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Jiang Z, Zhang N, Dong J. Reversible deposition of inflammatory cells on the surface of an intraocular lens in a patient with uveitis: Case report and literature review. Eur J Ophthalmol 2022; 33:NP126-NP130. [PMID: 35243920 DOI: 10.1177/11206721221086156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The deposition of inflammatory cells on an intraocular lens (IOL) is a rare but potentially serious complication. We report a patient who presented with reversible severe deposition of inflammatory cells on the anterior surface of a hydrophobic IOL. CASE DESCRIPTION A 68-year-old woman with remissive uveitis presented with blurred vision in her right eye that persisted for 1 month. She had undergone cataract surgery and hydrophobic IOL (ZA9003, Johnson & Johnson Surgical Vision) implantation 3 months before presentation. Deposition of inflammatory cells was diagnosed by ocular examination. The IOL became transparent after 6 months of treatment with combined antibiotic/steroid eyedrops (tobramycin/dexamethasone eyedrops) and atropine. However, the cellular deposition recurred after either discontinuing the tobramycin/dexamethasone eyedrops or switching to steroid-only eyedrops (fluorometholone). Therefore, she was prescribed continuous tobramycin/dexamethasone eyedrops, twice-daily, and her IOL remained transparent at the time of submission of this article. CONCLUSIONS We have reported a case of reversible severe deposition of inflammatory cells on the anterior surface of a hydrophobic IOL in a patient with uveitis that was managed by continuous administration of combined antibiotic/steroid eyedrops. The morphology of the inflammatory cells deposits and the treatment differed from those of previously reported cases.
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Affiliation(s)
- Zhijian Jiang
- Department of Ophthalmology, 117880Shanghai Xuhui Central Hospital, Shanghai, China
| | - Nan Zhang
- Department of Ophthalmology, 117880Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianhong Dong
- Department of Ophthalmology, 117880Shanghai Xuhui Central Hospital, Shanghai, China
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Resurgence of inflammatory giant-cell deposits in modern surface-modified intraocular lenses. J Cataract Refract Surg 2021; 46:149-151. [PMID: 32050246 DOI: 10.1097/j.jcrs.0000000000000003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah A, Rao C, Kumar K, George RJ, Dutta Majumder P. Inflammatory deposits on the foldable intraocular lens. Indian J Ophthalmol 2020; 68:190-191. [PMID: 31856509 PMCID: PMC6951167 DOI: 10.4103/ijo.ijo_1359_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amravi Shah
- Department of Uvea and Intraocular Inflammation, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Chetan Rao
- Department of Uvea and Intraocular Inflammation, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Krishna Kumar
- Department of Uvea and Intraocular Inflammation, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ronnie Jacob George
- Department of Uvea and Intraocular Inflammation, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Department of Uvea and Intraocular Inflammation, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Abela-Formanek C, Amon M, Kahraman G, Schauersberger J, Dunavoelgyi R. Biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in eyes with uveitis having cataract surgery: Long-term follow-up. J Cataract Refract Surg 2011; 37:104-12. [DOI: 10.1016/j.jcrs.2010.07.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 01/15/2010] [Accepted: 07/21/2010] [Indexed: 11/29/2022]
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Uveal and capsular biocompatibility of an intraocular lens with a hydrophilic anterior surface and a hydrophobic posterior surface. J Cataract Refract Surg 2010; 36:290-8. [DOI: 10.1016/j.jcrs.2009.09.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/14/2009] [Indexed: 11/20/2022]
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Affiliation(s)
- Lynn J P Perry
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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Mohammadpour M, Jafarinasab MR, Javadi MA. Outcomes of acute postoperative inflammation after cataract surgery. Eur J Ophthalmol 2007; 17:20-8. [PMID: 17294379 DOI: 10.1177/112067210701700104] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine characteristics and final visual and surgical outcomes of patients who experienced early onset postoperative inflammation after cataract surgery and their early and late complications. METHODS This is a prospective case series of 126 patients out of 1500 cases who underwent cataract surgery and experienced early onset postoperative inflammation during the first 2 weeks after cataract surgery. All the patients received complete ocular examinations at onset of signs and symptoms of inflammation. A total of 110 patients with follow-up examinations between 3 and 30 months after recovery of early onset postoperative inflammation (mean follow-up 11.6 months) were enrolled in the next part of the study to evaluate the final visual and surgical outcomes. Background systemic and ocular diseases, type of surgery, type of intraocular lenses and viscoelastic agent, early and late complications, and final best-corrected visual acuity were studied. RESULTS Among 1500 patients, 126 cases (8.4%) had early onset postoperative inflammation, 64 cases (50.7%) were male, and 62 cases (49.3%) were female. Early complications were posterior synechia in 9 cases (7.1%), pupillary block in 2 cases (1.5%), and acute rise of intraocular pressure in 6 cases (4.7%). Late complications consisted of posterior capsular opacity in 38 cases (34.5%) and cystoid macular edema in 4 cases (3.2%). Peak of signs and symptoms of inflammation was during 2 weeks after surgery and all patients responded well to topical steroids. Final best-corrected visual acuity (BCVA) was 20/30 and better in 76 cases (69%), between 20/40 and 20/80 in 24 cases (22%), and less than 20/80 in 10 cases (9%). All cases with BCVA less than 20/80 had ocular diseases like choroidal neovascularization scar or age-related macular degeneration, advanced glaucoma, or corneal opacity. CONCLUSIONS Early onset postoperative inflammation causes pain, decreased vision, and patient anxiety in the acute phase but neither decreases final visual acuity nor has any significant or permanent ocular sequels.
