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Qin C, Wen S, Fei F, Han Y, Wang H, Chen H, Lin Q. NIR-triggered thermosensitive polymer brush coating modified intraocular lens for smart prevention of posterior capsular opacification. J Nanobiotechnology 2023; 21:323. [PMID: 37679734 PMCID: PMC10483730 DOI: 10.1186/s12951-023-02055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Posterior capsule opacification (PCO) is the most common complication after cataract surgery. Drug-eluting intraocular lens (IOLs) is a promising concept of PCO treatment in modern cataract surgery. However, the large dose of drugs in IOL leads to uncontrollable and unpredictable drug release, which inevitably brings risks of overtreatment and ocular toxicity. Herein, a low-power NIR-triggered thermosensitive IOL named IDG@P(NIPAM-co-AA)-IOL is proposed to improve security and prevent PCO by synergetic controlled drug therapy and simultaneous photo-therapy. Thermosensitive polymer brushes Poly(N-isopropylacrylamide-co-Acrylic acid) (P(NIPAM-co-AA)) is prepared on IOL via surface-initiated reversible addition-fragmentation chain transfer (SI-RAFT) polymerization. Then, Doxorubicin (DOX) and Indocyanine green (ICG) co-loaded Gelatin NPs (IDG NPs) are loaded in P(NIPAM-co-AA) by temperature control. The IDG NPs perform in suit photodynamic & photothermal therapy (PTT&PDT), and the produced heat also provides a trigger for controllable drug therapy with a cascade effect. Such functional IOL shows excellent synergistic drug-phototherapy effect and NIR-triggered drug release behavior. And there is no obvious PCO occurrence in IDG@P(NIPAM-co-AA) IOL under NIR irradiation compared with control group. This proposed IDG@P(NIPAM-co-AA)-IOL serves as a promising platform that combines phototherapy and drug-therapy to enhance the therapeutic potential and medication safety for future clinical application of PCO treatment.
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Affiliation(s)
- Chen Qin
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Shimin Wen
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Fan Fei
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yuemei Han
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Haiting Wang
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Hao Chen
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Quankui Lin
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Prophylaxis of posterior capsule opacification through autophagy activation with indomethacin-eluting intraocular lens. Bioact Mater 2022; 23:539-550. [PMID: 36514385 PMCID: PMC9729928 DOI: 10.1016/j.bioactmat.2022.11.024] [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: 09/18/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Posterior capsule opacification (PCO) is the most common long-term postoperative complication of cataract surgery, leading to secondary vision loss. Optimized intraocular lens (IOL) structure and appropriate pharmacological intervention, which provides physical barriers and biological inhibition, respectively, can block the migration, proliferation, and epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) for PCO prophylaxis. Herein, a novel indomethacin-eluting IOL (INDOM-IOL) with an optimized sharper edge and a sustained drug release behavior was developed for PCO prevention. Indomethacin (INDOM), an ophthalmic non-steroidal anti-inflammatory drug (NSAID) used for postoperative ocular inflammation, was demonstrated to not only be able to suppress cell migration and down-regulate the expression of cyclooxygenase-2 (COX-2) and EMT markers, including alpha-smooth muscle actin (α-SMA) and cyclin D1, but also promote the autophagy activation in LECs. Additionally, autophagy was also verified to be a potential therapeutic target for the down-regulation of EMT in LECs. The novel IOL, serving as a drug delivery platform, could carry an adjustable dose of hydrophobic indomethacin with sustained drug release ability for more than 28 days. In the rabbit PCO model, the indomethacin-eluting IOL showed excellent anti-inflammatory and anti-PCO effects. In summary, indomethacin is an effective pharmacological intervention in PCO prophylaxis, and the novel IOL we developed prevented PCO in vivo under its sustained indomethacin release property, which provided a promising approach for PCO prophylaxis in clinical application.
