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Belda JI, Placeres J, Elvira JC, Puig X, Pérez-Vives C, Zou M, Yu J, Sun S, O’Boyle D. Five-Year Incidence of Nd:YAG Capsulotomy After Cataract Surgery with Different Single-Piece Monofocal Intraocular Lenses: A Follow-Up Study of 3955 Eyes. Clin Ophthalmol 2024; 18:1599-1605. [PMID: 38855011 PMCID: PMC11162221 DOI: 10.2147/opth.s441012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/18/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose To estimate the incidence of neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy up to five years after cataract surgery with different single-piece acrylic monofocal IOLs in a Spanish cohort. Patients and Methods Data were extracted from electronic medical records. Eligible participants were aged ≥65, had cataract surgery with one of five different acrylic monofocal IOLs (Alcon AcrySof, AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag and Zeiss Asphina), and more than six months baseline data. Participants were followed up to five years from surgery and up to six months from Nd:YAG. The incidence of Nd:YAG was compared between the IOLs and multivariate analyses were conducted to identify predictors of Nd:YAG incidence at five-years after cataract surgery. Results The initial cohort included 9545 patients with 14,519 eyes (53% female, average age 75 years). Of those, 3955 eyes were available for analysis five years after cataract surgery. Throughout the five years post-surgery, Nd:YAG incidence was consistently lower with Alcon Acrysof IOLs than the other IOLs. At five years the Nd:YAG incidence rate for Alcon Acrysof was 8.8%. In comparison, the incidence was 47.4% for AJL LLASY60 (OR = 9.54, 95% CI [6.57, 13.84]), 44.3% for Zeiss Asphina (OR = 8.35, 95% CI [5.85, 11.94]) and 44.0% for IOL Tech Stabibag (OR = 8.02, 95% CI [4.60, 13.84]). Conclusion Alcon AcrySof IOLs have a consistently lower risk of Nd:YAG incidence over a long follow-up period after cataract surgery, highlighting the importance of IOL choice for patients' long-term outcomes.
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Affiliation(s)
- José I Belda
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Alicante, Spain
| | - Javier Placeres
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Alicante, Spain
| | - Juan C Elvira
- Department of Ophthalmology, Hospital Universitario del Vinalopó, Alicante, Spain
| | | | | | - Ming Zou
- IQVIA Real World Solutions, Basel, Switzerland
| | - Jing Yu
- IQVIA Real World Solutions, Basel, Switzerland
| | - Shaohui Sun
- IQVIA Real World Solutions, Basel, Switzerland
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Srinija K, Bhat SK, Prasad KHL. Comparative histomorphologic study of basement membrane side staining and additional epithelial side staining of the anterior lens capsule with Trypan Blue. Indian J Ophthalmol 2024; 72:578-581. [PMID: 38146976 PMCID: PMC11149509 DOI: 10.4103/ijo.ijo_1558_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/19/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE To compare the histomorphologic changes on the anterior lens capsule by both epithelial and basement membrane side staining to those of only basement membrane side staining of the anterior lens capsule with Trypan Blue (TB). METHODS A cross-sectional study was done on 72 samples from patients who underwent cataract surgery between April 2021 and September 2022. After capsulorhexis of the TB-stained capsule, it was made into two halves externally and one half labeled as controls (sample A). The other half was immediately stained further with TB on the epithelial side and was taken as cases (sample B). Samples were analyzed for lens epithelial cells and basement membrane changes. RESULTS The loss of intactness of lens epithelial cells, partial or complete detachment of lens epithelial cells, degeneration of lens epithelial cells, and basement edema were significantly higher in cases compared to controls, whereas intactness of the basement membrane did not show any statistical significance between the two groups. There was a statistically significant decrease in cell density in cases compared to controls. CONCLUSION Staining the epithelial side of the capsular bag with TB is more detrimental to lens epithelial cells and paves the way for a further study of staining the capsular bag before intra-ocular lens implantation to reduce the incidence of posterior capsule opacification.
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Affiliation(s)
- Kommana Srinija
- Department of Ophthalmology, K. S. Hegde Medical Academy of Nitte DU, Deralakatte, Mangalore, Karnataka, India
| | - Subrahmanya K Bhat
- Department of Ophthalmology, K. S. Hegde Medical Academy of Nitte DU, Deralakatte, Mangalore, Karnataka, India
| | - Kishan H L Prasad
- Department of Pathology, K. S. Hegde Medical Academy of Nitte DU, Deralakatte, Mangalore, Karnataka, India
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Measurement of Force Required for Anterior Displacement of Intraocular Lenses and Its Defining Parameters. MATERIALS 2020; 13:ma13204593. [PMID: 33076490 PMCID: PMC7602541 DOI: 10.3390/ma13204593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 12/25/2022]
Abstract
Intraocular stability during or after cataract and glaucoma filtration surgeries and vitreous surgery with a gas/silicone oil tamponade might differ among intraocular lenses (IOLs). We used six different one-piece IOL models and measured the force that displaced the IOLs from the vitreous cavity to anterior chamber as a measure of stability against the pressure gradient between the anterior and posterior IOL surfaces. We measured IOL hardness, haptics junction area, and posterior IOL bulge to identify what determines the IOL displacement force. The KOWA YP2.2 IOL (1.231 mN) required significantly greater force than the HOYA XY1 (0.416 mN, p = 0.0004), HOYA 255 (0.409 mN, p = 0.0003), Alcon SN60WF (0.507 mN, p = 0.0010), and Nidek NS60YG (0.778 mN, p = 0.0186) IOLs; J&J ZCB00V IOL (1.029 mN) required greater force than the HOYA XY1 (p = 0.0032) and HOYA 255 (p = 0.0029) IOLs; the Nidek NS60YG IOL required greater force than the HOYA 255 (p = 0.0468) IOL. The haptics junction area was correlated positively with the IOL displacement force (r = 0.8536, p = 0.0306); the correlations of the other parameters were non-significant. After adjusting for any confounding effects, the haptics junction area was correlated significantly with the IOL displacement force (p = 0.0394); the IOL hardness (p = 0.0573) and posterior IOL bulge (p = 0.0938) were not. The forces that displace IOLs anteriorly differed among one-piece soft-acrylic IOLs, and the optics/haptics junction area was the major force determinant.
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Leydolt C, Schartmüller D, Schwarzenbacher L, Röggla V, Schriefl S, Menapace R. Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial. Am J Ophthalmol 2020; 217:224-231. [PMID: 32335056 DOI: 10.1016/j.ajo.2020.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years. DESIGN Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. PATIENT POPULATION Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye. OBSERVATION PROCEDURES Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA). MAIN OUTCOME MEASURE PCO score (scale, 0-10). RESULTS The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23). CONCLUSION The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.
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Early-stage clinical outcomes and rotational stability of TECNIS toric intraocular lens implantation in cataract cases with long axial length. BMC Ophthalmol 2020; 20:204. [PMID: 32450828 PMCID: PMC7249429 DOI: 10.1186/s12886-020-01465-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background A major focus of toric intraocular lens (IOL) implantation is the rotational stability, especially in the patients with long axial length (AL). In this study, we aimed to evaluate the clinical outcomes after implantation of TECNIS toric IOL in eyes with long AL and identify factors influencing their early-stage stability with preoperative corneal astigmatism. Methods The study population consisted of 64 eyes from 52 cataract patients, and these patients had preoperative corneal astigmatism between 1.0 and 3.7 diopters (D) and underwent phacoemulsification and TECNIS toric IOL implantation. Ophthalmic biological measurements were carried out preoperatively, including AL, anterior chamber depth (ACD), lens thickness (LT), vitreous length (VL), anterior chamber volume (ACV), sulcus-to-sulcus (STS) and keratometric value (K). Clinical examinations, including visual acuity, manifest refraction, keratometry, digital anterior segment photographs with pupillary dilation, were performed at 1 and 3 months after surgery. Results The mean best corrected distance visual acuity (BCDVA) was improved from 0.93 ± 0.35 logarithms of the minimal angle of resolution (logMAR) preoperatively to 0.07 ± 0.10 logMAR postoperatively at 3 months after surgery. The mean residual astigmatism (RAS) was 0.91 ± 0.74D at 3 months, which was significantly decreased compared with the preoperative corneal astigmatism of 1.71 ± 0.55 D. The mean absolute rotation of TECNIS toric IOL at 1 and 3 months was 7.42 ± 11.32 degree (°) (0–79°) and 7.48 ± 11.19°(0–79°), respectively. The mean area of capsulorhexis and the overlapped area between capsulorhexis and IOL optic intraoperatively was 21.04 ± 3.30 mm2 and 7.40 ± 2.87 mm2.A positive correlation was found between IOL rotation and the area of capsulorhexis (p = 0.017) at 3 months after surgery. No correlation was found between IOL rotation and AL (p = 0.876), ACD (p = 0.387), LT (p = 0.523), VL (p = 0.546), ACV (p = 0.480), STS (p = 0.884), K1 (p = 0.429), K2 (p = 0.644), average of K1 and K2 (p = 0.520), intraoperative IOL axial direction (p = 0.396), preoperative corneal astigmatism (p = 0.269) or the overlapped area between capsulorhexis and IOL optic intraoperatively (p = 0.131) . Conclusions The large CCC was a risk factor for toric IOL rotation. An appropriately smaller sized CCC was conducive to increase the rotational stability of TECNIS toric IOL implantation in cataract cases with long AL.
