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Evereklioglu C, Uysal Y, Sener H, Sönmez HK, Horozoglu F. The Incidence of Optic Cracks or Fractures During a Foldable AcrySof or Acriva BB Acrylic Monofocal Intraocular Lens Implantation via the Manual Monarch Injector System With the Cartridge in Phacoemulsification Surgery. Cureus 2023; 15:e38903. [PMID: 37303455 PMCID: PMC10257524 DOI: 10.7759/cureus.38903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To evaluate the incidence of optic cracks and/or fractures during foldable acrylic intraocular lens (IOL) implantation via the manual Monarch delivery system with the cartridge and to determine factors that help to avoid such complications. METHODS Small-incision phacoemulsification surgery was performed in 702 eyes with visually significant cataract formation. A foldable acrylic soft IOL (AcrySofâ MA60BM/MA30BA, Alcon, Fort Worth, TX, USA) or a single-piece acrylic soft IOL (Acriva BBâ, VSY Biotechnology, Amsterdam, The Netherlands) was inserted in all eyes using a cartridge and viscoelastic agents (sodium hyaluronate, Healon®, Advanced Medical Optics, Santa Ana, CA, USA). RESULTS Postoperative central, paracentral, or peripheral optic cracks or fractures were encountered in a total of six of 702 eyes (0.85%). Four of six lenses (0.57%) had optic cracks within the IOL substance, whereas two of 702 cases (0.28%) had full-thickness IOL fractures in the substance in multiple locations. Three of the four lenses with optic cracks were noted to be handled by tying forceps during the cartridge insertion, and one of them was the complication of holding forceps. Two IOLs with full-thickness optic fractures were encountered during the insertion of the IOLs in the capsular bag as a result of direct trauma to the lens optic by the plunger of the injector system overriding the lens optic during cartridge passage. None of the patients suffered from glare or other visual disturbances postoperatively, and, therefore, none of the six eyes required lens replacement. CONCLUSION The unintentional extensive pressure effect of the forceps during the holding process of the IOL or the direct trauma to the lens optic by the plunger of injector systems may cause optic cracks or fractures. Physicians should continue to monitor the eyes postoperatively regularly and must determine the benefits and risks to be derived from lens replacement, if such patients complain of significant glare, image degradation, and visual disturbances. We recommend the use of preloaded lenses, which have their own delivery systems and cartridges, to minimize the risk of such complications.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, TUR
| | - Yusuf Uysal
- Department of Ophthalmology, Gulhane Training and Research Hospital, Ankara, TUR
| | - Hidayet Sener
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, TUR
| | - Hatice Kübra Sönmez
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, TUR
| | - Fatih Horozoglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, TUR
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Teng H, Sun J, Wen K, Han G, Tian F. Observation of Cyclosporin A: Sustained Release Intraocular Lens Implantation in Rabbit Eyes. Curr Eye Res 2022; 47:1508-1515. [PMID: 35947019 DOI: 10.1080/02713683.2022.2110598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To observe the performance of cyclosporine A (CsA)-loaded intraocular lens (IOLs) implanted into rabbit eyes. METHODS To prepare a PLGA-based CsA-sustained release IOLs and study the in vitro drug release. Forty-two New Zealand white rabbits were randomly and equally divided into three groups, and all right eyes underwent phacoemulsification. In group A, a common polymethylmethacrylate (PMMA) IOLs was implanted, while polylactide-glycoli acid (PLGA-loaded)-PMMA-IOLs was implanted in group B, and CsA-PLGA-PMMA-IOLs was implanted in group C. All experimental eyes were examined by slit-lamp microscopy. In addition, fundoscopy and the number of corneal endothelial cells, anterior chamber flare grading, and the number of aqueous humor cells were assessed at different time points post-surgery. The wet lens capsule was weighed and histological examination was performed 6 months post-operation. RESULTS In the early post-operative period, the inflammatory reaction of anterior chamber in groups A and B were more severe than group C. The initial appearance of PCO in group C was much later than the other two groups (F = 68.91; p = 0.000), and PCO grade in group C was much lower than the other two groups (χ2 = 36.07; p = 0.000). The mean weights of wet lens capsules in groups A and B were significantly heavier than group C (F = 134.88; p = 0.00). Histological observation showed no obvious toxic reaction in the intraocular tissues of the CsA-PLGA-PMMA-IOLs group, and the proliferation and accumulation of lens epithelial cells in groups A and B were greater than in group C. CONCLUSION CsA-sustained release IOLs can effectively prevent PCO in rabbit eyes without defined intraocular toxicity.
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Affiliation(s)
- He Teng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jing Sun
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Kai Wen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Guoge Han
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, China
| | - Fang Tian
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Yang HY, Kao SC, Tsai CC, Yu WK. Late capsular blockage syndrome: Clinical and anterior segment optical coherence tomography characteristics. J Chin Med Assoc 2022; 85:799-803. [PMID: 35648136 DOI: 10.1097/jcma.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Late capsular blockage syndrome (CBS) is a rare phenomenon which is found after cataract surgery. The mechanism, anterior segment optical coherence tomography (OCT) presentation, and clinical characteristics are not well studied. METHODS We studied patients who developed late CBS in Taipei Veterans General Hospital from 2012 to 2019. Age, sex, systemic disease, ocular disease, interval between cataract surgery and CBS, axial length, type of intraocular lens implanted, grading of posterior capsular opacity, refraction, visual acuity, and anterior segment OCT findings were documented. Patients are categorized into two groups according to anterior segment OCT findings. All patients underwent Nd:YAG laser capsulotomy and were prescribed a low-dose topical steroid for 7 days. Postcapsulotomy refraction and visual acuity were recorded. All the clinical data were compared in the two groups. RESULTS This study included 18 eyes with late CBS. Patients' median age was 80 (range, 54-92) years. The mean duration between cataract surgery and CBS diagnosis was 80.28 (range 15-136) months. According to anterior segment OCT findings, we subcategorized the patients into two groups: gravel appearance (n = 7) and milky (n = 11) appearance. After laser capsulotomy, mean visual acuity improved 0.18 ± 0.10 on the LogMAR. A significant myopic shift in refraction after laser capsulotomy was noted in the gravel appearance group compared to the milky appearance group ( p = 0.027). No patient developed complications or needed further treatment for CBS during the median follow-up of 14.5 months (range 1-84 months). CONCLUSION High-resolution anterior segment OCT is useful for analyzing patients with late CBS. Our study implies that the two types of CBS presentation indicate different causes of late CBS formation, as well as distinct clinical presentation and postlaser capsulotomy refractive outcome. In addition, YAG laser capsulotomy is a safe late CBS treatment modality.
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Affiliation(s)
- Hsin-Yu Yang
- Taipei Veterans General Hospital Yuanshan and Suao Branch, Yilan, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Sui-Ching Kao
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chieh-Chih Tsai
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Kuang Yu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Kitaguchi-Iwakiri Y, Kamoi K, Takase H, Okubo Y, Ohno-Matsui K. Long-term incidence of posterior capsular opacification in patients with non-infectious uveitis. Sci Rep 2022; 12:4296. [PMID: 35277585 PMCID: PMC8917155 DOI: 10.1038/s41598-022-08325-7] [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: 08/24/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Little is known about the long-term incidence of posterior capsule opacification (PCO) after cataract surgery in patients with uveitis. This retrospective study included 211 eyes of 146 patients with non-infectious uveitis who underwent cataract surgery and implantation of an Acrysof SN60WF (Surface: plasma-treated, Optic and Haptic: hydrophobic acrylic), iSert XY-1 (Surface: UV-ozone-treated, Optic and Haptic: hydrophobic acrylic), or iSert 251/255 (Surface: UV-ozone-treated, Optics: hydrophobic acrylic, Haptic: polymethyl methacrylate). The cumulative incidences of PCO and subsequent yttrium–aluminum-garnet (Nd:YAG) capsulotomy over the 5-year follow-up were analyzed, and patients who were implanted with different intraocular lenses (IOLs) were compared. Mixed-effects Cox proportional hazard models showed that, compared with the Acrysof group, the iSert XY-1 group had higher risks of PCO (adjusted HR, 7.26; 95% CI, 1.82–28.8) and Nd:YAG capsulotomy (adjusted HR, 6.50; 95% CI, 1.55–27.2). Similar results were obtained when the Acrysof group was compared with the iSert 251/255 group for PCO (adjusted HR, 8.22; 95% CI, 2.35–28.7) and Nd:YAG capsulotomy (adjusted HR, 8.26; 1.90–36.0). These data suggest that a plasma-treated surface, hydrophobic acrylic optic and hydrophobic acrylic haptic, of the IOL could enhance biocompatibility even under inflammatory conditions, thus suppressing PCO development.
