (p < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof (p < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.
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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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Bhattacharjee H, Bhattacharjee K, Das D, Javeri H, Buragohain S. Raman Spectroscopy of six explanted acrylic hydrophobic foldable intraocular lenses with glistening. Indian J Ophthalmol 2022; 70:2872-2876. [PMID: 35918934 DOI: 10.4103/ijo.ijo_3083_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To study and interpret Raman spectra of six explanted acrylic hydrophobic foldable intraocular lenses (HFIOLs) with grade six microvacuoles and to understand the possible mechanism for microvacuole formation. Methods Clinical data, slit-lamp photographs, and optical microphotographs of the explanted analytes were obtained. RS of the analytes were registered using a confocal Raman microscope (Lab RAM HR Evolution, Horiba Jobin Yvon) and Horiba Lab Space 6 Spectroscopy Suite software. Data were interpreted by identifying the functional group and fingerprint region of the spectra about the available literature. Results IOLs were explanted for visual impairment after an average interval of 11.2 years following implantation. Each of the HFIOLs exhibited distinctive and identical Raman bands at the frequency range of 200-1,800, 2,600-3,000, and 3,200-3,700 cm-1 which were identified with those reported in the literature. The unique bands and peaks of the spectra were specific to the functional groups, its ring and other stretching variations, hydroxyl group, and water molecule. A spike at 1,640 cm-1 revealed the presence of monomer and indicated material bioincompatibility of the samples. Conclusion Raman spectroscopy (RS) was found specific and an effective tool to detect the material change in the HFIOL and constituents of polymer biomaterial about microvacuole formation and also suggested modification and development of a more biocompatible and non-biodegradable polymer blend where RS could be a monitoring tool.
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Affiliation(s)
| | | | - Dipankar Das
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Henal Javeri
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Xie J, Sun J, Liu T, Mao S, Dai Y. Comparison Between L-312 Hydrophobic-Hydrophilic Acrylate and US-860 UV Hydrophilic Acrylate IOL Opacification Characteristic. Front Med (Lausanne) 2022; 9:873684. [PMID: 35463016 PMCID: PMC9024102 DOI: 10.3389/fmed.2022.873684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To compare opacity characteristics of US-860 UV and L-312 IOL, and report the phenomenon of glistenings in hydrophobic-hydrophilic acrylic IOLs. Setting Qingdao Eye Hospital. Design Experimental study. Methods Four medical records (4 eyes) of patients with L-312 or US-860 UV IOL opacification reporting decreased or lost vision who underwent IOL explanation between 2019 and 2021 were reviewed. Explanted IOLs were analyzed by slit-lamp examination, confocal microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) at Qingdao Eye Hospital and Qingdao university of science and technology. Results The 4 explanted IOLs were represented by 2 hydrophilic acrylic designs. The preoperative mean corrected distance visual acuity changed from 1.84 ± 1.09 logarithm of the minimum angle of resolution (log MAR) to 0.20 ± 0.03 log MAR postoperatively except case 3. The mean interval of the L-312 IOL was 56.67 ± 14.19 months (range 44 to 72 months), and the interval of the US-860 UV IOL was 27 months. Morphological findings were surface, subsurface calcifications of the US-860 UV IOL material, and the optical region of L-312 IOLs are teeming with a great number of vacuoles by light microscope, scanning electron microscope and Energy Dispersive X-ray Spectral. Conclusion The cause of US-860 UV opacification was primary calcification, and vacuoles resulted in L-312 IOL opacification.