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Long-term Posterior Capsule Opacification Reduction with Square-Edge Polymethylmethacrylate Intraocular Lens. Ophthalmology 2017; 124:295-302. [DOI: 10.1016/j.ophtha.2016.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/24/2016] [Accepted: 11/09/2016] [Indexed: 11/30/2022] Open
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Kramer GD, Werner L, Mamalis N. Prevention of postoperative capsular bag opacification using intraocular lenses and endocapsular devices maintaining an open or expanded capsular bag. J Cataract Refract Surg 2016; 42:469-84. [PMID: 27063529 DOI: 10.1016/j.jcrs.2016.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED Postoperative capsule opacification is a multifactorial physiological consequence of cataract surgery that remains the most common complication of this procedure. A literature review that included several intraocular lenses (IOLs) and endocapsular devices studied in our laboratory found that devices maintaining the capsular bag in an open or expanded state were associated with improved bag clarity. This observed effect likely occurs secondary to the complex interactions of myriad mechanisms, which include formation of a barrier to lens epithelial cell (LEC) migration, mechanical compression of residual LECs, mechanical stretch at the level of the capsule equator, maintenance of overall bag contour, and enhanced endocapsular circulation of aqueous humor. We review the designs of endocapsular devices and IOLs that minimize the degree of postoperative capsule opacification by preventing capsular bag collapse and discuss the underlying mechanisms that contribute to this phenomenon. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Gregory D Kramer
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Liliana Werner
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
| | - Nick Mamalis
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Pallikaris IG, Stojanovic NR, Ginis HS. A new endocapsular open ring for prevention of anterior and posterior capsule opacification. Clin Ophthalmol 2016; 10:2205-2212. [PMID: 27843291 PMCID: PMC5098592 DOI: 10.2147/opth.s106770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study is to demonstrate the functionality of a new design of a thick endocapsular open ring for prevention of anterior capsule opacification (ACO) and posterior capsule opacification (PCO). SETTING The Institute of Vision and Optics, University of Crete and University Hospital of Heraklion, Crete, Greece. DESIGN Prospective, interventional pilot study. METHODS Fifteen patients (17 eyes) underwent cataract surgery with phacoemulsification. During surgery, a thick endocapsular open ring (peripheral capsule reconstructor) was inserted into the capsular bag, prior to intraocular lens (IOL) implantation. Six different models of IOL were implanted. Postoperatively, the degree of ACO and PCO was evaluated and described as none, mild, moderate, or severe. RESULTS The mean follow-up period was 30±8.06 months (range: 12-36 months). At the last follow-up, mild PCO was observed in only three eyes and mild ACO in three patients. The centration of IOLs was good in all but one eye, which had a tilted IOL. CONCLUSION The results of this pilot study suggest that the implantation of a new design of thick endocapsular open ring is feasible and may contribute to the prevention of PCO and ACO after cataract surgery.
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Affiliation(s)
- Ioannis G Pallikaris
- Institute of Vision and Optics, Department of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Nela R Stojanovic
- Institute of Vision and Optics, Department of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Harilaos S Ginis
- Institute of Vision and Optics, Department of Medicine, University of Crete, Heraklion, Crete, Greece
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Growth factor restriction impedes progression of wound healing following cataract surgery: identification of VEGF as a putative therapeutic target. Sci Rep 2016; 6:24453. [PMID: 27076230 PMCID: PMC4831005 DOI: 10.1038/srep24453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/29/2016] [Indexed: 01/29/2023] Open
Abstract
Secondary visual loss occurs in millions of patients due to a wound-healing response,
known as posterior capsule opacification (PCO), following cataract surgery. An
intraocular lens (IOL) is implanted into residual lens tissue, known as the capsular
bag, following cataract removal. Standard IOLs allow the anterior and posterior
capsules to become physically connected. This places pressure on the IOL and
improves contact with the underlying posterior capsule. New open bag IOL designs
separate the anterior capsule and posterior capsules and further reduce PCO
incidence. It is hypothesised that this results from reduced cytokine availability
due to greater irrigation of the bag. We therefore explored the role of growth
factor restriction on PCO using human lens cell and tissue culture models. We
demonstrate that cytokine dilution, by increasing medium volume, significantly
reduced cell coverage in both closed and open capsular bag models. This coincided
with reduced cell density and myofibroblast formation. A screen of 27 cytokines
identified nine candidates whose expression profile correlated with growth. In
particular, VEGF was found to regulate cell survival, growth and myofibroblast
formation. VEGF provides a therapeutic target to further manage PCO development and
will yield best results when used in conjunction with open bag IOL designs.
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Rajavi Z, Javadi MA, Daftarian N, Safi S, Nejat F, Shirvani A, Ahmadieh H, Shahraz S, Ziaei H, Moein H, Motlagh BF, Feizi S, Foroutan A, Hashemi H, Hashemian SJ, Jabbarvand M, Jafarinasab MR, Karimian F, Mohammad-Rabei H, Mohammadpour M, Nassiri N, Panahi-Bazaz M, Rohani MR, Sedaghat MR, Sheibani K. Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran. J Ophthalmic Vis Res 2016; 10:445-60. [PMID: 27051491 PMCID: PMC4795396 DOI: 10.4103/2008-322x.176913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients.
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Affiliation(s)
- Zhaleh Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Nejat
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Office for Healthcare Standards, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran; Department of Medical Education, Faculty of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moein
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sepehr Feizi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Foroutan
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Javad Hashemian
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Jafarinasab
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Mohammad-Rabei
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mohammadpour
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Nassiri
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Rohani
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Kourosh Sheibani
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
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Duman R, Karel F, Özyol P, Ateş C. Effect of four different intraocular lenses on posterior capsule opacification. Int J Ophthalmol 2015; 8:118-21. [PMID: 25709920 PMCID: PMC4325254 DOI: 10.3980/j.issn.2222-3959.2015.01.22] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/14/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the impact of 4 different intraocular lenses (IOLs) on posterior capsule opacification (PCO) by comparing the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy rates. METHODS This retrospective study included 4970 eyes of 4013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at one clinic. Four different IOLs were assessed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies. RESULTS An Nd:YAG laser posterior capsulotomy was performed in 153 (3.07%) of the 4970 eyes. The mean follow-up time was 84mo for all of the IOL groups. The percentage of eyes developing PCO was significantly greater for the acrylic hydrophilic IOLs than for the hydrophobic IOLs, although eyes with acrylic hydrophilic IOLs did not require Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs. There was no difference between the long-term PCO rates when 1- and 3-piece acrylic hydrophobic IOLs were compared or when IOLs made of the same material but with different haptic angles were compared. CONCLUSION In this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. The lens design (1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate.