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Affiliation(s)
- M Mohammadpour
- Ophthalmic Research Center, Labbafi Nejad Medical Center, Tehran, Iran.
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Abstract
PURPOSE The choice of intraocular lens (IOL) implanted by cataract surgeons has significant implications for the effectiveness of the operation and the subsequent need for capsulotomy. METHODS Comparison of pertinent peer-reviewed literature published from 1996 through 2001 obtained from a MEDLINE literature search on biocompatibility indicators and IOLs. This review pertains to routine, uncomplicated cataract surgery, and thus, the findings may not be relative to complicated surgeries. Currently available IOLs were not included in this review if no published data on the IOL were available. However, representative lenses from all the major biomaterial classes were included. RESULTS Overall results of a comparison of published accounts of posterior capsular opacification, Nd:YAG capsulotomies, anterior capsular opacification, aqueous flare, cellular reaction, capsular adhesion, and capsular stability show a polyacrylic elastomer to be the most highly biointegrated IOLs by the human eye. CONCLUSIONS Most evidence published in peer-reviewed journals suggests a clear IOL choice for cataract surgeons. In the field of implantable medical devices, one device in a category does not usually provide consistently superior performance of its intended function. The ability of the biomaterial to maintain a clear optical axis not only by suppressing the proliferation of lens epithelial cells, and thus inhibiting posterior capsular opacification formation and obviating the need for an Nd:YAG capsulotomy, but also by adhering to and stabilizing the capsular bag is, to date, unmatched by any other IOL available.
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Affiliation(s)
- James P McCulley
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9057, USA.
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Abstract
PURPOSE To describe the principles upon which present day cataract treatment success resides. DESIGN Literature review and collective experience of the authors. RESULTS Surgical removal remains the standard treatment for cataract now and in the foreseeable future. Ultrasound cataract removal with a foldable "in-the-bag" intraocular lens with a truncated edge treated for dysphotopsia best correlates with core treatment principles, as we now understand them. Improving refractive results is an important trend. The worldwide burden of this problem is immense. CONCLUSIONS While results for treatment of cataracts are excellent today, improvements in safety and refraction precision are needed. Other approaches are desperately needed to stem the worldwide tide of cataract related ocular dysfunction.
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Affiliation(s)
- Randall J Olson
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah 84132, USA.
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Abstract
Cataract surgery in a patient with uveitis is more complex than senile cataract extraction, because it involves multiple considerations related to the cause of uveitis, prospects of visual rehabilitation, appropriate surgical timing and technique, and the type and material of the intraocular lens used. Establishing the diagnosis, thorough eye examination, careful patient selection and meticulous control of perioperative inflammation are key elements to a successful visual outcome. Our aims in this article are to review the literature on this subject over the past year and highlight the behavior of intraocular lenses of various biomaterials in the uveitic eye. In addition, we also reemphasize the idea of a model of zero tolerance to intraocular inflammation to minimize the incidence of irreversible damage to ocular structures essential to good vision.
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Affiliation(s)
- Charles Stephen Foster
- Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, 02114, USA.