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Affiliation(s)
- Jin Xie
- Department of Ophthalmology, Graduate College of Shandong First Medical University, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Jie Sun
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- People's Hospital of Yinan, Linyi, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Shilan Mao
- Department of Ophthalmology, Graduate College of Shandong First Medical University, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Yunhai Dai
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- *Correspondence: Yunhai Dai
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Britton JJL, El-Defrawy S, Wong BM, Chandrakumar M, Omali NB, Pham S, Hatch W. Patient Satisfaction and Visual Function Following Implantation of Trifocal or Extended Range of Vision Intraocular Lenses. Clin Ophthalmol 2022; 16:669-676. [PMID: 35282167 PMCID: PMC8906876 DOI: 10.2147/opth.s339385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Julia J L Britton
- Faculty of Medicine, National University of Ireland-Galway, Galway, Ireland
| | - Sherif El-Defrawy
- Department of Ophthalmology and Vision Science, Kensington Eye Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Sherif El-Defrawy, Kensington Eye Institute, 340 College Street #400, Toronto, Ontario, M5T 3A9, Canada, Tel +1 416 978-7931, Email
| | - Bryan M Wong
- Department of Ophthalmology and Vision Science, Kensington Eye Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Manokaraananthan Chandrakumar
- Department of Ophthalmology and Vision Science, Kensington Eye Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Negar B Omali
- Department of Ophthalmology and Vision Science, Kensington Eye Institute, Toronto, Ontario, Canada
| | - Song Pham
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Hatch
- Department of Ophthalmology and Vision Science, Kensington Eye Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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Mao Y, Liu H, Long Gu F, Wu MX, Wang Y. The molecular design of performance-enhanced intraocular lens composites. Biomater Sci 2022; 10:1515-1522. [PMID: 35171153 DOI: 10.1039/d1bm01919h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Intraocular lens (IOL) implantation surgery is quite effective in the treatment of blindness caused by cataracts. However, in clinical applications, IOLs readily form glistening. This phenomenon usually occurs for a period after IOL implantation ranging from a few months to several years. The molecular mechanism of the formation of glistening in IOLs is still inconclusive. Failure to understand and explain the molecular mechanism of glistening formation greatly hinders the design and application of new glistening-free IOL materials. Here, in this study, we use molecular dynamics simulation methods to conduct in-depth research on the molecular mechanism of the glistening formation of IOLs, aiming to provide a possible molecular mechanism of glistening. Furthermore, based on this molecular mechanism, we propose a novel strategy of a glistening-free material based on a composite design method to reasonably copolymerize several types of molecules or functional groups, so that the glistening phenomenon can be effectively eliminated. The possible molecular mechanism of glistening formation proposed in this research can offer a solid theoretical basis and guidance for the subsequent construction of glistening-free IOL materials.
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Affiliation(s)
- Yan Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China.
| | - Hong Liu
- Key Laboratory of Theoretical Chemistry of Environment Ministry of Education, School of Chemistry, South China Normal University, Guangzhou, Guangdong 510006, People's Republic of China.
| | - Feng Long Gu
- Key Laboratory of Theoretical Chemistry of Environment Ministry of Education, School of Chemistry, South China Normal University, Guangzhou, Guangdong 510006, People's Republic of China.
| | - Ming-Xing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China.
| | - Yan Wang
- Key Laboratory of Theoretical Chemistry of Environment Ministry of Education, School of Chemistry, South China Normal University, Guangzhou, Guangdong 510006, People's Republic of China.
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Khoramnia R, Yildirim TM, Weindler J, Naujokaitis T, Dzhambazova M, Auffarth GU. Preloaded injectors used in a clinical study: videographic assessment and laboratory analysis of injector nozzle damage. J Cataract Refract Surg 2021; 47:1338-1344. [PMID: 34469394 DOI: 10.1097/j.jcrs.0000000000000587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate quality and duration of implantation of 2 preloaded intraocular lens (IOL) injectors and assess postimplantation damage. SETTING The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. DESIGN Prospective, randomized, comparative study with laboratory investigation. METHODS Implantation videos and postuse injectors from 60 paired eyes of 30 bilateral cataract patients were included. Patient eyes were randomly assigned for implantation with 2 different preloaded injectors: the AutonoMe with a Clareon IOL (Alcon Laboratories, Inc.) and the iSert with a Vivinex IOL (Hoya Corp.). Videos were reviewed for events during the implantation procedure, and the duration of each step of implantation. Injector nozzles were examined under light and scanning electron microscopy. Damage was graded and correlated with the IOL power. Three months postoperatively IOLs were assessed for material changes. RESULTS IOL delivery was without any critical events in 60 of the 60 eyes. The implantation took 56 seconds with the AutonoMe and 44 seconds with the iSert (P < .05). Most AutonoMe injectors (29; 97%) showed no damage or slight deformation. In most of the iSert injectors (25; 80%), short or extended cracks were present, and damage lengths correlated with the IOL power. All IOLs were free of material changes, including glistenings, 3 months postoperatively. CONCLUSIONS Both preloaded IOL injectors allowed a safe and convenient IOL delivery. Implantation of the Clareon IOL took, on average, slightly longer than that of the Vivinex IOL, mostly due to a slower IOL unfolding. The AutonoMe showed less nozzle tip damage than that of the iSert.