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Affiliation(s)
- Rahmi Duman
- Department of Ophthalmology, Ankara Oncology Hospital, Ankara 06200, Turkey
| | - Fatih Karel
- Department of Ophthalmology, Dünya Göz Hospital Group, Ankara 06680, Turkey
| | - Pelin Özyol
- Department of Ophthalmology, Ünye State Hospital, Ordu 52300, Turkey
| | - Can Ateş
- Department of Biostatistics, Ankara University School of Medicine, Ankara 06100, Turkey
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Huang YS, Bertrand V, Bozukova D, Pagnoulle C, Labrugère C, De Pauw E, De Pauw-Gillet MC, Durrieu MC. RGD surface functionalization of the hydrophilic acrylic intraocular lens material to control posterior capsular opacification. PLoS One 2014; 9:e114973. [PMID: 25501012 PMCID: PMC4263720 DOI: 10.1371/journal.pone.0114973] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
Posterior Capsular Opacification (PCO) is the capsule fibrosis developed on implanted IntraOcular Lens (IOL) by the de-differentiation of Lens Epithelial Cells (LECs) undergoing Epithelial Mesenchymal Transition (EMT). Literature has shown that the incidence of PCO is multifactorial including the patient's age or disease, surgical technique, and IOL design and material. Reports comparing hydrophilic and hydrophobic acrylic IOLs have shown that the former has more severe PCO. On the other hand, we have previously demonstrated that the adhesion of LECs is favored on hydrophobic compared to hydrophilic materials. By combining these two facts and contemporary knowledge in PCO development via the EMT pathway, we propose a biomimetically inspired strategy to promote LEC adhesion without de-differentiation to reduce the risk of PCO development. By surface grafting of a cell adhesion molecule (RGD peptide) onto the conventional hydrophilic acrylic IOL material, the surface-functionalized IOL can be used to reconstitute a capsule-LEC-IOL sandwich structure, which has been considered to prevent PCO formation in literature. Our results show that the innovative biomaterial improves LEC adhesion, while also exhibiting similar optical (light transmittance, optical bench) and mechanical (haptic compression force, IOL injection force) properties compared to the starting material. In addition, compared to the hydrophobic IOL material, our bioactive biomaterial exhibits similar abilities in LEC adhesion, morphology maintenance, and EMT biomarker expression, which is the crucial pathway to induce PCO. The in vitro assays suggest that this biomaterial has the potential to reduce the risk factor of PCO development.
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Affiliation(s)
- Yi-Shiang Huang
- Departments of Chemistry & Bio-Medical and Preclinical Sciences, Mass Spectrometry Laboratory & Mammalian Cell Culture Laboratory – GIGA R, Université de Liège, Liège, Belgium
- CBMN UMR5248, Institute of Chemistry & Biology of Membranes & Nanoobjects, Université de Bordeaux, Pessac, France
| | - Virginie Bertrand
- Departments of Chemistry & Bio-Medical and Preclinical Sciences, Mass Spectrometry Laboratory & Mammalian Cell Culture Laboratory – GIGA R, Université de Liège, Liège, Belgium
| | | | | | - Christine Labrugère
- PLACAMAT, Plateforme Aquitaine de Caractérisation des Matériaux, UMS 3626, Université de Bordeaux, Pessac, France
| | - Edwin De Pauw
- Departments of Chemistry & Bio-Medical and Preclinical Sciences, Mass Spectrometry Laboratory & Mammalian Cell Culture Laboratory – GIGA R, Université de Liège, Liège, Belgium
| | - Marie-Claire De Pauw-Gillet
- Departments of Chemistry & Bio-Medical and Preclinical Sciences, Mass Spectrometry Laboratory & Mammalian Cell Culture Laboratory – GIGA R, Université de Liège, Liège, Belgium
| | - Marie-Christine Durrieu
- CBMN UMR5248, Institute of Chemistry & Biology of Membranes & Nanoobjects, Université de Bordeaux, Pessac, France
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Abstract
Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology.
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Posterior capsule opacification and neodymium:YAG rates with 2 single-piece hydrophobic acrylic intraocular lenses: three-year results. J Cataract Refract Surg 2014; 39:1886-92. [PMID: 24427796 DOI: 10.1016/j.jcrs.2013.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the incidence and intensity of posterior capsule opacification (PCO) between 2 similar 1-piece foldable hydrophobic acrylic intraocular lenses (IOLs) over 3 years. SETTING Department of Ophthalmology, Medical University Vienna, Vienna, Austria. DESIGN Randomized prospective patient- and examiner-masked clinical trial with intraindividual comparison. METHODS Patients with bilateral age-related cataract had cataract surgery and implantation of a Tecnis ZCB00 continuous-optic-edge IOL in 1 eye and an Acrysof SA60AT interrupted-optic-edge IOL in the other eye. Postoperative examinations were performed at 6 months and 3 years. Digital retroillumination images were taken of each eye. The amount of PCO (score 0 to 10) was assessed subjectively at the slitlamp and objectively using automated image-analysis software. RESULTS The study comprised 54 patients (108 eyes). The mean objective PCO score was 1.3 ± 1.7 (SD) for the continuous-optic-edge IOLs and 0.9 ± 1.3 for the interrupted-optic-edge IOLs (P=.10). Three years postoperatively, a neodymium:YAG (Nd:YAG) capsulotomy was performed in 26.1% of eyes with the continuous-optic-edge IOL and 21.7% with the interrupted-optic-edge IOL (P=.56). There was no significant difference in corrected distance visual acuity, capsulorhexis–IOL overlap, capsule folds, or anterior capsule opacification 3 years after surgery. CONCLUSIONS Both IOLs had comparable PCO and Nd:YAG rates 3 years postoperatively. The optimized barrier function of the continuous-optic-edge IOL and the material properties of the interrupted-optic-edge IOL seemingly outbalanced the effect on lens epithelial cell migration and proliferation beneath the optic.
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Brockmann T, Brockmann C, Nietzsche S, Bertelmann E, Strobel J, Dawczynski J. Scanning electron microscopic characteristics of commercially available 1- and 3-piece intraocular lenses. J Cataract Refract Surg 2013; 39:1893-9. [DOI: 10.1016/j.jcrs.2013.04.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Ollerton A, Werner L, Fuller SR, Kavoussi SC, McIntyre SJ, Mamalis N. Evaluation of a new single-piece 4% water content hydrophobic acrylic intraocular lens in the rabbit model. J Cataract Refract Surg 2012; 38:1827-32. [DOI: 10.1016/j.jcrs.2012.05.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/02/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
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Nanavaty MA, Spalton DJ, Gala KB, Dhital A, Boyce J. Effect of intraocular lens asphericity on posterior capsule opacification between two intraocular lenses with same acrylic material: a fellow-eye study. Acta Ophthalmol 2012; 90:e104-8. [PMID: 22067557 DOI: 10.1111/j.1755-3768.2011.02286.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate intra-individual differences in posterior capsule opacification (PCO) and visual performance between spherical AcrySof SN60AT and an aspheric AcrySof SN60WF intraocular lens (IOL) with a posterior aspheric surface, both of which are made of same hydrophobic acrylic material. SETTING Ophthalmology Department, St Thomas' Hospital, London, UK. METHODS In this prospective randomized, fellow-eye comparison, an aspheric IOL, which is 9% thinner in comparison with the spherical IOL, was randomized to the first eye of 47 patients and fellow-eye surgery was performed within 3 weeks. Follow-up was at 1, 3, 6, 12 and 24 months. Corrected logMAR visual acuity (CDVA) was measured at 100% and 9% contrast. After pupil dilation, digital retroillumination photographs were taken and the mean PCO percentage was calculated using poco software at each follow-up visit. RESULTS At 1, 3, 6, 12 and 24 months, 47 (94 eyes), 44 (88 eyes), 42 (84 eyes) and 41 (82 eyes) patients were followed-up respectively. Hundred per cent and 9% of LogMAR CDVA was not significantly different between the two IOLs (p = NS at all time-points). Percentage area PCO scores (mean ± SD) at 1, 3, 6, 12 and 24 months with the spherical IOL was 5.82 ± 9.89, 7.76 ± 16.83, 7.21 ± 12.46, 9.29 ± 18.25 and 14.39 ± 25.42, respectively, and with an aspheric IOL was 8.91 ± 12.79, 5.97 ± 10.32, 5.15 ± 7.92, 7.68 ± 11.18 and 12.18 ± 20.10, respectively (p = NS at all time-points). CONCLUSIONS Posterior capsule opacification was not significantly different between the spheric and aspheric IOLs in this fellow-eye, randomized comparison. Additional asphericity on the existing model of IOL does not influence PCO performance.