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Abela-Formanek C, Amon M, Schauersberger J, Kruger A, Nepp J, Schild G. Results of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in uveitic eyes with cataract: comparison to a control group. J Cataract Refract Surg 2002; 28:1141-52. [PMID: 12106722 DOI: 10.1016/s0886-3350(02)01425-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses (IOLs) in eyes with uveitis. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS This prospective study comprised 72 eyes with uveitis and 68 control eyes having phacoemulsification and IOL implantation by 1 surgeon. Patients received 1 of the following IOLs: foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia). Postoperative evaluations were at 1, 3, and 7 days and 1, 3, and 6 months. Cell reaction was evaluated by specular microscopy of the anterior IOL surface and the anterior and posterior capsule reaction, by biomicroscopy. RESULTS Small round cell deposition was observed on all IOLs in the immediate postoperative period, especially in eyes with uveitis. This reaction decreased 3 to 6 months after surgery. Although the CeeOn 911 had a higher mean grade of small cells, there was no statistical difference between the 3 IOL types after 6 months in the uveitis and control groups. Foreign-body giant cells (FBGCs) increased after 1 week to 1 month. The AcrySof IOLs had the highest number of FBGCs; after 6 months, there was a statistically significant difference between the AcrySof and Hydroview uveitis groups (P =.036) and the AcrySof and CeeOn 911 uveitis groups (P =.003) but there was no difference among the 3 IOL types in the control group. Lens epithelial cell outgrowth persisted on the Hydroview IOLs in control eyes and regressed on all 3 IOL types in uveitic eyes and on the AcrySof and CeeOn 911 IOLs in control eyes (P =.0001). Anterior capsule opacification (ACO) was more severe on all IOL types in uveitic eyes and on the CeeOn 911 IOL in control eyes. Posterior capsule opacification (PCO) was more severe in uveitic eyes. The Hydroview group had more severe PCO than the AcrySof and the CeeOn 911 groups in uveitis and control eyes. Six months postoperatively, the difference was significant (P =.0001). There was no significant difference between the AcrySof and CeeOn 911 IOLs. CONCLUSIONS Intraocular lens biocompatibility is inversely related to inflammation. Hydrophilic acrylic material had good uveal but worse capsular biocompatibility. Hydrophobic acrylic material had lower uveal but better capsular biocompatibility. Silicone showed a higher small cell count (mild) and more severe ACO but achieved PCO results comparable to FBGC results and better than those with the AcrySof lens 6 months after surgery. Despite the differences in IOL biocompatibility, all patients benefited from the surgery.
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Daynes T, Spencer TS, Doan K, Mamalis N, Olson RJ. Three-year clinical comparison of 3-piece AcrySof and SI-40 silicone intraocular lenses. J Cataract Refract Surg 2002; 28:1124-9. [PMID: 12106719 DOI: 10.1016/s0886-3350(02)01460-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the 3-year performance of the 3-piece AcrySof (Alcon) and the SI-40 silicone (Allergan) intraocular lenses (IOLs). SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS In this retrospective study, patients with no complications and at least a 3-year follow-up after IOL implantation were examined for signs of inflammation, visual function, posterior capsule opacification (PCO), and satisfaction. RESULTS One hundred eleven patients were enrolled with equivalent visual acuity, inflammation, and PCO parameters. The AcrySof eyes had less anterior capsule opacification and more intralenticular inclusions than the other group. Complete anterior capsule overlap was associated with decreased PCO, and significantly more SI-40 eyes had complete anterior capsule overlap. CONCLUSIONS The second-generation silicone IOL was equivalent to the 3-piece AcrySof in patient satisfaction, visual function, inflammation, and PCO. The amount of anterior capsule overlap on the IOL may help to explain the study differences.
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Affiliation(s)
- Todd Daynes
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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Abela-Formanek C, Amon M, Schauersberger J, Schild G, Kolodjaschna J, Barisani-Asenbauer T, Kruger A. Uveal and capsular biocompatibility of 2 foldable acrylic intraocular lenses in patients with uveitis or pseudoexfoliation syndrome: comparison to a control group. J Cataract Refract Surg 2002; 28:1160-72. [PMID: 12106724 DOI: 10.1016/s0886-3350(02)01360-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic (Hydroview) and hydrophobic acrylic (AcrySof) intraocular lenses (IOLs) after phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) or uveitis and compare the results with those in a control group. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS This prospective nonrandomized comparative trial comprised 143 eyes recruited consecutively. Of these, 49 eyes had PEX, 43 had uveitis, and 51 served as controls. A standardized surgical protocol was used. Cell reaction, anterior (ACO) and posterior (PCO) capsule opacification, and flare were evaluated 1 year after cataract surgery. RESULTS Regarding uveal biocompatibility, the number of foreign-body giant cells (FBGCs) increased in proportion to associated ocular pathologies in both IOL groups. The difference between the Hydroview control and Hydroview uveitis groups was statistically significant. The number of FBGCs was greater on AcrySof IOLs than on Hydroview IOLs in all 3 groups. The difference in FBGCs between the 2 IOL types was statistically significant in the control and PEX groups. Regarding capsular biocompatibility, lens epithelial cell (LEC) outgrowth was inversely correlated with intraocular inflammation. Outgrowth was statistically significantly higher with Hydroview IOLs, occurring in 85% in the control group, 45% in the PEX group, and 28% in the uveitis group (P <.0001). With AcrySof lenses, the percentages were 0%, 8%, and 4%, respectively. The PEX and uveitis groups were more likely to develop ACO than the control group (P <.012). There was no statistically significant difference in ACO between the 2 IOL types in the 3 patient groups. The PCO was statistically significantly greater in the uveitis group than in the control group (P <.026) and statistically significantly more dense on Hydroview than on AcrySof IOLs in all 3 patient groups (P <.002). Flare was statistically significantly higher in the uveitis group than in the PEX and control groups with both IOL types (P <.012). There was no statistically significant difference in flare between the 2 IOL types. CONCLUSIONS Uveal and capsular biocompatibility depends on the intensity of ocular inflammation. The greater the inflammation, the less the biocompatibility of hydrophilic and hydrophobic acrylic materials. AcrySof stimulated more FBGCs. The Hydroview material had better uveal but poorer capsular biocompatibility than AcrySof. The sharp optic edge effect of the AcrySof IOL and the advantages of the Hydroview lens in normal eyes are less apparent in compromised eyes.