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Affiliation(s)
- Ramin Khoramnia
- From the The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Tandogan T, Auffarth GU, Choi CY, Son HS, Khoramnia R. Comparative analysis of in vitro accelerated glistening formation in foldable hydrophobic intraocular lenses. Int Ophthalmol 2021; 41:3073-3080. [PMID: 34013467 PMCID: PMC8364527 DOI: 10.1007/s10792-021-01870-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/15/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE To analyse and compare the propensity to form glistenings in 4 different types of hydrophobic acrylic intraocular lenses (IOLs): Alcon AcrySof ® MA60AC, HOYA iSert® PC-60AD, Bausch&Lomb enVista, and Kowa Avansee™ PU6A. METHODS We used an accelerated laboratory method to create glistenings. IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h. Microvacuole (MV) density and size were documented and calculated using an image analysis program. RESULTS Median density of glistenings [MV/mm2] for Alcon AcrySof ® MA60AC was 623 (range 507-804), for HOYA iSert® PC-60AD 1358 (range 684-2699), for Bausch&Lomb enVista 2 (range 1-2), and for Kowa Avansee™ PU6A 1 (range 1-4). The prevailing MV size was: 0-5 µm for Hoya IOLs, 5-10 µm for Alcon IOLs, 20-50 µm for Bausch&Lomb IOLs, and 5-50 µm for Kowa IOLs. CONCLUSIONS Glistenings could be induced in all studied IOLs using the accelerated laboratory method. The Alcon AcrySof ® MA60AC and HOYA iSert® PC-60AD IOLs showed MV of high density, while the glistenings in the Hoya IOLs were smaller in size compared to the Alcon IOLs. The MV density was minimal in the Bausch&Lomb enVista and Kowa Avansee™ PU6A IOLs. The propensity of the Alcon AcrySof ® MA60AC IOLs to form glistenings in vitro correlated with the findings of clinical results that are already published.
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Affiliation(s)
- Tamer Tandogan
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Gerd U. Auffarth
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
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Son HS, Łabuz G, Khoramnia R, Yildirim TM, Choi CY, Knorz MC, Auffarth GU. Visualization of Forward Light Scatter in Opacified Intraocular Lenses and Straylight Assessment. Diagnostics (Basel) 2021; 11:diagnostics11081512. [PMID: 34441445 PMCID: PMC8393541 DOI: 10.3390/diagnostics11081512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Qualitative visualization of forward light scatter and quantitative straylight measurement of intraocular lenses (IOLs). Methods: We analyzed two calcified IOL-explants, the Euromaxx ALI313Y (Argonoptics GmbH) and the LS-312 MF30 (Oculentis BV), one IOL with artificially induced glistenings (PC-60AD, Hoya), and one control (CT Asphina 409MP, Carl Zeiss Meditec AG) free of any opacification. Analysis included light microscopy, qualitative light scatter visualization using ray propagation imaging technique, and quantitative straylight measurement using C-Quant (Oculus). Results: More light scattering effect—visible as increased light intensity outside the IOL’s main focus—was evident in all opacified IOLs than the control. The highest straylight levels were observed in the Euromaxx (289.71 deg2/sr), which showed extensive granular deposits throughout its optic, followed by the MF30 (78.58 deg2/sr), which only showed opacification in its center. The glistenings-IOL demonstrated numerous microvacuoles within the optic and had straylight levels of 22.6 deg2/sr, while the control showed the lowest straylight levels (1.7 deg2/sr). Conclusions: Ray propagation imaging technique allowed qualitative assessment of off-axis veils of light that result from increased forward light scattering. Straylight was increased in all opacified lenses compared to the clear control lens. The IOL opacifications are significant sources of glare.