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Affiliation(s)
- Mayank A Nanavaty
- Department of Ophthalmology, St Thomas' Hospital, London SE1 7EH, UK.
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Kavoussi SC, Werner L, Fuller SR, Hill M, Burrow MK, McIntyre SJ, Mamalis N. Prevention of capsular bag opacification with a new hydrophilic acrylic disk-shaped intraocular lens. J Cataract Refract Surg 2011; 37:2194-200. [DOI: 10.1016/j.jcrs.2011.05.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 10/15/2022]
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Vasavada AR, Raj SM, Shah A, Shah G, Vasavada V, Vasavada V. Comparison of posterior capsule opacification with hydrophobic acrylic and hydrophilic acrylic intraocular lenses. J Cataract Refract Surg 2011; 37:1050-9. [PMID: 21596247 DOI: 10.1016/j.jcrs.2010.12.060] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 12/11/2010] [Accepted: 12/18/2010] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare posterior capsule opacification (PCO) 3 years postoperatively in contralateral eyes with a single-piece hydrophobic acrylic and 1 of 2 single-piece hydrophilic acrylic intraocular lenses (IOLs) with different configurations. SETTING Iladevi Cataract and IOL Research Institute, Ahmedabad, India. DESIGN Prospective randomized clinical trial. METHODS A hydrophobic Acrysof (hydrophobic group) or a hydrophilic C-flex (hydrophilic group C) or Akreos Adapt IOL (hydrophilic group A) was randomized for implantation in the fellow eye or vice versa of each patient. The Evaluation of Posterior Capsule Opacification (EPCO) area, EPCO score, and neodymium:YAG (Nd:YAG) capsulotomy rates were compared using digital photographs. RESULTS The study enrolled 68 patients. Although there was no significant difference at 1 month, the median EPCO score was statistically significantly lower in the hydrophobic group than in hydrophilic group C (P = .00) and hydrophilic group A (P = .000) at 3 years. There were no significant differences in the median EPCO area at 1 month; however, the area was statistically significantly less in the hydrophobic group than in hydrophilic group C and hydrophilic group A at 3 years (both P = .000). Four (12.9%) of 31 eyes in hydrophilic group C and 5 (16%) of 31 eyes in hydrophilic group A required an Nd:YAG capsulotomy; no eye in the hydrophobic group required a capsulotomy (P = .04 and P = .02, respectively). CONCLUSION Posterior capsule opacification was significantly less with the Acrysof hydrophobic acrylic IOL at 3 years. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Abhay R Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India
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Pathology of 219 human cadaver eyes with 1-piece or 3-piece hydrophobic acrylic intraocular lenses: capsular bag opacification and sites of square-edged barrier breach. J Cataract Refract Surg 2011; 37:923-30. [PMID: 21419595 DOI: 10.1016/j.jcrs.2010.11.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess capsular bag opacification and sites of initial posterior capsule opacification (PCO) in human cadaver eyes with square-edged 1-piece or 3-piece hydrophobic acrylic intraocular lenses (IOLs). SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Eyes were immersed in 10% formalin after enucleation and had anterior segment scanning with very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess capsular bag opacification, anterior capsule coverage of the IOL edge, and IOL fixation. Selected eyes had histopathologic examination. RESULTS One hundred nineteen eyes with 1-piece IOLs and 100 with 3-piece IOLs were included in the analyses of capsular bag opacification. There was no difference in central (P=.29) or peripheral (P=.76) PCO. In 63 of 84 eyes with a 1-piece IOL and peripheral PCO, the optic-haptic junction was the site of initiation. In eyes with a 3-piece IOL, initial peripheral PCO was observed at nearly the same rate whether there was full 360-degree anterior capsulorhexis overlap of the optic or no overlap (P=.13). In the latter, the site of PCO initiation was in areas lacking capsulorhexis coverage in 46% of eyes. CONCLUSIONS There was no difference in central or peripheral PCO between 1-piece and 3-piece hydrophobic acrylic IOLs. With 1-piece IOLs, PCO tended to start at the optic-haptic junctions. With 3-piece IOLs, full anterior capsule coverage did not produce a statistically significant benefit with respect to PCO prevention.
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Mathew RG, Coombes AGA. Reduction of Nd:YAG capsulotomy rates after implantation of a single-piece acrylic hydrophilic intraocular lens with 360° squared optic edge: 24-month results. Ophthalmic Surg Lasers Imaging Retina 2010; 41:651-5. [PMID: 20954645 DOI: 10.3928/15428877-20100929-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 07/29/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Posterior capsule opacification remains a significant problem following cataract surgery. The aim of the study was to evaluate the incidence of symptomatic posterior capsule opacification requiring Nd:YAG capsulotomy in patients who underwent cataract extraction and implantation of the Rayner C-flex 570C intraocular lens (IOL) (Rayner Intraocular Lens, Ltd., Sussex, UK). PATIENTS AND METHODS A retrospective study of 3,461 eyes that underwent cataract extraction and insertion of the Rayner C-flex IOL from January 2004 to December 2005. The cases that received Nd: YAG capsulotomies were evaluated. RESULTS Over a 24-month period, 3,461 Rayner C-flex IOLs were implanted. Nd:YAG capsulotomy was performed in 58 of these cases. The rate of Nd:YAG capsulotomy was 0.6% at 12 months and 1.7% at 24 months. The mean time to Nd:YAG capsulotomy was 9.3 months (range: 1.3 to 22.7 months). The follow-up period was 5.3 to 29.0 months. CONCLUSION The incidence of symptomatic posterior capsule opacification with the Rayner C-flex IOL is low.
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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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Werner L, Tetz M, Feldmann I, Bücker M. Evaluating and defining the sharpness of intraocular lenses: microedge structure of commercially available square-edged hydrophilic intraocular lenses. J Cataract Refract Surg 2009; 35:556-66. [PMID: 19251151 DOI: 10.1016/j.jcrs.2008.11.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/14/2008] [Accepted: 11/24/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the microstructure of the edges of currently available hydrophilic acrylic intraocular lenses (IOLs) in terms of their deviation from an "ideal" square as a follow-up of preliminary in vitro studies of experimental poly(methyl methacrylate) IOLs and commercially available foldable hydrophobic IOLs. SETTING Berlin Eye Research Institute, Berlin, Germany. METHODS Twenty-four designs of hydrophilic acrylic IOLs were used in this study. For each design, a +20.0 diopter (D) IOL and a +0.0 D IOL (or the lowest available plus dioptric power) were evaluated. The IOL edge was imaged under low-vacuum (0.7 torr), high-magnification scanning electron microscopy (SEM) using an environmental microscope and standardized technique. The photographs were imported to a digital computer program, and the area above the posterior-lateral edge, representing the deviation from a perfect square, was measured in square microns. RESULTS Currently available hydrophilic acrylic IOLs labeled as square edged had an area of deviation from a perfect square ranging from 60.84 to 871.51 microm(2) for the +20.0 D IOLs and from 35.52 to 826.55 microm(2) for the low-diopter IOLs. Although some differences in edge finishing between the IOLs analyzed were observed, edge surfaces of hydrophilic acrylic IOLs appeared overall smooth under environmental SEM. CONCLUSIONS Analysis of the microstructure of the optic edge of currently available square-edged hydrophilic acrylic IOLs showed a large variation of the deviation area from a perfect square.