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Ye Z, Huang Y, Li J, Ma T, Gao L, Hu H, He Q, Jin H, Li Z. Two-dimensional ultrathin Ti3C2 MXene nanosheets coated intraocular lens for synergistic photothermal and NIR-controllable rapamycin releasing therapy against posterior capsule opacification. Front Bioeng Biotechnol 2022; 10:989099. [PMID: 36110318 PMCID: PMC9468448 DOI: 10.3389/fbioe.2022.989099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Posterior capsule opacification (PCO) is one of the most frequent late-onset complications after cataract surgery. Several kinds of drug-eluting intraocular lenses (IOL) were designed for sustainable drug release to suppress ocular inflammation, the proliferation of lens epithelial cells (LECs) and the development of PCO after cataract surgery. Despite previous advances in this field, the drug-loaded IOLs were limited in ocular toxicity, insufficient drug-loading capacity, and short release time. To prevent PCO and to address these drawbacks, a novel drug-loaded IOL (Rapa@Ti3C2-IOL), prepared from two-dimensional ultrathin Ti3C2 MXene nanosheets and rapamycin (Rapa), was fabricated with a two-step spin coating method in this study. Rapa@Ti3C2 was prepared via electrostatic self-assembly of Ti3C2 and Rapa, with a loading capacity of Rapa at 92%. Ti3C2 was used as a drug delivery reservoir of Rapa. Rapa@Ti3C2-IOL was designed to have the synergistic photothermal and near infrared (NIR)-controllable drug release property. As a result, Rapa@Ti3C2-IOL exhibited the advantages of simple preparation, high light transmittance, excellent photothermal conversion capacity, and NIR-controllable drug release behavior. The Rapa@Ti3C2 coating effectively eliminated the LECs around Rapa@Ti3C2-IOL under a mild 808-nm NIR laser irradiation (1.0 W/cm−2). Moreover, NIR-controllable Rapa release inhibited the migration of LECs and suppressed the inflammatory response after photothermal therapy in vitro. Then, Rapa@Ti3C2-IOL was implanted into chinchilla rabbit eyes, and the effectiveness and biocompatibility to prevent PCO were evaluated for 4 weeks. The Rapa@Ti3C2-IOL implant exhibited excellent PCO prevention ability with the assistance of NIR irradiation and no obvious pathological damage was observed in surrounding healthy tissues. In summary, the present study offers a promising strategy for preventing PCO via ultrathin Ti3C2 MXene nanosheet-based IOLs with synergistic photothermal and NIR-controllable Rapa release properties.
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Affiliation(s)
- Zi Ye
- Senior Department of Ophthalmology, The Third Medical Center, The Chinese PLA General Hospital, Beijing, China
| | - Yang Huang
- Department of Ophthalmology, Shanghai Electric Power Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinglan Li
- Senior Department of Ophthalmology, The Third Medical Center, The Chinese PLA General Hospital, Beijing, China
| | - Tianju Ma
- Senior Department of Ophthalmology, The Third Medical Center, The Chinese PLA General Hospital, Beijing, China
| | - Lixiong Gao
- Senior Department of Ophthalmology, The Third Medical Center, The Chinese PLA General Hospital, Beijing, China
| | - Huihui Hu
- Suzhou Beike Nano Technology Co., Ltd., Suzhou, China
- *Correspondence: Huihui Hu, ; Qing He, 2608169765qq.com; Haiying Jin, ; Zhaohui Li,
| | - Qing He
- Suzhou Beike Nano Technology Co., Ltd., Suzhou, China
- *Correspondence: Huihui Hu, ; Qing He, 2608169765qq.com; Haiying Jin, ; Zhaohui Li,
| | - Haiying Jin
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Huihui Hu, ; Qing He, 2608169765qq.com; Haiying Jin, ; Zhaohui Li,
| | - Zhaohui Li
- Senior Department of Ophthalmology, The Third Medical Center, The Chinese PLA General Hospital, Beijing, China
- *Correspondence: Huihui Hu, ; Qing He, 2608169765qq.com; Haiying Jin, ; Zhaohui Li,
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Zhang X, Lai K, Li S, Wang J, Li J, Wang W, Ni S, Lu B, Grzybowski A, Ji J, Han H, Yao K. Drug-eluting intraocular lens with sustained bromfenac release for conquering posterior capsular opacification. Bioact Mater 2021; 9:343-357. [PMID: 34820575 PMCID: PMC8586266 DOI: 10.1016/j.bioactmat.2021.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 02/06/2023] Open
Abstract