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Affiliation(s)
- Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Grzegorz Łabuz
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Timur M. Yildirim
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Chul Young Choi
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Michael C. Knorz
- FreeVis LASIK Center, Medical Faculty Mannheim of the University of Heidelberg, 68167 Mannheim, Germany;
| | - Gerd U. Auffarth
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
- Correspondence:
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Yildirim TM, Łabuz G, Hammer M, Son HS, Schickhardt SK, Auffarth GU, Khoramnia R. A Novel Approach for Assessing Visual Impairment Caused by Intraocular Lens Opacification: High-Resolution Optical Coherence Tomography. Am J Ophthalmol 2021; 226:108-116. [PMID: 33571474 DOI: 10.1016/j.ajo.2021.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To quantify in vitro straylight induced by intraocular lens (IOL) localized opacification using an anterior segment optical coherence tomography (OCT) device. DESIGN Laboratory investigation. METHODS We obtained high-resolution OCT cross-section images of 44 explanted IOLs using a new in vitro application for an anterior segment OCT device, the Anterion (Heidelberg Engineering, Heidelberg, Germany). In 24 cases, the reason for IOL explantation was a centrally localized opacification, the sequela of a secondary ocular surgery. As a control, we used 20 IOLs removed after an IOL (sub-)luxation. Using image analysis, we found a threshold area value representing a metric for the amount of opacification in a region of interest in the IOL's central optic. We used a modified C-Quant straylight meter (Oculus, Wetzlar, Germany) to quantify light scattering. We derived a linear regression from calculating the correlation between the amount of opacification and straylight. RESULTS We visualized different amounts of IOL opacification using the OCT device. The opacified lenses showed a mean threshold area of 6.7% ± 3.3% and mean straylight was 95.1 ± 75.6 deg2/sr. The clear group's mean threshold area was 2.0% ± 0.8% and 5.0 ± 3.4 deg2/sr mean straylight. Straylight correlated statistically significantly with the threshold area, with a correlation coefficient of R2 = 0.80, P < .001. CONCLUSIONS This high-resolution OCT imaging technique can be used to visualize IOL opacities. The amount of opacification correlated well with the straylight induced by the lens. Anterior segment OCT imaging might be used in the future as a tool for predicting the extent of visual impairment and aid clinicians to quantify patients' complaints.
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Yildirim TM, Schickhardt SK, Wang Q, Friedmann E, Khoramnia R, Auffarth GU. Quantitative evaluation of microvacuole formation in five intraocular lens models made of different hydrophobic materials. PLoS One 2021; 16:e0250860. [PMID: 33930084 PMCID: PMC8087009 DOI: 10.1371/journal.pone.0250860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
In this laboratory study, we assessed the resistance to microvacuole (glistening) formation in hydrophobic intraocular lenses (IOLs). Glistenings were induced in five lenses each of five different hydrophobic acrylic IOL models, using an established in vitro laboratory model: 800C (Rayner, Worthing, UK), AcrySof SN60WF (Alcon, Fort Worth, USA), Tecnis ZCB00 (Johnson & Johnson Vision, Santa Ana, USA), Vivinex XY1 (Hoya, Tokyo, Japan) and CT Lucia 611P (Zeiss, Oberkochen, Germany). We evaluated the number of microvacuoles per square millimeter (MV/mm2) in the central part of each IOL. Results were analyzed statistically, and mean glistening numbers were ranked, with the highest in the SN60WF which had 66.0 (±45.5) MVs/mm, followed by the 611P with 30.7 (±8.4) MVs/mm2. The 800C and XY1 showed comparable values of 2.0 (±3.6) and 2.7 (±2.4) MVs/mm2, respectively. ZCB00 had the lowest number with 0.9 (±0.6) MVs/mm2. This study shows that the resistance to glistening formation differs depending on the hydrophobic acrylic copolymer composition of the IOL material. Some IOLs from current clinical use are still prone to develop glistenings whereas others, including the ZCB00, 800C and XY1 show high resistance to microvacuole formation.