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Abstract
Modern cataract surgery is constantly evolving and improving in terms of lens material and design. Researchers and physicians strive to obtain better refractive correction with smaller wound size and minimizing host cell response to limit the proliferation of lens epithelial cells leading to opacification of the lens capsule. Intraocular lens material varies in water content, refractive index, and tensile strength. Intraocular lens design has undergone revisions to prohibit lens epithelial cell migration and reflection of internal and external light. The evolution of intraocular lens and extracapsular cataract surgery has lead to faster postoperative recovery and better visual outcomes.
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Affiliation(s)
- Kim T Doan
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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Abela-Formanek C, Amon M, Schild G, Schauersberger J, Heinze G, Kruger A. Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses. J Cataract Refract Surg 2002; 28:50-61. [PMID: 11777710 DOI: 10.1016/s0886-3350(01)01122-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the long-term response of 6 types of 3-piece intraocular lenses (IOLs) by assessing the cellular reaction on the anterior IOL surface, the behavior of posterior and anterior capsule fibrosis, and flare. SETTING Department of Ophthalmology, Medical School, University of Vienna, Vienna, Austria. METHODS One hundred eighty eyes were prospectively randomized to receive 1 of 6 IOLs: hydrophilic acrylic Hydroview (Bausch & Lomb) or MemoryLens (ORC); hydrophobic acrylic AcrySof MA60BM (Alcon) or AMO Sensar AR40 (Allergan); hydrophobic silicone CeeOn 920 or CeeOn 911A (Pharmacia). The patients had standardized cataract surgery, postoperative medication, and follow-up. One year after surgery, 155 eyes were assessed. The cellular reaction was evaluated by specular microscopy of the anterior IOL surface. Anterior and posterior capsule opacification (PCO) was assessed semiquantitatively by biomicroscopy. Flare was measured with a Kowa FC-1000 laser flare-cell meter. RESULTS Regarding uveal biocompatibility, the hydrophobic acrylic IOLs showed the highest incidence of late foreign-body cell reaction (AcrySof, 30%; AR40, 17%) followed by the hydrophilic acrylic (MemoryLens, 8%; Hydroview, 4%) and silicone (CeeOn 920, 4%; CeeOn 911A, 0%) (P =.0044). In all cases, the cellular reaction was low grade and clinically insignificant. Regarding capsular biocompatibility, some eyes developed lens epithelial cell (LEC) outgrowth on the anterior IOL surface. The highest incidence was in the hydrophilic acrylic group (Hydroview, 85%; MemoryLens, 27%) followed by the hydrophobic acrylic (AcrySof, 4%; AR40, 3%). No silicone IOL had LECs on the anterior surface. The difference among IOL groups was significant (P =.0001). Anterior capsule opacification was more predominant in the hydrophobic IOL groups. Posterior capsule opacification of the central 3.0 mm area was lowest in the groups with a sharp-edged optic (CeeOn 911A, AcrySof) followed by the round-edged silicone (CeeOn 920), hydrophobic acrylic (AR40), and hydrophilic acrylic IOLs (P =.0001). There was a significant difference in flare between the AR40 lens and the Hydroview, MemoryLens, CeeOn 911A, and CeeOn 920 (P <.004). There was no statistically significant difference in the postoperative cell count at 1 year. The power calculation showed that the sample size was sufficient. CONCLUSIONS The differences in cellular reaction, although clinically mild in normal eyes, indicate that there were more giant cells with hydrophobic acrylic IOLs and an increased tendency toward LEC outgrowth with hydrophilic lenses. The incidence of PCO was lowest in the hydrophobic IOL groups, especially in groups with a sharp-edged optic. Second-generation silicone IOLs with a sharp edge had good uveal and capsular biocompatibility 1 year after surgery.
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Affiliation(s)
- Claudette Abela-Formanek
- Department of Ophthalmology, Medical School, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Olson RJ. Anterior introcular lens precipitates after combined phacotrabeculectomy. J Cataract Refract Surg 2000; 26:1101. [PMID: 11041718 DOI: 10.1016/s0886-3350(00)00617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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