Cataract is the leading cause of visual impairment, and posterior capsular opacification (PCO) is the most common long-term complication of modern cataract surgery, which can cause severe visual impairment after surgery. The proliferation, migration, and epithelial-mesenchymal transition (EMT) of residual lens epithelial cells (LECs) stimulated by growth factors and cytokines, are the key pathological mechanisms involved in the development of PCO. This study demonstrated that non-steroidal anti-inflammatory drug (NSAID), bromfenac, was capable of effectively inhibiting cell migration, overexpression of EMT markers, such as fibronectin (FN), matrix metalloproteinase 2 (MMP2), α-smooth muscle actin (α-SMA), and transcription factor Snail, and extracellular signal-regulated kinase (ERK)/glycogen synthase kinase-3β (GSK-3β) signaling induced by transforming growth factor-β2 (TGF-β2) in vitro. The inhibitory effect of bromfenac on TGF-β2-induced EMT was also verified on a primary lens epithelial cell model using human anterior capsules. Furthermore, based on ultrasonic spray technology, we developed a drug-eluting intraocular lens (IOL) using poly (lactic-co-glycolic acid) (PLGA) with sustained bromfenac release ability for the prevention of PCO development. In the rabbit models of cataract surgery, bromfenac-eluting IOL exhibited remarkable PCO prevention and inflammation suppression effects with excellent biocompatibility. In conclusion, bromfenac can inhibit TGF-β2-induced cell migration and the EMT of LECs via ERK/GSK-3β/Snail signaling. The present study offers a novel approach for preventing PCO through PLGA-based drug sustained-release IOLs. Bromfenac inhibited TGF-β2-induced migration and EMT of LECs through ERK/GSK-3β/Snail signaling. Drug-eluting IOLs with sustained bromfenac release were developed based on ultrasonic spray technology. Bromfenac-eluting IOLs exhibited remarkable PCO prevention and inflammation suppression effects in vivo. Bromfenac-eluting IOLs hold great potential for clinical application of PCO prevention.
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Affiliation(s)
- Xiaobo Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, PR China
| | - Kairan Lai
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, PR China
| | - Su Li
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, PR China
| | - Jing Wang
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, PR China
| | - Jiayong Li
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, PR China
| | - Wei Wang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Shuang Ni
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Bing Lu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, PR China
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 60-554 Olsztyn, Poland.,Institute for Research in Ophthalmology, Gorczyczewskiego 2/3, 61-553 Poznan, Poland
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, PR China
| | - Haijie Han
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, PR China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, PR China
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Mastromonaco C, Balazsi M, Zoroquiain P, Esposito E, Coblentz J, Logan P, Burnier MN. Removing Subjective Post-Mortem Grading from Posterior Capsular Opacification: A New Automated Detector Opacification Software, ADOS. Curr Eye Res 2018; 43:1362-1368. [DOI: 10.1080/02713683.2018.1501071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Christina Mastromonaco
- Ocular Pathology Laboratory- Department of Pathology, The MUHC-McGill University, Montreal, Quebec, Canada
| | | | - Pablo Zoroquiain
- Ocular Pathology Laboratory- Department of Pathology, The MUHC-McGill University, Montreal, Quebec, Canada
| | - Evangelina Esposito
- Ocular Pathology Laboratory- Department of Pathology, The MUHC-McGill University, Montreal, Quebec, Canada
| | - Jacqueline Coblentz
- Ocular Pathology Laboratory- Department of Pathology, The MUHC-McGill University, Montreal, Quebec, Canada
| | - Patrick Logan
- Ocular Pathology Laboratory- Department of Pathology, The MUHC-McGill University, Montreal, Quebec, Canada
| | - Miguel N. Burnier
- Ocular Pathology Laboratory- Department of Pathology, The MUHC-McGill University, Montreal, Quebec, Canada
- Department of Ophthalmology, MUHC-McGill University, Montreal, Quebec, Canada
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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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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, Talu S, Talu M, Serrao S, Ducoli P. Surface roughness of intraocular lenses with different dioptric powers assessed by atomic force microscopy. J Cataract Refract Surg 2010; 36:1573-8. [PMID: 20692572 DOI: 10.1016/j.jcrs.2010.