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Affiliation(s)
- Timur M. Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Sonja K. Schickhardt
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Qiang Wang
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
- Department of Ophthalmology, The Third Affiliated Hospital of Wenzhou Medical University, Rui’an, Zhejiang, China
| | - Elfriede Friedmann
- Faculty of Mathematics and Natural Sciences, University of Kassel, Kassel, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Gerd U. Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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23
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Abstract
The spectrum of complications in the use of intraocular lenses (IOL) is different today from at the time of their introduction. Opacities in the IOL material are increasingly described in the literature as a reason for IOL explantation. This paper provides an overview of the different forms of IOL material opacities. Currently relevant forms of IOL material opacities and their effects on optical quality are summarized. The main reason for opacification in hydrophilic IOLs is calcification, whereas in hydrophobic IOLs it is mainly the formation of so-called glistenings that is reported. Most material opacities affect various optical parameters and lead to increased intraocular straylight. In case of a disturbing material opacification, the only therapeutic option is to replace the opacified IOL.
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24
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Khoramnia R. Eintrübung von Intraokularlinsen. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1250-3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas Spektrum an Komplikationen und die Explantationsgründe bei der Verwendung von
Intraokularlinsen (IOL) haben sich durch die Weiterentwicklung der
Kataraktchirurgie verändert. Eintrübungen des Materials beeinflussen dabei
unterschiedlich stark die optische Qualität. Im Fall einer störenden Eintrübung
des Materials ist auch heute noch – trotz aller Fortschritte auf dem Gebiet der
IOL-Materialien – ein Austausch der IOL die einzige Behandlungsoption.
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25
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Tandogan T, Auffarth GU, Son HS, Merz P, Choi CY, Khoramnia R. In-vitro glistening formation in six different foldable hydrophobic intraocular lenses. BMC Ophthalmol 2021; 21:126. [PMID: 33685428 PMCID: PMC7938589 DOI: 10.1186/s12886-021-01879-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Glistenings describe small, refractile microvacuoles that may arise within the intraocular lens (IOL) material and reduce the patients’ quality of vision. Lenses composed of hydrophobic acrylic material are particularly affected by glistening formation. In this study, we compared the tendency of glistening formation in six different types of hydrophobic acrylic intraocular lenses (IOLs). Methods We used a well-established accelerated laboratory method to develop glistenings in the following IOLs: Vivinex XY1 (Hoya), AcrySof SN60WF (Alcon), Tecnis ZCB00 (AMO), Avansee PN6A (Kowa), Aktis SP NS-60YG (Nidek), and CT Lucia 601P (Zeiss). IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h in a water bath. Microvacuole (MV) density and size (Miyata grading) were documented and calculated using an image analysis program. Results The mean glistening density [MV/mm2] and mean Miyata grading (in brackets) were: Vivinex: 11.6 ± 5.7 (0), SN60WF: 264.4 ± 110.3 (2.6), Tecnis: 6.0 ± 2.8 (0), Avansee: 2.2 ± 0.7 (0), Aktis: 851.4 ± 59.4 (3+) and CT Lucia: 71.0 ± 71.6 (1). Conclusions While all tested IOLs showed glistenings with the accelerated laboratory method, the Aktis and SN60WF showed the highest microvacuole density, followed by the CT Lucia. In comparison, the Vivinex, Tecnis, and Avansee IOLs showed far fewer number of glistenings.