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Affiliation(s)
- Yuki Kitaguchi-Iwakiri
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koju Kamoi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Hiroshi Takase
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yusuke Okubo
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Maedel S, Evans JR, Harrer-Seely A, Findl O. Intraocular lens optic edge design for the prevention of posterior capsule opacification after cataract surgery. Cochrane Database Syst Rev 2021; 8:CD012516. [PMID: 34398965 PMCID: PMC8406949 DOI: 10.1002/14651858.cd012516.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posterior capsule opacification (PCO) is a clouding of the posterior part of the lens capsule, a skin-like transparent structure, which surrounds the crystalline lens in the human eye. PCO is the most common postoperative complication following modern cataract surgery with implantation of a posterior chamber intraocular lens (IOL). The main symptoms of PCO are a decrease in visual acuity, 'cloudy', blurred vision and reduced contrast sensitivity. PCO is treated with a neodymium:YAG (Nd:YAG) laser to create a small opening in the opaque capsule and regain a clear central visual axis. This capsulotomy might cause further ocular complications, such as raised intraocular pressure or swelling of the central retina (macular oedema). This procedure is also a significant financial burden for health care systems worldwide. In recent decades, there have been advances in the selection of IOL materials and optimisation of IOL designs to help prevent PCO formation after cataract surgery. These include changes to the side structures holding the lens in the centre of the lens capsule bag, called IOL haptics, and IOL optic edge designs. OBJECTIVES To compare the effects of different IOL optic edge designs on PCO after cataract surgery. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE, Ovid Embase, Latin American and Caribbean Health Sciences Literature Database (LILACS), the ISRCTN registry, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 17 November 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared different types of IOL optic edge design. Our prespecified primary outcome was the proportion of eyes with Nd:YAG capsulotomy one year after surgery. Secondary outcomes included PCO score, best-corrected distance visual acuity (BCDVA) and quality of life score at one year. Due to availability of important long-term data, we also presented data at longer-term follow-up which is a post hoc change to our protocol. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane and the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 10 studies (1065 people, 1834 eyes) that compared sharp- and round-edged IOLs. Eight of these studies were within-person studies whereby one eye received a sharp-edged IOL and the fellow eye a round-edged IOL. The IOL materials were acrylic (2 studies), silicone (4 studies), polymethyl methacrylate (PMMA, 3 studies) and different materials (1 study). The studies were conducted in Austria, Germany, India, Japan, Sweden and the UK. Five studies were at high risk of bias in at least one domain. We judged two studies to be at low risk of bias in all domains. There were few cases of Nd:YAG capsulotomy at one year (primary outcome): 1/371 in sharp-edged and 4/371 in round-edged groups. The effect estimate was in favour of sharp-edged IOLs but the confidence intervals were very wide and compatible with higher or lower chance of Nd:YAG capsulotomy in sharp-edged compared with round-edged lenses (Peto odds ratio (OR) 0.30, 95% CI 0.05 to 1.74; I2 = 0%; 6 studies, 742 eyes). This corresponds to seven fewer cases of Nd:YAG capsulotomy per 1000 sharp-edged IOLs inserted compared with round-edged IOLs (95% CI 9 fewer to 7 more). We judged this as low-certainty evidence, downgrading for imprecision and risk of bias. A similar reduced risk of Nd:YAG capsulotomy in sharp-edge compared with round-edge IOLs was seen at two, three and five years but as the number of Nd:YAG capsulotomy events increased with longer follow-up this effect was more precisely measured at longer follow-up: two years, risk ratio (RR) 0.35 (0.16 to 0.80); 703 eyes (6 studies); 89 fewer cases per 1000; three years, RR 0.21 (0.11 to 0.41); 538 eyes (6 studies); 170 fewer cases per 1000; five years, RR 0.21 (0.10 to 0.45); 306 eyes (4 studies); 331 fewer cases per 1000. Data at 9 years and 12 years were only available from one study. All studies reported a PCO score. Four studies reported the AQUA (Automated Quantification of After-Cataract) score, four studies reported the EPCO (Evaluation of PCO) score and two studies reported another method of quantifying PCO. It was not possible to pool these data due to the way they were reported, but all studies consistently reported a statistically significant lower average PCO score (of the order of 0.5 to 3 units) with sharp-edged IOLs compared with round-edged IOLs. We judged this to be moderate-certainty evidence downgrading for risk of bias. The logMAR visual acuity score was lower (better) in eyes that received a sharp-edged IOL but the difference was small and likely to be clinically unimportant at one year (mean difference (MD) -0.06 logMAR, 95% CI -0.12 to 0; 2 studies, 153 eyes; low-certainty evidence). Similar effects were seen at longer follow-up periods but non-statistically significant data were less fully reported: two years MD -0.01 logMAR (-0.05 to 0.02); 2 studies, 311 eyes; three years MD -0.09 logMAR (-0.22 to 0.03); 2 studies, 117 eyes; data at five years only available from one study. None of the studies reported quality of life. Very low-certainty evidence on adverse events did not suggest any important differences between the groups. AUTHORS' CONCLUSIONS This review provides evidence that sharp-edged IOLs are likely to be associated with less PCO formation than round-edged IOLs, with less Nd:YAG capsulotomy. The effects on visual acuity were less certain. The impact of these lenses on quality of life has not been assessed and there are only very low-certainty comparative data on adverse events.
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Affiliation(s)
- Sophie Maedel
- Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Jennifer R Evans
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Oliver Findl
- Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
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Zhang XJ, Leung CK, Li EY, Musch DC, Zheng CR, He MG, Chang DF, Lam DS. Diagnostic Accuracy of Rapid Assessment of Avoidable Blindness: A Population-based Assessment. Am J Ophthalmol 2020; 213:235-243. [PMID: 31846622 DOI: 10.1016/j.ajo.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of rapid assessment of avoidable blindness (RAAB). DESIGN Population-based diagnostic accuracy study. METHODS A total of 2145 (95.3%, 2145/2250) subjects aged 50 years and older who participated in the RAAB survey were included. All the recruited participants underwent ophthalmic examination according to the RAAB protocol and then were reexamined with instruments in a mobile eye clinic set up in a village center on the same day. Examination in the mobile clinic included standardized visual acuity (VA) tests using logMAR charts, refraction, slit-lamp biomicroscopy, and dilated fundal examination with a binocular indirect ophthalmoscope. Blindness and economic blindness were defined as VA in the better-seeing eye <3/60 and <6/60, respectively. Visual impairment (VI) was defined as VA <6/18 in the better eye. The primary cause of blindness and VI was defined according to the cause of VI in the participant's better eye. MAIN OUTCOME MEASURES The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) of receiver operating characteristics of RAAB for detection of blindness and the principal causes of VI. RESULTS A total of 1816 subjects (84.7%), including 686 men (37.8%) and 1130 women (62.2%), underwent ophthalmic examination in the mobile eye clinic. The mean (±standard deviation) age was 64.4 ± 9.6 years. The sensitivities, specificities, AUC, PLR, and NLR of RAAB were 90.3%, 99.3%, 0.948, 124.0, and 0.10, respectively, for detection of blindness (presenting visual acuity, PVA <3/60); 89.5%, 98.7%, 0.940, 69.2, and 0.11, respectively, for detection of economic blindness (PVA <6/60); and 90.3%, 97.7%, 0.940, 38.7, and 0.10, respectively, for detection of VI (PVA <6/18). The sensitivities, specificities, AUC, PLR, and NLR were 90.5%, 98.1%, 0.943, 48.1, and 0.10; and 60.4%, 98.7%, 0.796, 46.4, and 0.40 for detection of VI (PVA <6/18) owing to cataract and refractive error, respectively. CONCLUSION The diagnostic performances of RAAB were high for detecting the prevalence of blindness, VI, and VI owing to cataract.
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Factors Associated with the Development of Posterior Capsule Opacification Requiring Yttrium Aluminum Garnet Capsulotomy. Optom Vis Sci 2019; 96:492-499. [DOI: 10.1097/opx.0000000000001396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Katsuki Y, Matsushima H, Mukai K, Watabiki S, Aose M, Terauchi W, Nagamoto T, Senoo T. Open-capsule intraocular lens to prevent posterior capsule opacification. J Cataract Refract Surg 2019; 45:1007-1012. [PMID: 30853319 DOI: 10.1016/j.jcrs.2018.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop a single-piece open-capsule intraocular lens (IOL) that can be inserted through a small incision and that prevents posterior capsule opacification (PCO) by expanding the capsule and circulating aqueous humor into the capsular bag. SETTING Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan. DESIGN Experimental study. METHOD Using the same hydrophobic acrylic material as the NY-60 IOL, a prototype open-capsule IOL was constructed. The IOL has a single optic and 2 haptics, with a 2.8 mm high spacer and holes through which aqueous humor circulates into the capsular bag by separating the anterior capsule from the posterior capsule and expanding the capsule. The open-capsule IOL or NY-60 (as a control group) was inserted in rabbit eyes. Posterior capsule opacification development was evaluated by measuring the thickness of the cell layer at the center of the posterior capsule on histopathologic specimens and statistically comparing the thickness between the open-capsule IOL group and control group. RESULTS The open-capsule IOL could be inserted through a 3.2 mm corneal incision using a D cartridge. The mean thickness of the cell layer at the center of the posterior capsule was 4.78 μm ± 2.61 (SD) in the open-capsule IOL group and 101.14 ± 25.19 μm in the control group and was significantly smaller in the open-capsule IOL group. CONCLUSION The prototype single-piece IOL could be implanted through a small incision and prevented PCO by expanding the lens capsule and circulating aqueous humor into the capsular bag.
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Affiliation(s)
- Yoko Katsuki
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan; HOYA Corporation Medical Division, Tokyo, Japan.
| | | | - Koichiro Mukai
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan
| | - Satoshi Watabiki
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan
| | - Masamoto Aose
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan
| | - Wataru Terauchi
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan
| | | | - Tadashi Senoo
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan
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Uveale und kapsuläre Biokompatibilität unterschiedlicher Intraokularlinsen bei unterschiedlichen Ausgangssituationen. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Wu XM, Xie LX. Comparison of 25-gauge sutureless vitrectomy and 20-gauge vitrectomy in the treatment of posterior capsule opacification in pseudophakic children. Int J Ophthalmol 2015; 8:1179-83. [PMID: 26682169 DOI: 10.3980/j.issn.2222-3959.2015.06.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/12/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the effectiveness and safety of pars plana capsulotomy and vitrectomy using 25-gauge tansconjunctival sutureless vitrectomy system and 20-gauge vitrectomy system for posterior capsule opacification (PCO) in pseudophakic children. METHODS Retrospectively study. Pars plana capsulotomy and vitrectomy using 25-gauge sutureless vitrectomy system was performed for PCO in the study group (32 eyes). Patients in the control group (34 eyes) underwent capsulotomy and vitrectomy using standard 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications. The two groups were performed consequentially. The patients ages ranged from 2 to 13y (means: 6.61±2.73y). Surgical technique, intraoperative and postoperative complications, visual acuity, IOP, and recurrent PCO were recorded. RESULTS The surgical procedure was performed uneventfully in all patients. Visual acuity improved significantly in both groups. BCVA improved in 22 eyes (81.5%) in the study group and in 28 eyes (87.5%) in the control group. There was no statistical difference of visual acuity that were attainable in two groups (H=0.115, P=0.909). Mean postoperative IOP showed no significant difference between the groups at 1wk. All sort of PCO were accomplished by 20-gauge system, while 25-gauge system was effective for pearls style and 2 grade of fibrous PCO, and was insufficient to grade 3 of PCO. In the study group two cases were not accomplished by 25-gauge system while 20-gauge system conquered them. Compared with the control group, mean operative time for opening and closing the sclerotomy in the study group was considerably reduced. The mean follow-up was 38.2mo (range: 8-79mo). During the follow-up period, no incision leakage, corneal edema, vitreous loss, IOL damage, retinal detachment, recurrent PCO, or other complications were noted. CONCLUSION Pars plana capsulotomy and vitrectomy using 25-gauge transconjunctival sutureless vitrectomy appeared to be a safe and effective approach for PCO in pseudophakic children. Combined sutureless surgery needed shorter setup time for sclerotomy and caused less surgical trauma than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with PCO in pseudophakic children.