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/17/2010] [Accepted: 03/17/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyze the optic surface roughness and morphology of 2 types of hydrophobic acrylic intraocular lenses (IOLs) with various dioptric powers using atomic force microscopy (AFM). SETTING Technical University of Cluj-Napoca, Faculty of Mechanics, Cluj-Napoca, Romania. METHODS Atomic force microscopy was used to characterize the topography of 2 types of hydrophobic acrylic IOLs from a single manufacturer (SN60AT and SA30AL) with dioptric powers ranging from 10.0 diopters (D) to 30.0 D. The AFM analysis was performed in contact mode using a V-shaped silicon nitride cantilever with a pyramidal tip curvature of 15 nm and a nominal spring constant of 0.2 N/m. Detailed surface characterization of the IOL optic was obtained using 6 quantitative parameters provided by the AFM software. RESULTS Five of 6 roughness parameters indicated statistically significant differences (P<.05) between IOLs with different dioptric powers, with the 10.0 D IOL in both models providing the smoothest optic surface. Between models with the same dioptric power, the SN60AT model had lower values of each surface roughness parameter than the SA30AL model. CONCLUSIONS Atomic force microscopy was an accurate tool for assessing the surface properties of IOL optics. Manufacturing processes were responsible for introducing detectable differences in the topography of IOL biomaterials with identical copolymer constituents but different dioptric powers. Nanometric analysis may assist IOL manufacturers in developing IOLs with optimal surface characteristics.
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Pereira FA, Werner L, Milverton JE, Coroneo MT. Miyake-Apple posterior video analysis/photographic technique. J Cataract Refract Surg 2009; 35:577-87. [DOI: 10.1016/j.jcrs.2008.11.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/17/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
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Keller RL, Hendrix DVH, Greenacre C. Shope fibroma virus keratitis and spontaneous cataracts in a domestic rabbit. Vet Ophthalmol 2007; 10:190-5. [PMID: 17445082 DOI: 10.1111/j.1463-5224.2007.00531.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 7-year-old domestic rabbit presented for an enlarging ventral perilimbal mass OS. Keratectomy was performed to remove the mass. A diagnosis of Shope fibroma virus keratitis was confirmed based on signalment, clinical signs, histologic evaluation and virus isolation. Progression of bilateral cataracts leading to visual deficits was addressed with phacoemulsification. The rabbit remained visual and comfortable 5 months postoperatively and free of recurrence of the limbal mass 9 months after initial presentation.
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Affiliation(s)
- Rachel L Keller
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, C247 Veterinary Teaching Hospital, Knoxville, TN 37996-4544, USA.
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Vyas AV, Narendran R, Bacon PJ, Apple DJ. Three-hundred-sixty degree barrier effect of a square-edged and an enhanced-edge intraocular lens on centripetal lens epithelial cell migration Two-year results. J Cataract Refract Surg 2007; 33:81-7. [PMID: 17189798 DOI: 10.1016/j.jcrs.2006.08.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 08/24/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the 360-degree barrier effect of an intraocular lens (IOL) with a square edge at the optic and an enhanced square edge at the optic-haptic junctions (Rayner 570C C-flex) on centripetal migration of lens epithelial cells (LECs) over a 2-year period. SETTING Department of Ophthalmology, Scarborough Hospital, Scarborough, United Kingdom. METHODS In a prospective study of 40 consecutive eyes, a C-flex IOL was implanted in the bag after phacoemulsification surgery. Eyes with intraoperative complications, requiring additional procedures, without 360-degree overlap of the optic, or with capsule block syndrome were excluded. Follow-up was at 6, 10, 18, and 24 months. At each visit, high-magnification retroillumination digital photographs were taken using a slitlamp-attached digital camera. The barrier effect to LEC migration across the optic edge and the enhanced square edge at the optic-haptic junction was graded as complete (no epithelial pearls or sheet), partial (few epithelial pearls without sheet), and minimal/none (epithelial sheet behind the IOL optic). RESULTS Twenty-four patients came to the final follow-up at 24 months. Fifteen of these eyes (63%) had a complete barrier effect throughout the 360 degrees of the IOL. Three eyes (13%) had a partial barrier effect throughout the 360 degrees of the IOL. Three eyes had a complete optic barrier effect but a partial optic-haptic junction barrier effect. Three eyes had a partial optic barrier effect but a complete optic-haptic junction barrier effect. No eye had epithelial sheets extending behind the optic at any location. CONCLUSIONS This study showed the barrier effect of the edge design of the C-flex IOL and the efficacy of the enhanced edge in preventing LEC migration at the optic-haptic junction. The enhanced edge was as effective as a sharp square edge in restricting the LEC migration.