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Hancox J, Spalton D, Cleary G, Boyce J, Nanavaty MA, Thyagarajan S, Marshall J. Fellow-eye comparison of posterior capsule opacification with AcrySof SN60AT and AF-1 YA-60BB blue-blocking intraocular lenses. J Cataract Refract Surg 2008; 34:1489-94. [DOI: 10.1016/j.jcrs.2008.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 05/02/2008] [Indexed: 10/21/2022]
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Menapace R, Sacu S, Georgopoulos M, Findl O, Rainer G, Nishi O. Efficacy and safety of capsular bending ring implantation to prevent posterior capsule opacification. J Cataract Refract Surg 2008; 34:1318-28. [DOI: 10.1016/j.jcrs.2008.04.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 04/23/2008] [Indexed: 11/28/2022]
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Nanavaty MA, Spalton DJ, Boyce J, Brain A, Marshall J. Edge profile of commercially available square-edged intraocular lenses. J Cataract Refract Surg 2008; 34:677-86. [PMID: 18361993 DOI: 10.1016/j.jcrs.2007.12.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 12/03/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze the sharpness of the posterior optic edge profile and edge thickness of intraocular lenses (IOLs) marketed with a square-edged profile. SETTING Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS Seventeen square-edged 20.0 diopter IOLs of different manufacture, design, and material were selected. After the environmental scanning electron microscopy technique was standardized, repeatability of the technique was tested. Posterior optic edges of all IOLs were scanned at a magnification of x 500. Local radii of curvature of the posterior optic edges were measured by purpose-designed software. Optic edge thickness was also measured from the electron micrographs. RESULTS The repeatability of the scanning technique was excellent (+/-0.10 microm). The radius of curvature of posterior optic edges ranged from 7.6 to 23.1 microm. Hydrophilic acrylic IOLs (except the HumanOptics MC Microlens 611 MI-B and 1CU) had radii of curvatures more than 10.0 microm of the posterior optic edge compared with hydrophobic acrylic and silicone IOLs (<10.0 microm) except the Hoya AF-1 (19.9 microm). Alcon AcrySof single-piece (SN60WF), HumanOptics 1CU, and AMO Clariflex CLRFLXC IOLs had the thinnest optic edges in the hydrophobic, hydrophilic, and silicone groups, respectively. CONCLUSIONS Commercially marketed square-edged IOLs differed in the sharpness of the posterior optic edge. Hydrophobic acrylic and silicone IOLs have sharper posterior optic square edge than most hydrophilic acrylic IOLs. This probably reflects difference in manufacturing techniques. Differences in posterior optic edge profile may explain variation in posterior capsule opacification performance with different IOLs and materials.
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Affiliation(s)
- Mayank A Nanavaty
- Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom
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Evaluating and defining the sharpness of intraocular lenses. J Cataract Refract Surg 2008; 34:310-7. [DOI: 10.1016/j.jcrs.2007.09.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 09/23/2007] [Indexed: 11/19/2022]
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Shah A, Spalton DJ, Gilbert C, Vasavada A, Boyce JF, Minassian D, Jayaram H, Mabey D. Effect of intraocular lens edge profile on posterior capsule opacification after extracapsular cataract surgery in a developing country. J Cataract Refract Surg 2007; 33:1259-66. [PMID: 17586384 DOI: 10.1016/j.jcrs.2007.03.044] [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] [Received: 11/09/2006] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether square-edged polymethyl methacrylate (PMMA) intraocular lenses (IOLs) reduce posterior capsule opacification (PCO) in the context of extracapsular cataract surgery in a developing country. SETTING A rural hospital in India. METHODS This was a prospective randomized double-masked fellow-eye controlled study. Over a 4-month period, 118 patients with normal eyes apart from age-related cataract were randomized to receive a square-edged or round-edged PMMA IOL in the first eye. The IOLs were identical apart from the edge profile. The fellow-eye had implantation of the alternative IOL within 1 month. Retroillumination images of the posterior capsule were taken using a dedicated camera system and analyzed to quantify the PCO area using POCO software 1 and 2 years postoperatively and the PCO area and severity using POCOman semiqualitative software at 2 years. Visual acuity was measured using a Gujarati logMAR chart. RESULTS One hundred fifteen patients were available for examination at 1 year and 107 at 2 years. With POCO software, the PCO area was reduced in the square-edged IOL group at 1 year (median 30% versus 20%, P=.001) and at 2 years (median 45% versus 35%, P=.006). With POCOman, the PCO area and severity were reduced in the square-edged group at 2 years (median 41.5% versus 33.2%, P=.019 and 0.59 versus 0.46, P=.037, respectively). There was no significant difference in visual acuity between the 2 groups at 1 or 2 years. CONCLUSIONS Sophisticated image analysis techniques can be used in developing countries to quantify PCO. Using extracapsular surgery, square-edged PMMA IOLs reduced the PCO area and severity compared with an identical round-edged IOL; however, the differences were not as marked as those reported with phacoemulsification. This may be due to the difficulty of performing a capsulorhexis that lies on the IOL surface in this situation. Nevertheless, square-edged IOLs offer a potential benefit for extracapsular surgery in the developing world.
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Affiliation(s)
- Alpesh Shah
- Iladevi Cataract and IOL Research Centre, Ahmedabad, India
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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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Elgohary MA, Hollick EJ, Bender LE, Heatley CJ, Wren SM, Boyce J, Missotten T, Spalton DJ, Dowler JG. Hydrophobic acrylic and plate-haptic silicone intraocular lens implantation in diabetic patients. J Cataract Refract Surg 2006; 32:1188-95. [PMID: 16857508 DOI: 10.1016/j.jcrs.2006.01.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 01/17/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the capsular and uveal reaction after implantation of a plate-haptic silicone intraocular lens (IOL) (C11UB, Chiron) and a hydrophobic acrylic (AcrySof MA60, Alcon) IOL in diabetic patients. SETTING Moorfields Eye Hospital and St. Thomas' Hospital, London, United Kingdom. METHODS Thirty-five diabetic patients were recruited consecutively and randomly assigned to have implantation of either of the 2 IOLs. The percentage area of posterior capsule opacification (PCO), anterior capsule contraction (ACC), and postoperative inflammatory indices (flare and cells) were assessed objectively at 2 to 3 weeks, 6 months, and 1 year. Between-group and within-group analyses were conducted using the Student t test or Mann-Whitney test and Friedmann test, respectively. RESULTS Between-group analysis showed the percentage area of PCO was significantly greater in patients with plate-haptic silicone IOLs at 6 and 12 months (P = .002). At 6 months, ACC was significantly greater in the plate-haptic group (P = .04), but the difference was not significant at 12 months. There was higher flare in the hydrophobic acrylic IOL group than in the plate-haptic silicone IOL group at 2 to 3 weeks (P = .08). Within-group analysis showed that over the follow-up period, the plate-haptic silicone group, but not the hydrophobic acrylic group, had a progressive increase in PCO (P = .003). In the hydrophobic acrylic group, but not the plate-haptic silicone group, there was a significant reduction in the mean anterior chamber flare value (P = .01). There was no significant difference in visual acuity or contrast sensitivity at any postoperative visit. CONCLUSION In diabetic patients, hydrophobic acrylic IOLs can lead to an increased flare in the early postoperative period but they seem to be more favorable than plate-haptic silicone IOLs because the latter lead to more PCO.
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Abstract
PURPOSE OF REVIEW This paper assesses the factors that contribute to the formation of an effective capsular bend as a deterrent to posterior capsule opacification. Its goal is to assist the practicing ophthalmologist in separating current understanding of this process from various working models previously proposed. RECENT FINDINGS While a square-edge design appreciably improves resistance to posterior capsule opacification, significant factors remain under the control of the surgeon. These factors combine to form the physical and psychological barrier of a capsular bend. Innovative digital imaging has shown lens epithelial cell migration, allowing for a more rapid assessment of posterior capsule opacification resistance. A three-piece intraocular lens allows for full 360 degree capsular bend formation surrounding the optic edge; some single-piece designs may inhibit capsular bend formation. Decreasing, but not eliminating, the surviving lens epithelial cell population may diminish capsular bend strength, which may decrease resistance to posterior capsule opacification in the face of a regenerating cortex. All demographic features of clear/refractive lens exchange suggest higher rates of posterior capsule opacification than with standard cataract surgery. SUMMARY The quality of capsular bend formation will determine how resistant an intraocular lens will be to posterior capsule opacification as a consequence of regenerating cortex. As refractive lens exchange and new accommodating intraocular lens designs become more popular, the problems of regenerating cortex will increase in magnitude.