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Affiliation(s)
- Tamer Tandogan
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
| | - Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Patrick Merz
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
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26
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Wang Q, Yildirim TM, Schickhardt SK, Łabuz G, Khoramnia R, Merz PR, Son HS, Munro DJ, Friedmann E, Auffarth GU. Quantification of the In Vitro Predisposition to Glistening Formation in One Manufacturer's Acrylic Intraocular Lenses Made in Different Decades. Ophthalmol Ther 2021; 10:165-174. [PMID: 33544374 PMCID: PMC7886932 DOI: 10.1007/s40123-020-00329-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Foldable hydrophobic acrylic intraocular lenses (IOLs) are prone to develop a long-term postoperative material change called glistenings. The aim of this study was to investigate the changes in the predisposition for glistening formation in one type of hydrophobic acrylic IOL material from its introduction to the present day. Methods In a laboratory setup, an in vitro model was used to induce glistenings in hydrophobic acrylic IOLs manufactured by one company (Alcon, Fort Worth, TX, USA) in different years: 23 1990s-manufacture hydrophobic acrylic three-piece IOLs (MA30BA/MA60AC) that were explanted in 1996 and 1997, and five of each of the newer AcrySof IOL models (MA60AC, SA60AT, TFNT00 and SN60WF) from 2014 to 2017. Furthermore, five Clareon (SY60WF) IOLs were put through the same accelerated aging procedure. The number of microvacuoles per square millimeter (MV/mm2) was determined in the central part of each IOL optic and compared between the groups. Results The mean number of MV was highest in the 1990s-manufacture Alcon acrylic IOLs, with 1289 (± 738) MV/mm2. The number decreased to 650 (± 101), 192 (± 105), 175 (± 112) and 47 (± 26) for MA60AC, SA60AT, TFNT00 and SN60WF, respectively. The lowest count was obtained in the Clareon group, with 1 (± 1) MV/mm2.
Conclusions A high number of glistenings was induced in the explanted IOLs from the 1990s. The propensity for glistening formation decreased considerably after that decade and now in current use. Even though in vitro glistening formation in today’s AcrySof material was low, the Clareon material was essentially glistenings-free.
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Affiliation(s)
- Qiang Wang
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.,Department of Ophthalmology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Timur M Yildirim
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Sonja K Schickhardt
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Grzegorz Łabuz
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Patrick R Merz
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Hyeck-Soo Son
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Donald J Munro
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Elfriede Friedmann
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.,Numerics and Mathematical Modeling, Institute of Mathematics, Faculty of Mathematics and Natural Sciences (FB10), University of Kassel, Kassel, Germany
| | - Gerd U Auffarth
- David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
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Abstract
PURPOSE OF REVIEW Phacoemulsification cataract surgery is one of the most commonly performed surgical procedure worldwide. In the majority of cases, intraocular lenses (IOLs) are implanted. Due to the increasing life expectancy and the fact that cataract surgery is performed in earlier stages, the anticipated IOL duration in the eye has increased over the last decades. The aim of this study was to review the types and describe the characteristics of late intraocular lens opacifications. RECENT FINDINGS Calcification was the most commonly reported type of opacification in hydrophilic IOLs; it usually negatively impacted the visual function and required IOL explantation. Glistening manifested in hydrophobic acrylic lenses and was frequent in some IOL models. In most cases glistening and subsurface nanoglistenigs do not lead to a decline in visual acuity or require IOL exchange. Current studies indicate that fluid-related phenomena may induce straylight, leading to a decrease of comfort and quality of vision. SUMMARY Several reports on late IOL opacifications have been published in recent years. In some cases, particularly in glistening, the development of the opacifications might be related to IOL aging. The influence of the fluid-related microvacuoles on the quality of vision requires further research.
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Affiliation(s)
- Piotr Kanclerz
- Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland
| | - Timur M Yildirim
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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28
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Khoramnia R, Yildirim TM, Łabuz G, Mayer CS, Auffarth GU. [Opacification of intraocular lenses: laboratory and clinical findings]. Ophthalmologe 2020; 118:633-642. [PMID: 33188443 PMCID: PMC8260513 DOI: 10.1007/s00347-020-01259-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
Hintergrund Das Spektrum der Komplikationen beim Einsatz von Intraokularlinsen (IOL) ist heute ein anderes als zur Zeit ihrer Einführung. Trübungen im IOL-Material werden vermehrt als Explantationsgrund in der Literatur beschrieben. Ziel der Arbeit Diese Arbeit soll einen Überblick über die verschiedenen Formen von IOL-Materialeintrübungen geben. Material und Methoden Die heute relevanten Formen von IOL-Materialeintrübungen und deren Auswirkungen auf die optische Abbildungsqualität wurden zusammengestellt. Ergebnisse und Diskussion Als Grund für eine Eintrübung steht bei hydrophilen IOL die Kalzifikation im Vordergrund, während bei hydrophoben IOL v. a. über die Entstehung sog. „Glistenings“ berichtet wird. Die meisten Materialeintrübungen beeinflussen verschiedene optische Parameter und führen zu einem erhöhten intraokularen Streulicht. Im Falle einer störenden Materialeintrübung besteht die einzige Therapieoption in einem Austausch der eingetrübten IOL.