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Affiliation(s)
- Ashokkumar V Vyas
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, Salt Lake City, Utah, USA.
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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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14
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Nishi Y, Rabsilber TM, Limberger IJ, Reuland AJ, Auffarth GU. Influence of 360-degree enhanced optic edge design of a hydrophilic acrylic intraocular lens on posterior capsule opacification. J Cataract Refract Surg 2007; 33:227-31. [PMID: 17276262 DOI: 10.1016/j.jcrs.2006.10.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 10/12/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the rate of posterior capsule opacification (PCO) with the single-piece hydrophilic acrylic foldable Rayner Centerflex 570H intraocular lens (IOL), which has a sharp optic edge design excluding the optic-haptic junction, and the Rayner C-flex 570C IOL, which has an improved 360-degree sharp edge. SETTING Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. METHODS As part of a multicenter U.S. Food and Drug Administration (FDA) study, 42 patients who had implantation of a C-flex IOL in 1 eye after uneventful phacoemulsification were enrolled. Six and 12 months postoperatively, PCO was evaluated by retroillumination photographs using Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software. The data were then compared with those in a matched group of patients with a Centerflex IOL who participated in a previous FDA study. RESULTS The mean age of the patients with the C-flex IOL was 71.5 years +/- 8.2 (SD) There was a statistically significant difference in EPCO scores between the C-flex group and Centerflex group. Six months after surgery, the mean EPCO value (total IOL optic) was 0.07 +/- 0.17 in the C-flex group (n = 37) and 0.20 +/- 0.20 in the Centerflex group (n = 36) (P<.01, Wilcoxon test). By 12 months, the mean had increased to 0.16 +/- 0.20 in the C-flex group (n = 37) and 0.35 +/- 0.22 in the Centerflex group (n = 31) (P<.01, Wilcoxon test). CONCLUSIONS The C-flex IOLs showed good functional results and significantly lower PCO formation than the earlier model Centerflex IOL. The enhanced edge of the C-flex IOL seemed to improve PCO prevention clinically.
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Affiliation(s)
- Yutaro Nishi
- International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Zemaitiene R, Jasinskas V, Auffarth GU. Influence of three-piece and single-piece designs of two sharp-edge optic hydrophobic acrylic intraocular lenses on the prevention of posterior capsule opacification: a prospective, randomised, long-term clinical trial. Br J Ophthalmol 2006; 91:644-8. [PMID: 17124239 PMCID: PMC1954737 DOI: 10.1136/bjo.2006.103648] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Posterior capsule opacification (PCO) is still a major long-term complication of modern cataract surgery. We evaluated the impact of sharp-edged intraocular lenses (IOLs) with different haptic designs made from the same hydrophobic acrylic material on posterior and anterior lens capsule opacification. SETTING Eye clinic of Kaunas University of Medicine, Lithuania. Prospective randomised clinical study. METHODS Seventy-four eyes of 74 patients scheduled for cataract surgery were included in a prospective randomised clinical study. Thirty-seven eyes of 37 patients received a three-piece acrylic hydrophobic (AcrySof, MA3OBA, Alcon) IOL; and thirty-seven eyes of 37 patients received a one-piece acrylic hydrophobic (AcrySof, SA3OAL, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsular folds, capsulorrhexis/optic overlapping and posterior capsule opacification (PCO) were evaluated. ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3 mm optic zone were assessed using a photographic image-analysis system (EPCO2000). Follow-ups were performed postoperatively at 1 day, 6 months, 1 year and 2 years. RESULTS There were no significant differences in best corrected visual acuity, grade of ACO and capsulorrhexis/optic overlapping between IOL types during the follow-up period. Patients in the one-piece acrylic hydrophobic IOL group more frequently presented with capsular folds behind the IOL optic area than those in the three-piece IOL group. In the three-piece acrylic hydrophobic IOL group, PCO values (mean (SD)) of the entire IOL optic area were significantly lower six months postoperative (three-piece: 0.002 (0.009); one-piece: 0.007 (0.017); p=0.04), one year postoperative (three-piece: 0.004 (0.016); one-piece: 0.026 (0.041); p=0.001) as well as one year postoperative in the central 3 mm optic zone (three-piece: 0.000 (0.0002); one-piece: 0.019 (0.049); p=0.001). However, two years postoperative, the PCO values of the groups did not show significant differences (entire IOL optic area: three-piece, 0.136 (0.223); one-piece, 0.154 (0.190); p=0.18; central zone: three-piece, 0.023 (0.065); one-piece: 0.020 (0.039); p=0.44). CONCLUSION The 2 year follow-up after cataract surgery showed no significant difference in ACO and PCO development between three-piece and one-piece acrylic hydrophobic intraocular lenses.