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Affiliation(s)
- Steven Dewey
- Colorado Springs Health Partners, PC, 209 South Nevada Avenue, CO 80903, USA.
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Elgohary MA, Chauhan DS, Dowler JG. Optical coherence tomography of intraocular lens implants and their relationship to the posterior capsule: a pilot study comparing a hydrophobic acrylic to a plate-haptic silicone type. Ophthalmic Res 2005; 38:116-24. [PMID: 16388198 DOI: 10.1159/000090532] [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] [Received: 08/16/2004] [Accepted: 01/06/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) has been used to examine the anterior as well as the posterior segment and can be used to examine the intraocular lens (IOL) and their relationship to the posterior capsule in vivo. OBJECTIVES To use OCT to examine two of the IOLs and some of the features related to the development of posterior capsular opacification (PCO). METHODS This is a pilot study of a prospective (n = 12) and a retrospective (n = 14) series of patients who had uneventful phacoemulsification and IOL implantation of either hydrophobic acrylic (Acrysof; Alcon) or plate-haptic (PH) silicone (C11UB; Chiron, Bausch & Lomb) IOLs. The outcome of interest was the ability of OCT to clearly delineate the outline of the IOL optics and their appositional relationship to the posterior capsule. RESULTS OCT showed that hydrophobic acrylic IOLs had a better defined outline than PH silicone IOLs. It also showed close apposition between hydrophobic acrylic optics and the mid-peripheral part of the posterior capsule and the absence thereof with PH silicone IOLs. CONCLUSIONS Hydrophobic acrylic implants have better definition on the OCT scans than PH silicone and they develop close apposition to the posterior capsule. The latter feature is consistent with the 'no space, no cell, no PCO' concept and what is known about the effect of the implant material and design on the rate of PCO.
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Mian SI, Fahim K, Marcovitch A, Gada H, Musch DC, Sugar A. Nd:YAG capsulotomy rates after use of the AcrySof acrylic three piece and one piece intraocular lenses. Br J Ophthalmol 2005; 89:1453-7. [PMID: 16234452 PMCID: PMC1772911 DOI: 10.1136/bjo.2005.067405] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Acrylic lens size and shape may influence the rate of posterior capsule opacification (PCO) and need for Nd:YAG capsulotomy. The aim of this study is to compare the Nd:YAG capsulotomy rate of the three piece acrylic/PMMA AcrySof MA series lens with the one piece acrylic AcrySof SA series lens. METHODS 434 eyes of 329 patients who had cataract extraction and implantation of one of four types of intraocular lenses (IOLs) were evaluated for rate of Nd:YAG capsulotomy. 176 eyes received the acrylic AcrySof MA30AC IOL, 71 eyes the acrylic AcrySof MA60AC IOL, 45 eyes the acrylic AcrySof SA30AL IOL, and 142 eyes the acrylic AcrySof SA60AT IOL. RESULTS The rates of Nd:YAG capsulotomy with the three piece IOL (MA30AC/MA60AC) and the one piece IOL (SA30AL/SA60AT) were 1.2% and 2.1% at 6 months, 2.8% and 5.9% at 12 months, and 3.6% and 7.5% at 24 months, respectively. The incidence of Nd:YAG capsulotomy was higher in patients who received the one piece IOL (p=0.01, log rank test). There was no difference in Nd:YAG capsulotomy rates when comparing lens optic size, age, sex, history of pars plana vitrectomy, and diabetes mellitus. CONCLUSIONS This study shows a greater incidence of Nd:YAG capsulotomy in patients who receive one piece acrylic AcrySof lenses when compared to those who receive three piece acrylic AcrySof lenses.
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Affiliation(s)
- S I Mian
- Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA.
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Findl O, Buehl W, Menapace R, Sacu S, Georgopoulos M, Rainer G. Long-term Effect of Sharp Optic Edges of a Polymethyl Methacrylate Intraocular Lens on Posterior Capsule Opacification. Ophthalmology 2005; 112:2004-8. [PMID: 16168485 DOI: 10.1016/j.ophtha.2005.06.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Accepted: 06/07/2005] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the posterior capsule opacification (PCO) inhibiting effect of a 3-piece polymethyl methacrylate (PMMA) intraocular lens (IOL) with a sharp optic edge design with that of the round-edged version of the same IOL during a 5-year period. DESIGN Randomized patient- and examiner-masked clinical trial with intraindividual comparison. PARTICIPANTS Thirty-two patients with bilateral age-related cataract (64 eyes). METHODS Each study patient had phacoemulsification cataract surgery in both eyes and received a sharp optic edge PMMA IOL in one eye and a round optic edge PMMA IOL in the fellow eye (both by Dr Schmidt in Germany). Follow-up examinations were at 1 week, 1 month, 1 year, 3 years, and 5 years. Digital retroillumination images were taken from each eye. The amount of posterior capsule opacification was assessed objectively by means of automated image analysis software (Automated Quantification of After-Cataract) at 1 year, 3 years, and 5 years after surgery. MAIN OUTCOME MEASURE Posterior capsule opacification score: 0-10. RESULTS The sharp optic edge IOL showed significantly less regeneratory and fibrotic PCO at 1 year, 3 years, and 5 years after surgery. The mean AQUA PCO score was 5.12 for the round-edge and 2.49 for the sharp-edge IOL (scale, 0-10; P<0.001) at 5 years. The mean difference among patients for the PCO score in the eye implanted with the sharp optic edge versus the score in the eye with the round optic edge was 2.83 at 5 years (95% confidence interval, 1.66-4.00). Due to the large number of neodymium:yttrium-aluminum-garnet laser capsulotomies that were performed (12 in the round-edge group and 4 in the sharp-edge group), there was no significant difference in visual acuity between both groups at any time point. CONCLUSIONS Compared with the round-edge version, the sharp optic edge design of a 3-piece PMMA IOL led to significantly less PCO at 1 year, 3 years, and 5 years after surgery. However, the sharp optic edge did not lead to complete PCO prevention during this follow-up period. This finding has implications for the design of PMMA IOLs used for cataract surgery, especially in the developing world.
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Affiliation(s)
- Oliver Findl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
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Menapace R, Wirtitsch M, Findl O, Buehl W, Kriechbaum K, Sacu S. Effect of anterior capsule polishing on posterior capsule opacification and neodymium:YAG capsulotomy rates: Three-year randomized trial. J Cataract Refract Surg 2005; 31:2067-75. [PMID: 16412917 DOI: 10.1016/j.jcrs.2005.08.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2005] [Accepted: 03/13/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the long-term effect of extensive polishing and nonpolishing of the anterior lens capsule on posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS This prospective randomized bilateral double-masked study included 108 eyes of 54 consecutive patients with age-related cataract. Following phacoemulsification, 3-piece intraocular lenses (IOLs) with round-edged silicone optics were implanted. Patients received an Allergan SI-40 IOL with a truncated, round optic edge or a Domilens Silens6 IOL with a fully round optic edge. Patients were randomly assigned to have extensive anterior capsule polishing with the Menapace aspiration curette or no treatment in the first eye; the second eye received the opposite treatment. Digital retroillumination images were taken at 1 week, 1 year, and 3 years, and Nd:YAG capsulotomy rates were evaluated. Posterior capsule opacification was objectively scored using automated image analysis software (AQUA) or estimated based on clearly defined assumptions if a capsulotomy had been performed. RESULTS Thirty-nine patients (78 eyes) concluded the study. Three-year PCO scores after polishing did not differ significantly (P>.05). However, 21 polished eyes (53.8%) required Nd:YAG laser capsulotomy compared with 14 nonpolished eyes (35.9%). The mismatch between PCO scores and Nd:YAG rates resulted from a change in PCO morphology that is not detected by scoring methods based on retroillumination photography but is visually disturbing to patients. CONCLUSIONS Polishing the anterior capsule was effective in reducing fibrotic opacification but ineffective in reducing regeneratory opacification. Changes in regeneratory PCO morphology not picked up by retroillumination photography increased the need for Nd:YAG laser capsulotomy.