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Affiliation(s)
- Xiao-Ming Wu
- Qingdao University Medical College, Qingdao 266071, Shandong Province, China ; Shandong Eye Institute, Qingdao 266071, Shandong Province, China
| | - Li-Xin Xie
- Shandong Eye Institute, Qingdao 266071, Shandong Province, China
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Krall EM, Arlt EM, Jell G, Strohmaier C, Moussa S, Dexl AK. Prospective Randomized Intraindividual Comparison of Posterior Capsule Opacification After Implantation of an IOL With and Without Heparin Surface Modification. J Refract Surg 2015; 31:466-72. [PMID: 26158927 DOI: 10.3928/1081597x-20150623-05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/12/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare posterior capsule opacification (PCO) of a hydrophobic acrylic heparin surface modified intraocular lens (HSM-IOL) and an uncoated IOL (UC-IOL) 1 year after implantation. METHODS One hundred two eyes of 51 patients underwent routine phacoemulsification with randomized implantation of a HSM-IOL in one eye (the HSM-IOL group) and a UC-IOL in the fellow eye (the UC-IOL group). Morphologic PCO evaluation was performed comparing digital photographs in retroillumination using the Evaluation of Posterior Capsule Opacification (EPCO) system, grading the density of the opacification from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, and 4 = severe). Distance visual acuities, subjective manifest refraction, pupil size, straylight measurements, flare in the anterior chamber using a laser flare meter, and contrast sensitivity were also evaluated. RESULTS The mean total EPCO score was slightly higher in the HSM-IOL group (0.50 ± 0.45) compared to the UC-IOL group (0.45 ± 0.46), but did not reach statistical significance. No statistically significant differences were found in the other main outcome parameters (straylight measurement, distance visual acuities, flare in the anterior chamber, and mesopic and photopic contrast sensitivity) when comparing both IOLs. CONCLUSION Although the HSM-IOL showed decreased flare 1 day postoperatively, no statistically significant differences regarding PCO were found 1 year postoperatively.
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Comparison of clinical efficacy: Nd:YAG laser rates after implantation of AcrySof® SN60WF, Akreos® AO-MI60 and Hoya® YA-60BB. J Fr Ophtalmol 2013; 36:575-82. [PMID: 23618731 DOI: 10.1016/j.jfo.2012.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/04/2012] [Accepted: 07/17/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare Nd:YAG laser rates following implantation of AcrySof(®) SN60WF (Alcon), Akreos(®) AO-MI60 (Baush & Lomb), and Hoya(®) YA-60BB (Hoya) intraocular lenses. METHODS This retrospective study was conducted at three French centers with each implanting at least two of the three implants. Included patients had undergone uncomplicated cataract surgery with at least 3 years of follow-up. Records of patients implanted with one of the three IOL's were drawn randomly from the surgical logs. Postoperative data were obtained from the medical records of either the surgeon or the referring physician. Time elapsing until Nd:YAG laser was analysed using Kaplan-Meier survival curves. RESULTS Three hundred eyes were implanted (AcrySof(®) 126, Akreos(®) 89, and Hoya(®) 85). AcrySof(®) recipients were the youngest (AcrySof(®) 72.1, Akreos(®) 76.4, and Hoya(®) 75.2 years of age: P=0.0007). The sex ratio was 4:6 male:female. Follow-up was longest for Hoya eyes (AcrySof(®) 29.4, Akreos(®) 24.6 and Hoya(®) 34.6 months; P=0.0002). Eyes implanted with AcrySof(®) had 1.74 times less chance of Nd:YAG laser treatment than Hoya eyes (P=0.0327) and 3.50 times less than Akreos(®) eyes (P<0.0001). The results remained unchanged when the analysis was restricted to events in the first 24 months (Risk Ratios: Hoya(®)=2.64: P=0.02; and Akreos(®)=4.22: P=0.0001). Adjustment on unbalanced confounding variables did not alter the results. CONCLUSIONS Eyes with AcrySof(®) implants required significantly fewer Nd:YAG laser capsulotomies than those with Hoya(®) and Akreos(®) implants and were therefore less subject to Nd:YAG laser treatment complications, thus ensuring better vision at the lowest cost.
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Abstract
BACKGROUND Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO. OBJECTIVES To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions. SEARCH STRATEGY We searched CENTRAL, MEDLINE, EMBASE, LILACS in March 2009 and reference lists of identified trial reports. SELECTION CRITERIA We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices and pharmacological therapy compared to each other, placebo or standard treatment. DATA COLLECTION AND ANALYSIS We extracted data and entered it into RevMan. We compared visual acuity data, PCO scores and YAG capsulotomy rates and performed a meta-analysis when possible. MAIN RESULTS Sixty six studies were included in the review. The review was divided into three parts. 1. Influence of IOL optic material on the development of PCO. There was no significant difference in PCO development between the different IOL materials (PMMA, hydrogel, hydrophobic acrylic, silicone) although hydrogel IOLs tend to have higher PCO scores and silicone IOLs lower PCO scores than the other materials. 2. Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however not between 1-piece and 3-piece IOLs. 3. Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intraoperative/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) which led to a significantly lower PCO rate. AUTHORS' CONCLUSIONS Due to the highly significant difference between round and sharp edged IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.
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Affiliation(s)
- Oliver Findl
- Hanusch HospitalDepartment of OphthalmologyHeinrich‐Collin‐Strasse 30ViennaAustriaA‐1140
| | - Wolf Buehl
- Medical University of ViennaDepartment of OphthalmologyWähringer Gürtel 18‐20ViennaAustria1090
| | - Peter Bauer
- Medical University of ViennaInstitute of Medical StatisticsSpitalgasse23ViennaAustriaA‐1090
| | - Thomas Sycha
- Medical University of ViennaDepartment of NeurologyWähringer Gürtel 18‐20ViennaAustriaA‐1090
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Solving intraocular lens-related pigment dispersion syndrome with repositioning of primary sulcus implanted single-piece IOL in the capsular bag. J Cataract Refract Surg 2009; 35:1459-63. [PMID: 19631135 DOI: 10.1016/j.jcrs.2009.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 05/22/2009] [Accepted: 05/25/2009] [Indexed: 12/31/2022]
Abstract
We describe 2 cases of pigment dispersion syndrome (PDS) after uneventful phacoemulsification and implantation of a posterior chamber single-piece intraocular lens (IOL) with a sharp-edge design. In both cases, several days after IOL implantation, marked pigment dispersion was seen on the iris and in the trabecular meshwork, associated with an elevation in intraocular pressure (IOP). Thorough examination showed that the implanted IOL was in the ciliary sulcus. After surgical repositioning of both IOLs in the capsular bag, the pigment dispersion regressed and the IOP returned to normal limits. The 2 cases suggest that particularly in PDS patients, an IOL with an anterior sharp-edge design should be implanted in the capsular bag. Implantation in the ciliary sulcus should be avoided.
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Caporossi A, Casprini F, Martone G, Balestrazzi A, Tosi GM, Ciompi L. Contrast sensitivity evaluation of aspheric and spherical intraocular lenses 2 years after implantation. J Refract Surg 2009; 25:578-90. [PMID: 19662914 DOI: 10.3928/1081597x-20090610-03] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the quality of vision with aspheric and spherical intraocular lenses (IOLs) in pseudophakic patients after long-term follow-up. METHODS Two hundred eyes of 100 patients with bilateral cataracts were randomly assigned to receive spherical (Acrysof SN60AT [Alcon Laboratories Inc] or Sensar AR40e [Advanced Medical Optics Inc]) or aspheric IOLs (Acrysof SN60WF [Alcon] or Tecnis Z9000 [Advanced Medical Optics]). Ophthalmologic examination, including best spectacle-corrected visual acuity (BSCVA), pupil size, ocular dominance, contrast sensitivity under mesopic and photopic conditions, and wavefront analysis, was performed 2 months and 1 and 2 years after surgery. RESULTS No statistically significant differences among the four groups in terms of age, pupil diameter, postoperative BSCVA, comeal spherical aberration, and posterior capsular opacification were noted. At all followup examinations, contrast sensitivity results showed no significant differences between the two aspheric IOLs at all spatial frequencies. Under photopic conditions, significant differences (P<.05) between spherical and aspheric IOLs were detected for spatial frequencies of 12 and 18 cycles per degree (cpd) at 2 months and 2 years and 12 cpd at 1 year. Under mesopic conditions, significant differences (P<.05) were detected between spherical and aspheric IOLs for all spatial frequencies at 2 months; all spatial frequencies except 18 cpd at 1 year; and spatial frequencies of 3, 12, and 18 cpd at 2 years. In addition, aspheric IOLs had statistical reductions in total spherical aberration at all follow-up examinations (P<.01). CONCLUSIONS This study confirms that implantation of a modified aspheric IOL improves functional visual performance at 2 years postoperative.