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Affiliation(s)
- Ramin Khoramnia
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Timur M Yildirim
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Grzegorz Łabuz
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Christian S Mayer
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Gerd U Auffarth
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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29
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Grzybowski A, Markeviciute A, Zemaitiene R. A narrative review of intraocular lens opacifications: update 2020. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1547. [PMID: 33313292 PMCID: PMC7729367 DOI: 10.21037/atm-20-4207] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The opacifications of intraocular lenses (IOLs) can significantly impact patients visual quality. Despite the identification of specific risk factors, manufacturing changes, opacifications are not eliminated. Likewise, more attention in recent studies was paid to possible new risk factors, however one of the most important purposes of the studies remains opacifications effect on visual performance, which could be disturbed in different aspects. The aim of this review is to discuss the main risk factors of IOLs opacification in particular IOL types, and its impact on vision quality. Different risk factors were discussed in the study, including the material of IOLs, the impact of the breakdown of blood-aqueous barrier (BAB), and certain surgeries that can be associated with opacification formation. Glistenings occur more often in a hydrophobic material, however, the changes in water content of the IOLs can significantly reduce the formation of glistenings. The studies showed a significant effect of intraocular injection of exogenous air or gas during Descemet-stripping endothelial keratoplasty, Descemet-stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, and pars plana vitrectomy on calcification formation. It raises a concern, as the incidence of these surgeries is increasing. Visual acuity decreases significantly after the calcification in IOLs occurs, and it usually causes IOLs exchange. However, disability glare seems to be more affected in patients with IOLs, which were affected by glistenings than visual acuity. Disability glare is associated with increased levels of straylight, which was widely evaluated in recent studies and it was reported to be a susceptible measurement to detect the presence of IOLs pathology. For future researches, it should be noticed that disability glare and straylight are more appropriate in evaluating IOLs opacification effect on visual quality than visual acuity. While reviewing the main risk factors of IOLs opacifications particular attention must be paid on calcification occurrence in hydrophilic acrylic IOLs after surgeries with intraocular injection of exogenous air or gas.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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30
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Durr GM, Ahmed IIK. Intraocular Lens Complications: Decentration, Uveitis-Glaucoma-Hyphema Syndrome, Opacification, and Refractive Surprises. Ophthalmology 2020; 128:e186-e194. [PMID: 32652203 DOI: 10.1016/j.ophtha.2020.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
As cataract surgery has evolved, intraocular lens (IOL) complications are rare. The purpose of this review was to report the incidence, diagnosis, and management of IOL decentrations, uveitis-glaucoma-hyphema (UGH) syndrome, IOL opacifications, and refractive surprises. Literature review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Controlled Trial Database and the reference lists of original studies as well as reviews. Intraocular lens decentrations and dislocations can appear at any time, particularly in patients with predisposing factors such as pseudoexfoliation, prior vitreoretinal surgery, or trauma. Recognizing when they require surgical intervention for UGH or to improve visual function is critical in limiting long-term sequela. Intraocular lens opacifications such as glistenings rarely require intervention, but others, such as subsurface nanoglistenings, calcifications, or discolorations, may require IOL exchange. Finally, despite our best efforts to enhance measurements and IOL calculations, refractive surprises still occur. Intraocular lens complications are uncommon with modern cataract surgery. A number of these complications require proper identification and care to optimize patient outcomes.