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Affiliation(s)
- Rupert Menapace
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
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Tetz M, Wildeck A. Evaluating and defining the sharpness of intraocular lenses. J Cataract Refract Surg 2005; 31:2172-9. [PMID: 16412935 DOI: 10.1016/j.jcrs.2005.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop a new method for the evaluation of the optic edge design of intraocular lenses (IOLs). SETTING Charité Humboldt University and Berlin Eye Research Institute (Beri), Berlin, Germany. METHODS Poly(methyl methacrylate) IOLs with 11 edge designs were manufactured. Each lens design was evaluated using EPCO 2000. Also, edge's ability to stop cell growth was observed by placing each IOL into cell culture and observing cell growth over 18 days on average. RESULTS Only 3 groups, those with the sharpest edge design, prevented the growth of lens epithelial cells onto the visual axis of the lens. The edge design that effectively stopped cell growth was characterized by an area above the edge of 13.5 microm2 at the most. CONCLUSION Results shows that the edge design of IOLs plays an important role in the prevention of posterior capsule opacification. A specific optic edge design was most effective in this prevention.
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Affiliation(s)
- Manfred Tetz
- Berlin Eye Research Institute (Beri), Berlin, Germany.
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Linnola RJ, Findl O, Hermann B, Sattmann H, Unterhuber A, Happonen RP, Drexler W. Intraocular lens-capsular bag imaging with ultrahigh-resolution optical coherence tomography Pseudophakic human autopsy eyes. J Cataract Refract Surg 2005; 31:818-23. [PMID: 15899462 DOI: 10.1016/j.jcrs.2004.06.050] [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] [Accepted: 07/16/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare in vitro ultrahigh-resolution optical coherence tomography (UHR OCT) cross-sectional images of the pseudophakic human autopsy eye with histology to evaluate the potential of this imaging technique for enhanced visualization of the anterior segment, especially the capsular bag, intraocular lens (IOL), and posterior capsule opacification (PCO) formation after cataract surgery. SETTING Department of Medical Physics and Department of Ophthalmology, University of Vienna, Vienna, Austria, and Department of Oral and Maxillofacial Surgery Institute of Dentistry, University of Turku, Turku, Finland. METHODS Ultrahigh-resolution OCT images were acquired from 7 pseudophakic human autopsy eyes using 1.4 microm axial x 3.0 microm transverse resolution. The axial resolution with UHR OCT is 1.4 microm compared to 10.0 microm with the commercially available OCT. Plastic-embedded histologic sections were obtained in precise alignment with the OCT tomograms. RESULTS Ultrahigh-resolution OCT cross-sectional tomograms corresponded to the histologic sections. With the wavelength used (800 nm), the anterior and posterior capsules, area of lens epithelial cell growth and extracellular matrix proliferation, and IOL could be clearly visualized. The extent of capsular bag adhesion to the IOL could be detected, as well as the amount of PCO formation. CONCLUSIONS The improved resolution makes UHR OCT a powerful tool in anterior segment imaging and evaluation of the capacity of IOL materials and models to induce capsular bag adhesion. Ultrahigh-resolution OCT may also help in determining the area of origin of PCO after cataract surgery.
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Wren SME, Spalton DJ, Jose R, Boyce J, Heatley CJ. Factors that influence the development of posterior capsule opacification with a polyacrylic intraocular lens. Am J Ophthalmol 2005; 139:691-5. [PMID: 15808166 DOI: 10.1016/j.ajo.2004.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify factors that contribute to posterior capsule opacification (PCO) after implantation of a 5.5 mm polyacrylic (IOL). DESIGN A retrospective analysis of a cohort of sequential images taken from the PCO database at St. Thomas' Hospital, London, to include all patients with an AcrySof MA30 lens and a 1-year retroillumination image. METHODS Records of age, gender, axial length, and PCO measurements using the POCO software system were available. Images were divided into those with greater or less than 10% PCO. The degree of rhexis-IOL contact was recorded in clock hours. RESULTS Images of 60 eyes were analyzed. Twenty-one eyes had more than 10% PCO. No correlation was found between PCO and age, gender, or axial length. Forty-eight eyes (80%) had some loss of rhexis-IOL contact. These eyes had increased PCO (P < .001) compared with eyes with complete IOL-rhexis contact. More PCO developed when the rhexis was partly on and partly off the IOL. CONCLUSIONS PCO is reduced when the rhexis is in complete contact with the anterior IOL surface. The failure to achieve this accounts for the majority of increased PCO seen in patients implanted with this IOL model. PCO formation is related to surgical technique as well as IOL design, and comparisons cannot be made between IOLs without taking this into consideration. These results support the trend to the use of larger optic IOLs to prevent PCO and also support the "capsule compression" theory of PCO prevention.
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Affiliation(s)
- Siobhan M E Wren
- Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom
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Sacu S, Menapace R, Findl O, Kiss B, Buehl W, Georgopoulos M. Long-term efficacy of adding a sharp posterior optic edge to a three-piece silicone intraocular lens on capsule opacification: five-year results of a randomized study. Am J Ophthalmol 2005; 139:696-703. [PMID: 15808167 DOI: 10.1016/j.ajo.2004.12.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the intensity of capsule opacification with the sharp and the round optic edge variant of an open-loop hydrophobic silicone intraocular lens (IOL). DESIGN Randomized, controlled, double-blind clinical trial with intraindividual comparison. METHODS Fifty-one patients with bilateral age-related cataract were included (102 eyes). Each patient had had cataract surgery in both eyes and received a Microsil IOL with a sharp optic edge design (model S) in one eye and a Microsil IOL with a round optic edge design (model R) in the fellow eye. Both IOLs had an identical haptic design (nonangulated polymethylmethacrylate) and silicone optic material. The patients were examined at the slit lamp, best-corrected visual acuity was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken 5 years after surgery. The intensity of regeneratory posterior capsule opacification (rPCO), fibrotic PCO (fPCO), and anterior capsule opacification (ACO) was assessed subjectively at the slit lamp, and of rPCO, objectively using automated image analysis software (AQUA). The need for an Nd:YAG laser capsulotomy (Nd:YAG-LCT) was noted. RESULTS The mean AQUA PCO score was 1.2 for the model S and 2.4 for the model R lens (P = .001). The model S lens also led to less peripheral fPCO (P = .003). Concerning ACO, there was no significant difference between both IOL groups (P = .72). Whereas no capsulotomy was required with the model S, four cases (16%) had been performed in the model R group. CONCLUSION Five years postoperatively, the sharp-edged silicone IOL showed less rPCO and fPCO than the round-edged IOL. However, regarding ACO, there was no significant difference between both IOL styles.
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Affiliation(s)
- Stefan Sacu
- Medical University of Vienna, Department of Ophthalmology, Vienna, Austria
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Heatley CJ, Spalton DJ, Kumar A, Jose R, Boyce J, Bender LE. Comparison of posterior capsule opacification rates between hydrophilic and hydrophobic single-piece acrylic intraocular lenses. J Cataract Refract Surg 2005; 31:718-24. [PMID: 15899448 DOI: 10.1016/j.jcrs.2004.08.060] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the effect of intraocular lens (IOL) material on the development of posterior capsule opacification (PCO) at 1 year. SETTING Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS One hundred six eyes of 53 patients with bilateral cataract and no other ocular comorbidity were prospectively randomized to receive a hydrophobic acrylic or hydrophilic acrylic single-piece IOL in the first eye to have surgery. The alternate IOL was implanted in the fellow eye 4 to 6 weeks later. All surgery was performed by a single surgeon. Postoperative follow-up was 1 day, 1 and 6 months, and 1 year. At each visit, the best corrected high- and low-contrast visual acuities were assessed and a high-intensity digital retroillumination photograph was taken. Posterior capsule opacification was assessed from the digital images by a single operator using a dedicated software program and calculated as the percentage area of opacified capsule. RESULTS One year postoperatively, the median percentage area of PCO was 50.3% in the hydrophilic IOL group and 4.9% in the hydrophobic IOL group (P<.001). The difference in PCO was not accounted for by loss of contact between the capsulorhexis and IOL surface. Further analysis showed that lens epithelial cells tended to invade the posterior capsule at the haptic-optic junction. This was more marked in the hydrophilic IOL group. CONCLUSIONS The rate of PCO was significantly higher with the hydrophilic IOL. However, the results cannot be attributed to the IOL material alone as they show the importance of both IOL material and design.