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Affiliation(s)
- Aldo Caporossi
- Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy
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Boureau C, Lafuma A, Jeanbat V, Berdeaux G, Smith AF. Incidence of Nd:YAG laser capsulotomies after cataract surgery: comparison of 3 square-edged lenses of different composition. Can J Ophthalmol 2009; 44:165-70. [PMID: 19491950 DOI: 10.3129/i09-007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare the incidence of Nd:YAG laser treatment following 3 square-edged intraocular lenses (IOLs) of different composition implanted during cataract surgery. DESIGN Patient chart analysis. PARTICIPANTS Patients aged 50-85 years and given a hydrophobic acrylic IOL (either SA60AT or AR40E) or hydrophilic acrylic IOL (XL-Stabi) were included. Analysis was conducted of 767 eyes treated with SA60AT (n = 250), AR40E (n = 254), or XL-Stabi (n = 263). METHODS This retrospective study involved patients who had undergone cataract surgery between 2001 and 2002. Ophthalmology centres were accepted into the study if they used at least 2 of the IOLs being investigated. The medical files of patients fulfilling the inclusion criteria were listed, and eligible cases were selected randomly. Patients' characteristics were obtained from their medical files. Data on postsurgical complications and Nd:YAG laser treatment over 3 years were also extracted. Follow-up data were obtained from the medical files and the patients' ophthalmologists. Time to Nd:YAG laser treatment was analysed using Kaplan-Meier survival curves adjusted with a Cox model. RESULTS After 3 years' follow-up the proportions of patients who had not received Nd:YAG laser treatment were 87.0% with SA60AT, 76.6% with AR40E, and 54.6% with XL-Stabi (p < 0.001). Cox's model adjusted for centre effects and the presence of diabetes estimated risk ratios of 2.8 for AR40E (p < 0.0005) and 5.1 for XL-Stabi (p < 0.0001), compared with the reference lens SA60AT. CONCLUSIONS Of the 3 square-edged lenses studied, the SA60AT was associated with a lower incidence of Nd:YAG laser treatment than either AR40E or XL-Stabi.
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Lombardo M, Carbone G, Lombardo G, De Santo MP, Barberi R. Analysis of intraocular lens surface adhesiveness by atomic force microscopy. J Cataract Refract Surg 2009; 35:1266-72. [DOI: 10.1016/j.jcrs.2009.02.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/04/2009] [Accepted: 02/06/2009] [Indexed: 11/27/2022]
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Boureau C, Lafuma A, Jeanbat V, Smith AF, Berdeaux G. Cost of cataract surgery after implantation of three intraocular lenses. Clin Ophthalmol 2009; 3:277-85. [PMID: 19668579 PMCID: PMC2708987 DOI: 10.2147/opth.s4890] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Posterior capsule opacification is one of the most frequent adverse events following cataract surgery. This manuscript reports the lifetime cost of complications linked to posterior capsule opacification using three types of intraocular lens with square edges. Methods: Costs were estimated from a retrospective study of patients who underwent cataract surgery and data from the literature. The lenses studied were hydrophobic acrylic (SA60AT and AR40E) and hydrophilic acrylic (XL-Stabi) lenses with square edges. The frequency of Nd-Yag laser capsulotomies after 4 years’ survival was estimated by two methods: the first involved linear adjustment of the rate at 5 and 6 years follow-up and then application of a constant rate after 6 years; the second involved linear adjustment after 5 years follow-up. The economic perspective was that of the French Sickness Fund. Results: After 3 years’ follow-up the percentage of patients who had not undergone laser Nd-Yag capsulotomy was 86.9% with SA60AT, 76.6% with AR40E and 54.6% with XL-Stabi lenses (p < 0.001). The total cost of capsulotomy and management of complications per patient lifetime was estimated to be €90.5 for SA60AT, €189.5 for AR40E and €288.0 for XL-Stabi lenses by the first extrapolation method. With the second method of extrapolation the costs were €94.8, €200.0 and €300.2, respectively. Interpretation: Lower costs for cataract surgery and management of related complications were observed with the two hydrophobic acrylic lenses; the lowest costs were observed with SA60AT lenses as they were associated with fewer Nd-Yag laser capsulotomies.
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Kohnen T, Fabian E, Gerl R, Hunold W, Hütz W, Strobel J, Hoyer H, Mester U. Optic Edge Design as Long-term Factor for Posterior Capsular Opacification Rates. Ophthalmology 2008; 115:1308-14, 1314.e1-3. [DOI: 10.1016/j.ophtha.2008.01.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 12/20/2007] [Accepted: 01/02/2008] [Indexed: 10/22/2022] Open
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Sekundärer Augeninnendruckanstieg nach komplikationsloser Kataraktoperation mit Hinterkammerlinsenimplantation. Ophthalmologe 2008; 106:156-60. [DOI: 10.1007/s00347-008-1771-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Katayama Y, Kobayakawa S, Yanagawa H, Tochikubo T. The Relationship between the Adhesion Characteristics of Acrylic Intraocular Lens Materials and Posterior Capsule Opacification. Ophthalmic Res 2007; 39:276-81. [PMID: 17851268 DOI: 10.1159/000108121] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Accepted: 04/19/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the relationship between the adhesion characteristics of similarly designed hydrophobic acrylic intraocular lenses (IOLs) and posterior capsule opacification (PCO). METHODS Three similarly shaped hydrophobic acrylic IOLs with a sharp-edged optic were used. Adhesive force of IOLs was measured with a tackiness tester. Human lens epithelial cells (LECs) were grown on each IOL for 48 h. LECs were then stained with crystal violet, which served as an index of the amount of cells attached to IOLs. Cellular migration and proliferation assays were performed using chamber inserts containing a collagen membrane. After 96 h of incubation, the collagen membranes were stained with hematoxylin and eosin for analysis. Three similarly shaped IOLs were implanted in rabbits. The eyes were enucleated 3 weeks later and analyzed for PCO area. RESULTS Hydrophobic acrylic IOLs were classified into three groups: A (less adhesive), B (moderately) and C (highly). The migration area of LECs on the collagen membrane was 5.65 +/- 4.5% in group A, 2.83 +/- 2.1% in group B, and 1.41 +/- 1.5% in group C, with a significant difference between groups A and C (p < 0.05). The mean percentage area of PCO in the rabbit eye was 19.4 +/- 16.7% in group A, 17.5 +/- 8.5% in group B, and 5.5 +/- 3.8% in group C, with a significant difference between groups A and C (p < 0.05). CONCLUSION Adhesive force of hydrophobic acrylic IOLs may play an important role in preventing PCO. Among the similarly shaped hydrophobic acrylic IOLs, IOLs of highly adhesive material inhibited LEC migration and PCO more than IOLs of less adhesive material.
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Affiliation(s)
- Yasuhiro Katayama
- The First Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
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Hayashi K, Hayashi H. Influence on posterior capsule opacification and visual function of intraocular lens optic material. Am J Ophthalmol 2007; 144:195-202. [PMID: 17553447 DOI: 10.1016/j.ajo.2007.04.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 04/17/2007] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the influence of optic material on posterior capsule opacification (PCO) by comparing PCO and visual functions between eyes with an acrylic intraocular lens (IOLs) and those with a silicone IOL of the same optic design and with the same haptics. DESIGN Randomized clinical trial. METHODS One hundred patients scheduled for phacoemulsification surgery underwent implantation of an acrylic IOL (AMO Sensar; AR40e) in one eye and implantation of a silicone IOL (ClariFlex) of the same optic design and loops in the fellow eye. Eighty-nine patients (89%) remained for analysis. The PCO value was measured using the Scheimpflug videophotography system at one, three, six, 12, 18, 24, 30, and 36 months postoperatively. The incidence of eyes that required a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy was examined; visual acuity and contrast sensitivity with and without a glare source were also evaluated. RESULTS The mean PCO value did not increase significantly during follow-up in either the acrylic or silicone IOL group. When comparing the groups, no statistically significant difference was found in the PCO or in the incidence of Nd:YAG capsulotomy, although both tended to be slightly better in the silicone group than in the acrylic group. There was also no significant difference between the groups in visual acuity or in photopic and mesopic contrast sensitivity with or without glare. CONCLUSIONS When acrylic and silicone IOLs are of the same optic design and with the same haptics, the optic material does not influence the development of PCO enough to impair visual function.
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Abstract
BACKGROUND Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however, this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO. OBJECTIVES To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions. SEARCH STRATEGY We searched CENTRAL, MEDLINE, EMBASE, LILACS in January 2007 and reference lists of identified trial reports. SELECTION CRITERIA We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices, and pharmacological therapy, compared to each other, placebo or standard treatment. DATA COLLECTION AND ANALYSIS Data were extracted and entered into Review Manager. Visual acuity data, PCO score and YAG capsulotomy rates were compared and a meta-analysis was performed when possible. MAIN RESULTS Fifty three studies were included in the review. The review was divided into three parts. (1) Influence of IOL optic material on the development of PCO. Compared to other materials, the meta-analysis of the included studies showed a significantly higher PCO score (overall effect: 12.39 (95% confidence interval: 9.82 to 14.95), scale 0 to 100) and YAG rate (odds ratio: 8.37 (3.74 to 20.36)) only in hydrogel IOLs. (2) Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however, not between 1-piece and 3-piece IOLs. (3) Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intra-/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) leading to a significantly lower PCO rate. AUTHORS' CONCLUSIONS Due to the highly significant difference between round and sharp edge IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials, except for hydrogel IOLs, that showed more PCO than the other materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.
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Affiliation(s)
- O Findl
- Medical University of Vienna, Department of Ophthalmology, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, Vienna, Austria, A-1090.
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Nishi O, Yamamoto N, Nishi K, Nishi Y. Contact inhibition of migrating lens epithelial cells at the capsular bend created by a sharp-edged intraocular lens after cataract surgery. J Cataract Refract Surg 2007; 33:1065-70. [PMID: 17531703 DOI: 10.1016/j.jcrs.2007.02.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 02/23/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate whether the lens epithelial cells (LECs) at the capsular bend created by a sharp-edged intraocular lens (IOL) are in the G(0) phase of the cell cycle. SETTING Nishi Eye Hospital, Osaka, Japan. METHOD A CeeOn Edge silicone IOL (AMO) with sharp edges was implanted in 1 eye and a PhacoFlex II silicone IOL (AMO) with rounded edges in the contralateral eye after standard cataract surgery in 6 rabbits. Immunohistochemical staining for the Ki-67 antibody was performed 1 day, 3, 4, and 7 weeks after surgery. RESULTS In eyes with the sharp-edged IOL, LECs with thin, elongated nuclei accumulated at, but did not extend beyond, the capsular bend and stained negative for the Ki-67 antibody, indicating that they were in the G(0) phase of the cell cycle. In contrast, in the eye with the round-edged IOL, continuous migration of a predominantly monolayer of LECs over the IOL and onto the posterior capsule occurred. These cells were Ki-67 positive, indicating that they were proliferating. CONCLUSIONS Lens epithelial cells at the capsular bend of sharp-edged IOLs were in the G(0) phase of the cell cycle, indicating that they were contact inhibited. These findings support the theory the sharp posterior optic edge of the IOL inhibits LEC migration, reducing formation of posterior capsule opacification. Whether these LECs can reactivate when the capsular bend is eliminated by later formation of a Soemmerring's ring requires further studies.