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Affiliation(s)
- Georges M Durr
- Department of Ophthalmology, Université de Montréal, Montréal, Canada; Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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31
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Variation in intraocular lens calcification under different environmental conditions in eyes with supplementary sulcus-supported lenses. Am J Ophthalmol Case Rep 2020; 19:100797. [PMID: 32760851 PMCID: PMC7390754 DOI: 10.1016/j.ajoc.2020.100797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose Analysis of explanted intraocular lenses (IOLs) from pseudophakic eyes with supplementary sulcus-supported IOLs. Methods In this laboratory investigation, ten supplementary and capsular bag IOLs were analyzed. All lenses were received between January 2012 and March 2018. Explants were examined morphologically with histological and electron microscopic techniques and patients’ medical history was evaluated. Additionally, we used a technique new to this field: Transmission Electron Microscopy and electron diffraction pattern analysis was performed to investigate the structure of the opacifying crystals in detail. Results Eleven lenses were explanted due to IOL opacification from seven polypseudophakic eyes: In three cases the supplementary lens calcified, in three cases the capsular bag IOL (both lenses analyzed) and in one case both IOLs (only the supplementary was received). Additional surgical procedures and comorbidities included pars plana vitrectomy or Descemet stripping endothelial keratoplasty and diabetes mellitus. For each opacified lens, a varying layer of a Calcium phosphate beneath the optic surface was apparent. Crystal characterization revealed its composition to be Hydroxyapatite. Conclusions and Importance We report on a series of secondary calcification in lenses explanted from polypseudophakic eyes. In some cases, calcification occurred in the capsular bag lens, in other cases in the supplementary lens, or in both. The severity of the morphological change could be related to the comorbidities and the presence of surgery subsequent to the lens implantations. Detailed morphology of the opacifying crystals was revealed. Intraocular lenses exhibited calcification in a series of polypseudophakic eyes. Pathology occurred in the capsular bag lens, the supplementary lens, or in both. Calcification was associated with different environmental factors. Depending on the factor, morphology and pattern of the opacity differed. Transmission Electron Microscopy revealed the opacifying crystals' ultrastructure.
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32
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Yildirim TM, Fang H, Schickhardt SK, Wang Q, Merz PR, Auffarth GU. Glistening formation in a new hydrophobic acrylic intraocular lens. BMC Ophthalmol 2020; 20:186. [PMID: 32375708 PMCID: PMC7204243 DOI: 10.1186/s12886-020-01430-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background The formation of fluid-filled microvacuoles, termed glistenings, is a common complication of intraocular lenses (IOLs) made from hydrophobic acrylate. Using our well-established in-vitro laboratory method, we evaluated a new IOL material’s resistance to glistening formation. Methods An in-vitro stress test for glistening induction was performed on 20 samples of hydrophobic acrylic IOLs: ten of the new Eyecryl ASHFY600 (Biotech Vision Care, Ahmedabad, India) compared with ten samples of AcrySof IQ SN60WF (Alcon, Fort Worth, USA). The number of microvacuoles per square millimetre (MV/mm2) was evaluated in five sections of each IOL. The results for each model were compared and rated on a modified Miyata Scale for grading glistening severity. Results In all cases, glistening number was higher in the central section of the IOL optic than in the periphery. Mean number of MV/mm2 was highest in the central part of the AcrySof IQ SN60WF, with 41.84 (±27.67) MVs/mm2. The lowest number of glistenings was found in the five sections of the Eyecryl ASHFY600 with 0.52 (±0.24) MVs/mm2. Mean value of the Eyecryl ASHFY600 IOL, using the Miyata Scale, was Zero. Conclusion In this in-vitro laboratory study, the new hydrophobic acrylic IOL showed a high resistance to microvacuole formation. Results from this in-vitro study suggest that glistening numbers will be low in clinical use in the Eyecryl ASHFY600.
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Affiliation(s)
- Timur M Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hui Fang
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sonja K Schickhardt
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Qiang Wang
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Department of Ophthalmology, The Third Affiliated Hospital of Wenzhou Medical University, 108# Wansong Road, Rui'an, Zhejiang, 325200, China
| | - Patrick R Merz
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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33
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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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