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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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Sacu S, Findl O, Linnola RJ. Optical coherence tomography assessment of capsule closure after cataract surgery. J Cataract Refract Surg 2005; 31:330-6. [PMID: 15767154 DOI: 10.1016/j.jcrs.2004.04.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To develop a technique for documenting and quantifying capsule bend formation in pseudophakic eyes, evaluate when the anterior and posterior lens capsules become completely apposed to the optic, and determine how soon a capsule bend is created at the optic edge of an intraocular lens (IOL) after cataract surgery. SETTING Medical University of Vienna, Department of Ophthalmology, Vienna, Austria. METHODS This prospective study comprised 33 eyes of 33 patients with age-related cataract who were scheduled to have cataract surgery. All eyes had phacoemulsification with implantation of 1 of 3 types of open-loop IOLs: 1-piece acrylic (SA60AT, Alcon), 3-piece acrylic (AcrySof MA60BM, Alcon), or 3-piece silicone (911A, AMO). Each group included 11 eyes. One and 3 days and 1, 2, 3, and 4 weeks after surgery, contact between the lens capsule and IOL optic as well as capsule bend formation were evaluated using optical coherence tomography (OCT). The postoperative times at which the capsule came into contact with the IOL optic and when the capsule bend formed were determined. RESULTS One day postoperatively, the mean distance between the anterior capsule and the IOL was 197 microm in the 1-piece acrylic IOL group, 161 microm in the 3-piece acrylic IOL group, and 220 microm in the 3-piece silicone IOL group. The posterior capsule was in contact with the IOL on the same day or earlier than the anterior capsule in 28 patients (85%). Postoperatively, the capsule bend formed at a mean of 10 days in the 1-piece acrylic group, 13 days in the 3-piece acrylic group, and 15 days in the 3-piece silicone group. The short-term reproducibility of the OCT technique was excellent (r = 0.99). CONCLUSIONS Optical coherence tomography produced cross-sectional tomograms of capsule-IOL contact in the early postoperative period. There was no significant difference in the time to capsule bend formation between the 3 IOLs. However, capsule bend formation at the optic edge occurred earlier with the 1-piece acrylic IOL than with the 3-piece silicone IOL.
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Affiliation(s)
- Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Sacu S, Menapace R, Buehl W, Rainer G, Findl O. Effect of intraocular lens optic edge design and material on fibrotic capsule opacification and capsulorhexis contraction. J Cataract Refract Surg 2004; 30:1875-82. [PMID: 15342049 DOI: 10.1016/j.jcrs.2004.01.042] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS This randomized controlled patient- and examiner-masked study comprised 210 eyes of 105 patients with bilateral age-related cataract. In Group 1 (n = 53), the Sensar OptiEdge AR40e hydrophobic acrylic IOL with a sharp posterior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex OptiEdge silicone IOL with a sharp posterior optic edge was compared with the PhacoFlex SI-40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digital slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillumination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm(2)) was determined objectively. RESULTS One year after surgery, the mean ACO score was 32% in eyes with the sharp-edged acrylic IOL and 29% in eyes with the round-edged acrylic IOL (P<.05). In the silicone group, the mean was 31% and 26%, respectively (P<.05). The mean fibrotic PCO score was lower in eyes with a sharp-edged acrylic IOL than in eyes with a round-edged acrylic IOL (0.26 and 0.93, respectively; P<.05) and in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (0.24 and 0.82, respectively; P<.001). At 1 year, the mean capsulorhexis area was statistically significantly smaller in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (P<.05). CONCLUSIONS Acrylic and silicone IOLs with the sharp OptiEdge design led to significantly less fibrotic PCO but more ACO than round-edged acrylic and silicone IOLs. The sharp-edged silicone IOL caused significantly more capsulorhexis contraction than the round-edged silicone IOL and both acrylic IOLs.
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Affiliation(s)
- Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna, A-1090 Vienna, Austria.
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Saika S. Relationship between posterior capsule opacification and intraocular lens biocompatibility. Prog Retin Eye Res 2004; 23:283-305. [PMID: 15177204 DOI: 10.1016/j.preteyeres.2004.02.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The type of healing process that occurs in response to cataract surgery and intraocular lens (IOL) implantation is dependent on a complex set of variables. Their interactions determine whether or not optical clarity is restored as a result of this procedure. In this process, wound healing entails cells undergoing either epithelial-mesenchymal transition, resulting in the generation of fibroblastic cells and accumulation of extracellular matrix, or lenticular structure formation. Such desperate cellular behaviors are regulated by the localized release of different cytokines, including transforming growth factor beta and fibroblast growth factors, which can result in post-operative capsular opacification. Other factors affecting the biological and mechanical outcome of IOL implantation are its composition, surface properties and shape.
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Affiliation(s)
- Shizuya Saika
- Department of Ophthalmology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan.
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Bender LE, Nimsgern C, Jose R, Jayaram H, Spalton DJ, Tetz MR, Packard RB, Meacock W, Boyce J. Effect of 1-piece and 3-piece AcrySof intraocular lenses on the development of posterior capsule opacification after cataract surgery. J Cataract Refract Surg 2004; 30:786-9. [PMID: 15093639 DOI: 10.1016/j.jcrs.2003.08.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2003] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effect of 1-piece and 3-piece hydrophobic acrylic intraocular lenses (IOLs) on posterior capsule opacification (PCO) after cataract surgery. SETTING Ophthalmology departments of 3 hospitals in the United Kingdom and Germany and the Department of Physics at a United Kingdom university. METHODS A series of 131 patients having cataract surgery had implantation of an acrylic 1-piece (SA30AL) or an acrylic 3-piece (MA30BA) IOL (AcrySof, Alcon). Surgery was performed according to standardized protocol by a single surgeon at each hospital. Posterior capsule opacification was assessed using digital retroillumination photography. All images were analyzed at a single center according to a standard protocol. Data were analyzed 6 months and 1 year after surgery. RESULTS There was no statistically significant difference in the percentage area of PCO between the 1-piece (mean 16.0% +/- 15.7% [SD]) and 3-piece (mean 13.6% +/- 19.8%) cohorts 6 months and 1 year after surgery (P =.0664). CONCLUSION There was no evidence of a difference in the area of PCO after cataract surgery between 1-piece and 3-piece IOLs, which were otherwise matched for material and lens geometry.
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Abstract
PURPOSE OF REVIEW Although cataract extraction seems to be feasible without major technical obstacles, the surgical technique has changed completely, and patients are no longer satisfied with good spectacle-corrected vision but anticipate complete visual rehabilitation after cataract surgery, without correction. To fulfill this desire, toric or accommodative intraocular lenses are of increasing popularity, and the intraocular lens power calculation after keratorefractive surgery has been improved. RECENT FINDINGS In this review article, we provide an overview of different mathematical strategies of calculating the intraocular lens power with standard formulas and with new algorithms, such as paraxial or numeric ray-tracing. These enhanced techniques may improve the validity of lens power calculation due to reduction of the prediction error, especially in cases with high or excessive corneal astigmatism and after refractive laser surgery. Furthermore, a new calculation scheme for the determination of bitoric eikonic intraocular lenses allows a distortion-free imaging in astigmatic eyes. The biometric determinants for the different formulas and calculation schemes are discussed in detail. SUMMARY In difficult cases, standard calculation schemes are overemployed and new mathematical algorithms are necessary to adequately address these problems. Ray-tracing algorithms and other complex mathematical computation schemes are of increasing interest and will more and more replace conventional calculation formulas for determination of intraocular lens power.
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Affiliation(s)
- Achim Langenbucher
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
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48
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Abstract
The human lens capsule has recently been the subject of much attention in an attempt to understand its physiological function in relation to the accommodative function, its functional reserve in the elderly population, and its potential in relation to cataract surgery. This overview presents our current knowledge of the mechanical properties of the human lens capsule, discussed on basis of its structure and its role in accommodation and cataract surgery.
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Affiliation(s)
- Susanne Krag
- Department of Ophthalmology, Aarhus University Hospital, Aarhus C, Denmark 8000.
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