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Affiliation(s)
- Okihiro Nishi
- Nishi Eye Hospital, 4-14-26 Nanamichi, Higashinari-ku, Osaka 537-0025, Japan.
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Problemfälle in der Kataraktchirurgie: Operationstechnik und Linsenauswahl. SPEKTRUM DER AUGENHEILKUNDE 2007. [DOI: 10.1007/s00717-007-0189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hancox J, Spalton D, Heatley C, Jayaram H, Yip J, Boyce J, Marshall J. Fellow-eye comparison of posterior capsule opacification rates after implantation of 1CU accommodating and AcrySof MA30 monofocal intraocular lenses. J Cataract Refract Surg 2007; 33:413-7. [PMID: 17321391 DOI: 10.1016/j.jcrs.2006.10.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To measure posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between the AcrySof MA30 intraocular lens (IOL) (Alcon) and the 1CU IOL (HumanOptics) in a fellow-eye comparison. SETTING Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom. METHODS Thirty patients who had bilateral cataract surgery with a 1CU IOL prospectively randomly allocated to 1 eye and an AcrySof MA30 monofocal IOL to the other eye were examined. Best corrected distance visual acuity was recorded using the Early Treatment Diabetic Retinopathy Study logMAR chart. Digital retroillumination images of the posterior capsule were taken with the pupil dilated and analyzed with POCO software. RESULTS Eyes with the 1CU IOL had significantly higher PCO rates than eyes with the MA30 IOL at all time points. By 2 years after surgery, 50% of eyes with a 1CU IOL had required Nd:YAG capsulotomy compared with no eyes with an MA30 IOL. There was no significant difference in visual acuity at any time point when post Nd:YAG capsulotomy was taken in to account. CONCLUSIONS The 1CU IOL has 4 broad optic-haptic junctions where the square-edged barrier is breached; this appeared to allow passage of lens epithelial cells, leading to an increase in PCO. However, the increased PCO cannot be attributed to this alone as the 1CU is hydrophilic, a factor known to be associated with higher PCO rates.
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Affiliation(s)
- Joanne Hancox
- Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom
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Cheng JW, Wei RL, Cai JP, Xi GL, Zhu H, Li Y, Ma XY. Efficacy of different intraocular lens materials and optic edge designs in preventing posterior capsular opacification: a meta-analysis. Am J Ophthalmol 2007; 143:428-36. [PMID: 17224119 DOI: 10.1016/j.ajo.2006.11.045] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Revised: 11/16/2006] [Accepted: 11/19/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the efficacy of different intraocular lens (IOL) materials and optic edge designs in preventing posterior capsular opacification (PCO). DESIGN Systematic review and meta-analysis. METHODS Pertinent studies were selected through an electronic search of the Cochrane Library, MEDLINE, and Embase. The randomized controlled trials meeting the predefined criteria were reviewed systematically by meta-analysis. The treatment effects were measured as risk difference, and the pooled estimates were computed according to a random effect model. RESULTS In total, 23 randomized controlled trials were included in the present meta-analysis. The pooled risk differences of Nd:YAG laser capsulotomy rates were -24% (95% confidence interval [CI], -29% to -20%) comparing acrylic with polymethylmethacrylate (PMMA) lenses; -9% (95% CI, -17% to -1%) comparing silicone with PMMA lenses; 14% (95% CI, -8% to 36%) comparing hydrogel with PMMA lenses; 4% (95% CI, -2% to 10%) comparing silicone with acrylic lenses; 19% (95% CI, 8% to 30%) comparing hydrogel with acrylic lenses; and 28% (95% CI, 10% to 46%) comparing hydrogel with silicone lenses. The pooled risk differences of PCO rates were -39% (95% CI, -47% to -31%) comparing acrylic with PMMA lenses; -14% (95% CI, -29% to 0%) comparing silicone with acrylic lenses; 56% (95% CI, 36% to 75%) comparing hydrogel with acrylic lenses; and 48% (95% CI, 31% to 64%) comparing hydrogel with silicone lenses. When comparing sharp with rounded-edge designs, pooled risk differences of capsulotomy rates were -47% (95% CI, -77% to -17%) in PMMA lenses, -22% (95% CI, -47% to 2%) in acrylic lenses, and -9% (95% CI, -17% to 0%) in silicone lenses; pooled risk differences of PCO rates were -28% (95% CI, -50% to -7%) in acrylic lenses and -37% (95% CI, -46% to -27%) in silicone lenses. CONCLUSIONS The rates of PCO and Nd:YAG laser capsulotomy may be influenced by different IOL biomaterials and optic edge designs. The lenses made by acrylic and silicone and those with sharp optic edges are superior in lowering the rates of PCO and laser capsulotomy.
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Affiliation(s)
- Jin-Wei Cheng
- Department of Ophthalmology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Elgohary MA, Beckingsale AB. Effect of posterior capsular opacification on visual function in patients with monofocal and multifocal intraocular lenses. Eye (Lond) 2006; 22:613-9. [PMID: 17187030 DOI: 10.1038/sj.eye.6702661] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the effect of posterior capsular opacification (PCO) on visual function in patients with monofocal and multifocal intraocular lenses (IOLs). METHODS Thirty-three consecutive patients with clinically significant PCO, 24 with monofocal, and nine with multifocal IOLs, were recruited. Patients with concurrent cause of visual loss or pupillary distortion were excluded. LogMAR high- and low-contrast (10%) distance visual acuity (VA), logMAR near VA, Pelli-Robson contrast sensitivity (CS), colour confusion index (CCI), and the presenting symptoms were compared between the two groups. RESULTS There was no significant difference between the proportions of patient with different PCO grade in the two groups. At presentation, high- and low-contrast distance VA were significantly greater in the multifocal group (0.40 vs 0.20; P=0.04 and 0.34 vs 0.98; P=0.006), whereas near VA, CS, and CCI were not significantly different between the two groups. After capsulotomy, the above visual functions were not significantly different between the two groups. Blurred distance and near vision were the most common presenting symptoms (95.8 and 100% in the monofocal group and 88.9 and 66.7% in the multifocal group). A greater proportion of patients in the monofocal group had blurred near vision (100 vs 66.7%) and, whereas the symptoms in the majority of patients in the monofocal group were moderate to severe, they were mild to moderate in the multifocal group. CONCLUSION The effect of PCO on visual function in the two groups seems to be comparable, although patients in the multifocal group appear to present with earlier loss of visual function.
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Nixon DR, Apple DJ. Evaluation of lens epithelial cell migration in vivo at the haptic-optic junction of a one-piece hydrophobic acrylic intraocular lens. Am J Ophthalmol 2006; 142:557-62. [PMID: 17011844 DOI: 10.1016/j.ajo.2006.05.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 05/11/2006] [Accepted: 05/21/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the pattern of lens epithelial cell (LEC) ingrowth behind the intraocular lens (IOL) optic in patients implanted with the AcrySof SA60AT one-piece IOL. DESIGN Retrospective case series. METHODS Patients implanted with the AcrySof SA60AT one-piece IOL with complete overlap of the capsulorrhexis and IOL optic and no ocular pathology were selected from the practices of six surgeons. High-resolution digital images of the distribution of LECs were captured. Circumferential location and extent of LEC growth behind the optic were measured. RESULTS Mean +/- SD follow-up was 13.2 +/- 1.7 months for 40 patients (mean age 72 years). LEC migration beyond the edge of the IOL optic was displayed by 57.5% (23/40) of patients. LECs migrated into the visual axis in 22.5% (9/40) of patients, leading to a visual acuity of <6/9 (20/30) in 10% (4/40) of patients. Cell migration was located preferentially at the optic-haptic junction. Serial photographs were used to monitor LEC migration over time. In some cases, LECs extended from the opposing optic-haptic junctions to converge in the center of the IOL, creating a path across the optic. CONCLUSIONS The optic-haptic junction of the AcrySof one-piece IOL is a point of weakness in the barrier effect of the square-edge IOL design that provides migrating LECs access to the posterior capsule.
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Miyata K, Kato S, Nejima R, Miyai T, Honbo M, Ohtani S. Influences of optic edge design on posterior capsule opacification and anterior capsule contraction. ACTA ACUST UNITED AC 2006; 85:99-102. [PMID: 17244219 DOI: 10.1111/j.1600-0420.2006.00758.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the influence of optic edge design on posterior capsule opacification (PCO) and anterior capsule contraction (ACC). METHODS A total of 43 eyes of 43 patients scheduled to undergo cataract surgery were included in this study. Patients received either a Sensor AR40 intraocular lens (IOL) or a Sensor AR40e IOL. The area of the anterior capsule opening (ACO) was determined by diaphanoscopy using the anterior eye segment analysis system EAS-1000 at 1 day, 1 week and 1, 3, 6 and 12 months postoperatively. Posterior capsule opacification was evaluated objectively in two ways, using either the EAS-1000 or POCOman. RESULTS There was no significant difference between the two groups in either ACO area or percentage reduction of ACO area at any time-point after surgery. The difference in the degree of PCO 1 year after surgery was not significant when measured by either the EAS-1000 or POCOman. CONCLUSIONS A sharp IOL edge is required to prevent PCO. Sharp-edged IOLs do not appear to be a risk factor for ACC.
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Wolffe M, Landry RJ, Alpar JJ. Identification of the source of permanent glare from a three-piece IOL. Eye (Lond) 2006; 21:1078-82. [PMID: 16936648 DOI: 10.1038/sj.eye.6702539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify the source of unwanted glare images from a three-piece intraocular lens (IOL) implant following cataract surgery. METHOD The IOL and posterior capsule were examined under mydriatic and nonmydriatic conditions using direct focal illumination from a slit lamp biomicroscope. Direct focal illumination was undertaken with both a narrow beam (0.1 mm in width) and small spot (0.1 mm in diameter) to identify the points at which the glare images were stimulated. While observing the location of the beam with the slit lamp biomicroscope, the patient indicated when the glare images were stimulated. RESULTS The nasal haptic insertion into the optic was identified as the source of temporal line images arising from lights such as headlamps from oncoming cars and street lamps. The adjacent edge of the IOL was also identified as the likely source of additional cob web-like light rays. CONCLUSIONS The haptic insertions in three-piece IOLs may, under certain conditions, interfere with light entering the pupil and produce extraneous images. Large mesopic pupils and decentred IOLs are conditions that increase the likelihood of unwanted glare images.
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Lombardo M, De Santo MP, Lombardo G, Barberi R, Serrao S. Analysis of intraocular lens surface properties with atomic force microscopy. J Cataract Refract Surg 2006; 32:1378-84. [PMID: 16863979 DOI: 10.1016/j.jcrs.2006.02.068] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 02/14/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the surface optics of 4 currently available intraocular lenses (IOLs) with atomic force microscopy. SETTING Licryl Laboratory, University of Calabria, Rende, Italy. METHODS The surface roughness and topography of poly(methyl methacrylate) (PMMA), silicone, hydrophobic, and hydrophilic acrylic IOLs were evaluated with atomic force microscopy in contact mode. The analysis was performed in a liquid environment using cantilevers with a 0.01 Newtonw/meter nominal elastic constant. Measurements were made over areas of 10 microm2 on different locations of the posterior optic surface of the IOL. RESULTS Atomic force microscopy permitted high-resolution imaging of IOL optic surface characteristics. Surface topography showed different features with respect to the lens biomaterial. The root-mean-square roughness of the IOL optic surface was significantly different between lenses of various materials (P < .001). The hydrophobic acrylic and silicone IOLs had the lowest mean surface roughness, 3.8 nm +/- 0.2 (SD) and 4.0 +/- 0.5 nm, respectively, and the 2 PMMA IOLs had the highest mean surface roughness, 6.6 +/- 0.3 nm and 7.0 +/- 0.6 nm. CONCLUSIONS Atomic force microscopy was effective and accurate in analyzing IOL optics. The surface topography of IOLs may vary with different manufacturing processes.
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Affiliation(s)
- Marco Lombardo
- Department of Experimental and Clinical Medicine, University Magna Graecia, Catanzaro and Vision Engineering, Reggio, Calabria, Italy.
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Hayashi K, Yoshida M, Hayashi H. Comparison of posterior capsule opacification between fellow eyes with two types of acrylic intraocular lens. Eye (Lond) 2006; 22:35-41. [PMID: 16823457 DOI: 10.1038/sj.eye.6702496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the degree of posterior capsule opacification (PCO) and visual function between fellow eyes that received two different types of hydrophobic acrylic intraocular lenses (IOLs). METHODS Forty-five patients underwent bilateral phacoemulsification and implantation of an Alcon AcrySof IOL (MA60AC) in one eye and an AMO Sensar IOL (AR40e) in the fellow eye. The PCO density value was measured using the Scheimpflug videophotography system at 1, 6, 12, and 24 months after surgery. The incidence of eyes that required a neodymium:YAG (Nd:YAG) laser capsulotomy, visual acuity, and contrast sensitivity with and without a glare source were also examined. RESULTS The mean PCO value did not show a significant increase in either the AcrySof MA60AC or Sensar AR40e IOL groups, and was similar between the two groups throughout the 24-month follow-up period. The incidence of Nd:YAG laser capsulotomy was also the same between the groups. No significant difference was found in mean visual acuity between the two IOL groups during the follow-up, and there was no significant difference in photopic or mesopic contrast visual acuity with and without a glare source at 1 and 24 months after surgery. CONCLUSION The degree of PCO in eyes with an AcrySof IOL are almost the same as that in eyes with a Sensar IOL, with the results that visual acuity and contrast sensitivity with and without glare are similar.
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Affiliation(s)
- K Hayashi
- Private Hospital of Ophthalmology, Hayashi Eye Hospital, Hakata-Ku, Fukuoka, Japan.
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Becker KA, Martin M, Rabsilber TM, Entz BB, Reuland AJ, Auffarth GU. Prospective, non-randomised, long term clinical evaluation of a foldable hydrophilic single piece intraocular lens: results of the Centerflex FDA study. Br J Ophthalmol 2006; 90:971-4. [PMID: 16687454 PMCID: PMC1857197 DOI: 10.1136/bjo.2006.092437] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Owing to the improvement of modern intraocular lenses (IOLs) in terms of design and material, posterior capsule opacification (PCO) usually takes 2-3 years to develop. Thus, long term clinical evaluation of new implants is important. METHODS As part of a prospective, non-randomised FDA trial, the Rayner Centerflex, a foldable hydrophilic acrylic, single piece IOL was implanted in one eye of 83 patients (mean age 73.5 (SD 7.0) years). Over 3 years postoperatively, a standardised FDA protocol concerning IOL safety and efficacy was followed including evaluation of spherical equivalent (SE), best corrected distance visual acuity (BCDVA), endothelial cell count (ECC), flare meter values, PCO development, and anterior capsule shrinkage. RESULTS Postoperatively, mean SE was stable ranging between -0.3D and 0.17D. After 1-2 months, all patients achieved a BCDVA of 20/40 or better. At 3-6 months postoperatively, mean ECC decreased from 2612 (SD 346) cells/mm2 to 2380 (316) cells/mm2. Mean PCO score for the entire optic increased from 0.20 (0.20) months (3-6 months postoperatively) to 0.87 (0.57) resulting in a Nd:YAG rate of 29.41% after 3 years. No anterior capsule shrinkage was found. CONCLUSION The Centerflex showed excellent functional results, low values for endothelial cell loss and inflammatory signs, and no anterior capsule shrinkage. PCO formation was higher compared to other IOLs, which could be explained by the incomplete sharp edge at the optic-haptic junctions representing an "Achilles' heel" for cell ingrowth.
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Affiliation(s)
- K A Becker
- Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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Okajima Y, Saika S, Sawa M. Effect of surface coating an acrylic intraocular lens with poly(2-methacryloyloxyethyl phosphorylcholine) polymer on lens epithelial cell line behavior. J Cataract Refract Surg 2006; 32:666-71. [PMID: 16698492 DOI: 10.1016/j.jcrs.2006.01.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 09/18/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the effect of surface coating of an acrylic intraocular lens (IOL) with poly(2-methacryloyloxyethyl phosphorylcholine) (MPC) on the behavior of the lens epithelial cell (LEC) line, alpha-TN4. SETTING Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan. METHODS A hydrophobic soft acrylic IOL (AF-1, Hoya) was coated with MPC polymer. A noncoated IOL served as control. An IOL from each group was placed on the membrane of collagen I or IV of the cell culture dish. The alpha-TN4 cells were seeded in the insert. Cell behaviors (ie, cell proliferation and spreading) on IOLs and membranes were observed. Cell migration beneath the IOL optic portion was assayed using a computer software program (POCOman system) for posterior capsule opacification (PCO). Type I or IV collagen is the major matrix component of PCO or native lens capsule. RESULTS Cell proliferation was more marked on the noncoated IOL than on the coated IOL. Type IV collagen accelerated proliferation more than type I collagen. Cell migration to the area beneath the IOL optic was more prominent in the group with the type I collagen membrane and noncoated IOL than in other groups. CONCLUSION Coating an acrylic IOL surface with MPC polymer suppressed adhesion and proliferation of LECs, suggesting it improves IOL biocompatibility.
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Affiliation(s)
- Yasuhiko Okajima
- Department of Ophthalmology (Okajima, Sawa), Nihon University School of Medicine, Tokyo, Japan.
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Nishi O, Nishi K, Osakabe Y. Evaluation of posterior capsule opacification using a new posterior view method in rabbits. J Cataract Refract Surg 2005; 31:2369-74. [PMID: 16473233 DOI: 10.1016/j.jcrs.2005.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE To introduce a new procedure for evaluating posterior capsule opacification (PCO) in rabbit eyes and to perform a comparative study of the single-piece and 3-piece acrylic intraocular lenses (IOLs) on PCO using the new evaluation method. SETTING Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS A single-piece or 3-piece acrylic IOL was implanted in 1 eye and the other in the contralateral eye of 5 rabbits. Three weeks after surgery, PCO was scored by Evaluation of Posterior Capsule Opacification (EPCO) in posterior view. Before the posterior view was photographed, the anterior capsule was removed from the whole optic area to eliminate disturbing anterior capsule opacification (ACO) for the PCO evaluation. RESULTS Posterior capsule opacification could be well observed and viewed in the posterior view so that it could be scored by EPCO without confusion with ACO. The mean PCO score of the single-piece and 3-piece acrylic IOLs was 3.12 +/- 0.19 and 2.41 +/- 0.70, respectively (P < .05 and P = .03, respectively). CONCLUSION The removal of ACO allowed scoring of PCO by EPCO in rabbit eyes. The single-piece acrylic IOL showed significantly more PCO than the 3-piece acrylic IOL at least 3 weeks after surgery in rabbits.
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Hayashi K, Hayashi H. Posterior Capsule Opacification in the Presence of an Intraocular Lens with a Sharp versus Rounded Optic Edge. Ophthalmology 2005; 112:1550-6. [PMID: 16005976 DOI: 10.1016/j.ophtha.2005.03.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 03/22/2005] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the degree of posterior capsule opacification (PCO) and visual function in eyes implanted with an acrylic intraocular lens (IOL) with a sharp posterior optic edge with that in eyes implanted with an IOL with a rounded optic edge. DESIGN Randomized clinical trial. PARTICIPANTS Seventy-five consecutive patients scheduled for bilateral phacoemulsification were assigned randomly to 1 of 2 groups. One group received an acrylic IOL with a sharp edge (Sensar AR40e, AMO, Santa Ana, CA) in the left eye and an acrylic IOL of the same optic material and loops but with a rounded-edge optic (Sensar AR40) in the right eye. The other group received the sharp-edged IOL in the right eye and the rounded-edge IOL in the left eye. Sixty-nine patients (92%) completed follow-up. INTERVENTION All patients underwent implantation of a sharp-edged IOL in 1 eye and a rounded-edge IOL in the fellow eye. MAIN OUTCOME MEASURES The PCO value of these patients was measured using the Scheimpflug videophotography system at 1, 3, 6, 12, 18, and 24 months after surgery. The incidence of eyes that required a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy was examined. Visual acuity and contrast sensitivity with and without a glare source also were evaluated. RESULTS The mean PCO value in the sharp-edge IOL group was significantly less than that in the rounded-edge IOL group throughout the follow-up period. The incidence of Nd:YAG capsulotomy also was significantly less in the sharp-edge group than in the rounded-edge group (P = 0.0095). No significant difference was found in mean visual acuity during the 24 months of follow-up. However, contrast visual acuity with and without glare was significantly better in the sharp-edge group than in the rounded-edge group at 24 months after surgery. CONCLUSIONS The degree of posterior capsule opacification in eyes with an acrylic IOL with a sharp posterior optic edge is significantly less than that in eyes with a rounded-edge IOL, and the sharp-edge optic led to better contrast sensitivity with and without glare.
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Auffarth GU, Rabsilber TM, Reuland AJ. [New methods for the prevention of posterior capsule opacification]. Ophthalmologe 2005; 102:579-86. [PMID: 15889259 DOI: 10.1007/s00347-005-1234-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Even though tremendous advances have been made especially during the last 10-15 years in terms of surgical techniques and improvement of implant technology, posterior capsule opacification (PCO) still remains a serious long-term complication. New clinical and laboratory studies (especially of autopsy eyes) have improved our understanding of how IOL design and material influence PCO. Sharp edge optic designs of IOLs of various materials have been shown to significantly reduce secondary cataract. The application of pharmacological substances selectively into the capsular bag is now possible due to the development of the PerfectCapsule System for vacuum-sealed capsule irrigation. Major advances in other areas of biotechnology and immunology including gene therapeutic methods offer totally new approaches for the future in the elimination of lens epithelium cells from the capsular bag. This survey gives an update on current and future means and trends to reduce or prevent PCO formation.
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Affiliation(s)
- G U Auffarth
- Augenklinik, Ruprecht-Karls-Universität, Heidelberg.
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Nishi O. [Influence of intraocular lens material and design on the development of posterior capsule opacification]. Ophthalmologe 2005; 102:572-8. [PMID: 15895236 DOI: 10.1007/s00347-005-1222-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Based on the literature of 1999-2005, we attempted to clarify the influence of material and design of an intraocular lens (IOL) on the development of posterior capsule opacification (PCO) and identify the future problems to be solved. The sharp edge design of an IOL has significantly reduced PCO in recent years. Histopathological studies showed that a sharp capsular bend was formed at the sharp posterior optic edge, and the migration of lens epithelial cells was obviously inhibited at the site. Experimental and clinical studies suggest that the sharper the edge is, the sharper the capsular bend, and the greater the preventive effect, regardless of IOL material. The sharp capsule bend appears to represent a physical hindrance, which may induce contact inhibition of cell movement. How material participates in the preventive effect should be clarified in a future study. Thus, at the moment, the formation of capsular bend at the posterior optic edge appears to be the decisive criterion to evaluate the influence of IOL material and design on the development of PCO. Optimization of design and material of an IOL, which facilitates capsular bend formation as sharply and quickly as possible, may reduce PCO to a clinically negligible level.
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Affiliation(s)
- O Nishi
- Nishi Eye Hospital, Osaka, Japan.
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Sundelin K, Shams H, Stenevi U. Three-year follow-up of posterior capsule opacification with two different silicone intraocular lenses. ACTA ACUST UNITED AC 2005; 83:11-9. [PMID: 15715551 DOI: 10.1111/j.1600-0420.2005.00408.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare posterior capsule opacification (PCO) after cataract surgery with implantation of two silicone intraocular lenses (IOLs) with different designs. METHODS We carried out a prospective, clinical study of 116 patients randomized to standardized phacoemulsification with implantation of CeeOn Edge (n = 57) or SI40NB (n = 59) IOLs. The follow-up period was 3 years. To evaluate PCO morphologically, digital images were obtained and analysed using evaluation of posterior capsule opacification computer software (epco). The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded. RESULTS At 2 and 3 years, the eyes with SI40NB IOLs had significantly more PCO than those with the CeeOn Edge IOLs (p = 0.00014 and p = 0.002). Nine Nd:YAG capsulotomies were performed in the SI40NB group and none in the CeeOn Edge group. This difference was statistically significant (p = 0.003). In some patients a regression of PCO was noticed and confirmed using epco. Statistically less PCO was noted when the capsulorhexis rim was placed so that it covered all 360 degrees of the optic of the IOL. CONCLUSIONS A clinically and statistically significant difference in PCO development between CeeOn Edge and SI40NB IOLs at 2 and 3 years postoperatively was found. These findings support earlier studies indicating that a sharp edge of the optic is a more important factor in IOL design than IOL material in the prevention of PCO.
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Affiliation(s)
- Karin Sundelin
- Department of Ophthalmology, Sahlgrenska University Hospital/Mölndal's Hospital, S-431 80 Mölndal, Sweden.
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Nishi O, Nishi K, Osakabe Y. Effect of intraocular lenses on preventing posterior capsule opacification: design versus material. J Cataract Refract Surg 2004; 30:2170-6. [PMID: 15474832 DOI: 10.1016/j.jcrs.2004.05.022] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2004] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the preventive effect of 4 types of design- and material-matched intraocular lenses (IOLs) on posterior capsule opacification (PCO). SETTING Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS After phacoemulsification, 1 of 2 matched IOLs in 3 groups was implanted in 1 eye and the other IOL in the contralateral eye of 4 to 6 rabbits. Three weeks postoperatively, posterior view and histopathological evaluations were performed and the capsular bending effect and amount of PCO evaluated. RESULTS The capsular bending effect was similar between a sharp-edged acrylic IOL (Sensar 40e, AMO) and a sharp-edged silicone IOL (ClariFlex, AMO) and between the Sensar 40e IOL and a sharp-edged acrylic IOL (AcrySof, Alcon Laboratories). There was no significant difference between IOL types in the amount of PCO. The capsular bend effect was slightly better and the PCO amount slightly less with the ClariFlex IOL than with the round-edged silicone PhacoFlex II IOL (AMO). CONCLUSIONS There was no substantial difference in PCO prevention between IOLs with sharp posterior optic edges, regardless of the IOL's material composition. The anterior edge design appeared to have no preventive effect. These results confirm that a sharp posterior optic edge is the main factor in preventing PCO.
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Nguyen NX, Seitz B, Reese S, Langenbucher A, Küchle M. Accommodation after Nd: YAG capsulotomy in patients with accommodative posterior chamber lens 1CU. Graefes Arch Clin Exp Ophthalmol 2004; 243:120-6. [PMID: 15599585 DOI: 10.1007/s00417-004-1041-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Revised: 08/18/2004] [Accepted: 09/06/2004] [Indexed: 10/25/2022] Open
Abstract
PURPOSE After initial encouraging results with the accommodative 1CU posterior chamber lens (PCIOL), we investigated the rate, the postoperative time point of posterior capsular opacification (PCO) necessitating YAG capsulotomy and the accommodative range after Nd: YAG capsulotomy in patients with 1CU-PCIOL. PATIENTS AND METHODS This prospective clinical study included 65 patients who underwent phacoemulsification and implantation of the accommodative 1CU-PCIOL with postoperative follow-up from 3 to 24 months. Postoperative examination was performed 3, 6 and 12 months after surgery, then before and 6 weeks after Nd: YAG capsulotomy. Measurements included: the best corrected distance visual acuity, distance refraction, near visual acuity (Birkhauser charts in 35 cm) obtained with best distance correction, accommodative range measured by subjective near point with an accodommometer and defocusing with a visual acuity fall to 0.4. RESULTS Both best corrected distance visual acuity (1.1+/-0.1) and near visual acuity with best distance correction (0.4+/-0.1) remained stable over the follow-up period until 12 months postoperatively. The accommodative range determined by near point was stable (mean 2.0+/-0.5 D). Also, the defocusing range remained stable over 12 months (1.8+/-0.4 D). A clinically relevant posterior capsule opacification with a significant decrease of visual acuity (0.4+/-0.2) and a need for Nd: YAG capsulotomy was diagnosed in 12 patients between 15 and 22 (mean 20+/-4, median 20) months postoperatively. All capsulotomies were performed without complication. Six weeks after capsulotomy, best corrected distance visual acuity was improved (1.1+/-0.1), near visual acuity with best distance correction was 0.4+/-0.1 and the accommodative range determined by near point was 1.95+/-0.6 D and by defocusing was 1.88+/-0.47 D. Six weeks after capsulotomy, measurements of the accommodative range did not show any statistical difference to the 12-month results before the occurrence of PCO (P>0.5). CONCLUSIONS A clinically relevant PCO with a significant decrease of visual acuity necessitating Nd: YAG capsulotomy occurred mainly after 15 postoperative months in patients with 1CU. Our results indicate that Nd: YAG capsulotomy may not affect the accommodation ability of the 1CU. Nevertheless, long-term studies are needed to further analyze the accommodative properties.
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Affiliation(s)
- Nhung X Nguyen
- Department of Ophthalmology, University Erlangen-Nürnberg, Erlangen, Germany.
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Nixon DR. In vivo digital imaging of the square-edged barrier effect of a silicone intraocular lens. J Cataract Refract Surg 2004; 30:2574-84. [PMID: 15617927 DOI: 10.1016/j.jcrs.2004.06.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2004] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate and compare by high-magnification digital photography the lens epithelial cell (LEC) response and capsule dynamics in vivo after implantation of a square-edged and a round-edged silicone intraocular lens (IOL) in a fellow-eye study. SETTING Private practice and Royal Victoria Hospital, Barrie, and Soldiers' Memorial Hospital, Orillia, Ontario, Canada. METHODS After phacoemulsification, a single surgeon implanted a square-edged silicone IOL (SoFlex SE, Bausch & Lomb) in 25 patients who had previously had a conventional round-edged version of the same IOL (SoFlex Li61U, Bausch & Lomb) implanted in their contralateral eye within a 6-week period. SoFlex SE IOL recipients were selected sequentially from those scheduled for surgery within a 3-day period. The IOLs were sequentially photographed 1 week and 1, 3, 6, and 9 months after surgery using magnification of at least x64 through a biomicroscope and a high-resolution digital camera with adapter. Images were transferred to a graphics computer and compared over time. RESULTS At 1 week, both designs had evidence of LEC migration along the posterior capsule, with the highest cell density around the 6 o'clock position. At 1 month, both IOL designs showed 360 degrees of anterior and posterior capsule adhesion to the edge of the optic. At 1 month, however, migrating LECs encountered a "damming" effect at the square posterior edge but not at the round edge. A thin fibrotic ring began to form around the SoFlex SE edge at 2 months and was complete for 360 degrees at 3 months. At 9 months, there was no evidence of LEC migration beyond this ring. With round-edged IOLs, the fibrotic ring never fully formed and LEC migration continued posterior to the optic. There was a tight capsule shrink-wrap effect with the square-edged IOLs with the fibrotic ring, allowing minimal IOL movement between 1 month and 9 months. The round-edged IOLs tended to decenter and rotate. Anterior capsulorhexis contraction was greater at every time point with the round-edged IOLs than with the square-edged IOLs. CONCLUSION Early contact inhibition of LECs by a square-edged IOL design and its effects were demonstrated in vivo with sequential, high-resolution digital photography and commercially available graphics software.
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Wejde G, Kugelberg M, Zetterström C. Position of anterior capsulorhexis and posterior capsule opacification. ACTA ACUST UNITED AC 2004; 82:531-4. [PMID: 15453848 DOI: 10.1111/j.1600-0420.2004.00322.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate whether the position of the anterior continuous curvilinear capsulorhexis influences the rate of posterior capsule opacification (PCO). METHODS A total of 119 patients, aged 61-86 years, underwent cataract surgery with phacoemulsification performed by a single surgeon. The patients were randomized to implantation with either a silicone intraocular lens (IOL) (SI40NB, Allergan) or an AcrySof IOL (MA60BM, Alcon). Three years after surgery, the rate of PCO was analysed using the evaluation of posterior capsule opacification computer software (EPCO). The results were related to the capsulorhexis position, which was assessed with a retroillumination photograph. RESULTS If the capsulorhexis was located partially or completely off the optics of the IOL, compared to totally on the IOL, significantly more PCO was found (p = 0.0014). When comparing within each IOL type, patients with AcrySof IOLs were found to have significantly less PCO when the capsulorhexis was totally on the optic (p = 0.0048). This difference was also significant in the silicone group (p = 0.041). CONCLUSION A relatively small and central capsulorhexis allowing for the complete covering of the IOL optics by the rhexis edges seems to protect against PCO in cataract surgery, with both round-edged silicone IOLs and sharp-edged hydrophobic acrylic IOLs.
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Aslam TM, Patton N. Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement. BMC Ophthalmol 2004; 4:13. [PMID: 15387889 PMCID: PMC521490 DOI: 10.1186/1471-2415-4-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Accepted: 09/23/2004] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This paper attempts to clarify the usefulness of various simple pre-operative measures in estimating the potential for a visually successful capsulotomy. METHODS 24 patients attending for capsulotomy had pre-operative measures of glare with BAT tester, visibility of posterior pole and grading of posterior capsular pearls and fibrosis seen at slit lamp. Visual function was measured before and after standardised capsulotomy. Correlations of the various preoperative measures with eventual visual function improvements were calculated. RESULTS Pearls at slit lamp and poor posterior pole visualisation were all correlated with improvements in visual acuity and contrast sensitivity after capsulotomy. Amount of fibrosis visible at slit lamp and glare assessment were not correlated with vision improvements after laser. CONCLUSION Of the various measures that are taken prior to Nd : YAG capsulotomy, some correlate with eventual visual improvement but for others no clinical utility was found. Practitioners should note these findings as they are especially of use in more questionable or high-risk cases to help determine whether referral for PCO treatment by Nd: YAG capsulotomy is likely to benefit the patient.
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Hayashi K, Hayashi H. Effect of a modified optic edge design on visual function. J Cataract Refract Surg 2004; 30:1668-74. [PMID: 15313289 DOI: 10.1016/j.jcrs.2004.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the impairment in visual function caused by glare with 2 acrylic intraocular lenses (IOLs) with different modified optic edges. SETTING Hayashi Eye Hospital, Fukuoka, Japan. METHODS Fifty-four patients had implantation of an IOL with a textured edge (Alcon MA60AC) in 1 eye and an IOL with a round-anterior, sloped-sided edge (AMO AR40e) in the opposite eye. Visual acuity was measured at 5 contrast visual targets (100%, 25%, 10%, 5%, and 2.5%) (contrast visual acuity) under photopic and mesopic conditions with and without a glare source approximately 1 month after surgery using the Contrast Sensitivity Accurate Tester (Menicon CAT-2000). RESULTS The mean mesopic contrast visual acuity at moderate- to low-contrast visual targets was significantly worse in the presence of a glare source in both groups, whereas photopic contrast visual acuity did not change significantly. There were no significant differences between the 2 groups in the mean visual acuity or in photopic or mesopic lighting contrast visual acuity with and without a glare source. Furthermore, there was no significant difference in loss of contrast visual acuity in the presence of glare. CONCLUSION Mesopic contrast sensitivity with both acrylic IOLs was impaired significantly in the presence of glare, but the impairment of contrast sensitivity from glare was approximately the same between eyes with a textured-edge IOL and eyes with a round-anterior, sloped-sided edge IOL.
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Affiliation(s)
- Ken Hayashi
- Hayashi Eye Hospital, 4-7-13 Hakataekimae, Hakata-Ku, Fukuoka 812, Japan.
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Buehl W, Menapace R, Sacu S, Kriechbaum K, Koeppl C, Wirtitsch M, Georgopoulos M, Findl O. Effect of a silicone intraocular lens with a sharp posterior optic edge on posterior capsule opacification. J Cataract Refract Surg 2004; 30:1661-7. [PMID: 15313288 DOI: 10.1016/j.jcrs.2004.02.051] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2003] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the inhibiting effect on posterior capsule opacification (PCO) of a silicone intraocular lens (IOL) with a sharp posterior optic edge (ClariFlex OptiEdge, Advanced Medical Optics) and a silicone IOL with a round optic edge (PhacoFlex SI-40, Advanced Medical Optics). SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS This prospective randomized patient- and examiner-masked study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients had cataract surgery in both eyes and received a sharp-edged IOL in 1 eye and a round-edged IOL in the other eye. Postoperative examinations were at 1 week, 1 and 6 months, and 1 year. Digital slitlamp and retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using Automated Quantification of After-Cataract (AQUA) automated-image analysis software. RESULTS The sharp-edged IOL group had significantly less regeneratory and fibrotic PCO 1 month, 6 months, and 1 year after surgery. The mean AQUA PCO score (scale 0 to 10) was 0.71 in the sharp-edged IOL group and 1.40 in the round-edged IOL group (P<.001). The sharp-edged IOL group had less peripheral fibrotic PCO. There was no significant difference between the 2 IOL groups in patient reports of edge glare. CONCLUSION The sharp-edged design of the ClariFlex OptiEdge silicone IOL led to significantly less PCO than the round-edged PhacoFlex SI-40 IOL 1 year postoperatively.
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Affiliation(s)
- Wolf Buehl
- Department of Ophthalmology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Schild G, Amon M, Abela-Formanek C, Schauersberger J, Bartl G, Kruger A. Uveal and capsular biocompatibility of a single-piece, sharp-edged hydrophilic acrylic intraocular lens with collagen (Collamer): 1-year results. J Cataract Refract Surg 2004; 30:1254-8. [PMID: 15177600 DOI: 10.1016/j.jcrs.2003.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To analyze uveal and capsular biocompatibility 1 year following implantation of a sharp-edged, hydrophilic, collagen-containing posterior chamber intraocular lens (IOL). SETTING Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. METHOD In a prospective study, a Collamer CC4204BF IOL was implanted in 30 eyes of patients with senile cataract. A standardized surgical technique and postoperative regimen were applied. To assess uveal biocompatibility, cellular inflammation on the anterior IOL surface was evaluated with a specular microscope. Capsular biocompatibility was registered semiquantitatively with a biomicroscope, based on an assessment of fibrosis on the anterior and posterior capsules. Tyndall values were measured with the Kowa FC-1000 laser flare-cell meter. Decentration of the lens was also registered. RESULTS One year after implantation, the values of flare and cell count in the anterior chamber were lower than preoperatively. Round and spindle-shaped, epithelioid, and foreign-body giant cells were not found on the anterior surface of the IOL. The capsulorhexis rim was moderately fibrosed in 56.6% of cases. Fibrosis of the capsule over the optic was also moderate in 36.6%. The central portion of the posterior capsule was devoid of fibrosis in 43.3% and mildly fibrosed in 50%. Three lenses revealed outgrowth of lens epithelial cells to the anterior surface of the IOL. A neodymium:YAG capsulotomy had to be performed in 1 case. All lenses were well centered in the capsular bag 1 year after implantation. CONCLUSIONS The absence of inflammatory cells on the anterior surface of the IOL indicates the high uveal biocompatibility of the lens. In terms of capsular biocompatibility, the results were satisfactory.
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Affiliation(s)
- Gebtraud Schild
- Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria
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Davison JA. Neodymium:YAG laser posterior capsulotomy after implantation of AcrySof intraocular lenses. J Cataract Refract Surg 2004; 30:1492-500. [PMID: 15210228 DOI: 10.1016/j.jcrs.2003.11.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2003] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the incidence of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and implantation of AcrySof (Alcon) intraocular lenses (IOLs). SETTING Private practice, Wolfe Clinic, Marshalltown, Iowa, USA. METHODS A retrospective diagnosis and procedure code review of 12419 consecutive cases having phacoemulsification and AcrySof IOL implantation from January 1995 through December 2002 was performed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies. RESULTS An Nd:YAG laser posterior capsulotomy was performed in 763 (6.1%) of the 12419 cases. The incidence of posterior capsulotomy was approximately 1% at 1 year, increasing in linear fashion by approximately 1% to 2% per year. CONCLUSIONS The Nd:YAG laser posterior capsulotomy rate after implantation of AcrySof IOLs was relatively low; the cumulative rate was approximately 1% to 2% new cases per year over a 7-year period, with a plateau suggested at year 6.
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Affiliation(s)
- James A Davison
- Wolfe Clinic, 309 East Church Street, Marshalltown, IA 50158, USA.
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