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Affiliation(s)
- Reda Zemaitiene
- Eye Clinic of Kaunas University of Medicine, Mickeviciaus 9, LT 44307 Kaunas, Lithuania.
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Werner L, Chew J, Mamalis N. Experimental evaluation of ophthalmic devices and solutions using rabbit models. Vet Ophthalmol 2006; 9:281-91. [PMID: 16939455 DOI: 10.1111/j.1463-5224.2006.00495.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze and compare the geometry of the anterior segment of rabbit and human eyes, with relevance for the evaluation of intraocular lenses, and to review rabbit models used in our laboratory for the evaluation of different ophthalmic devices and solutions. PROCEDURES Fifteen rabbit and 15 human eyes (10 phakic and 5 pseudophakic/group) obtained postmortem were used. Anterior-posterior length, equatorial diameter, and white-to-white (corneal diameter) were measured with calipers. The eyes were then analyzed with a very high-frequency ultrasound (Artemis, Ultralink) for measurements of the anterior chamber depth, and anterior chamber and ciliary sulcus diameters. The capsular bag diameter was measured with calipers from a posterior view, and the diameter and thickness of the crystalline lenses were measured after their excision from the phakic eyes. RESULTS Although the size of the rabbit eye is overall smaller than the size of the human eye, the dimensions of the anterior segment of rabbit eyes are generally larger. The differences between rabbit and human eyes were statistically significant (Wilcoxon rank sum test) in terms of anterior-posterior length, equatorial diameter, white-to-white measurements (P < 0.0001), anterior chamber diameter (P = 0.0004), ciliary sulcus diameter (P = 0.0012), and crystalline lens diameter and thickness (P = 0.0003). CONCLUSIONS Experimental evaluation of design features of new phakic intraocular lenses in rabbit eyes may be inconclusive without adaptation of their size/design, contrary to the evaluation of new pseudophakic lenses by implantation in the capsular bag. The rabbit is a very valuable model for the experimental evaluation of different ophthalmic devices and solutions.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
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Werner L, Mamalis N, Stevens S, Hunter B, Chew JJL, Vargas LG. Interlenticular opacification: Dual-optic versus piggyback intraocular lenses. J Cataract Refract Surg 2006; 32:655-61. [PMID: 16698490 DOI: 10.1016/j.jcrs.2006.01.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 05/31/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate and compare the incidence of capsular bag opacification, particularly interlenticular opacification (ILO), in rabbit eyes implanted with a dual-optic silicone intraocular lens (IOL) or piggyback lenses. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS Ten dual-optic study IOLs (Synchrony), 10 control pairs of piggyback silicone-plate lenses, and 10 control pairs of piggyback single-piece hydrophobic acrylic lenses were implanted in the capsular bag of 30 rabbit eyes following phacoemulsification. After a 6-week follow-up, the rabbits were killed and their eyes enucleated. Anterior capsule opacification and posterior capsule opacification were graded on a 0 to 4 scale from a posterior or Miyake-Apple view. Interlenticular opacification was noted in relation to the center of the interlenticular space (periphery, paracentral, and central area) and to the number of quadrants involved. The eyes were then evaluated histopathologically. RESULTS Postoperative inflammatory reaction was similar in all groups. Interlenticular opacification formation was statistically different among the 3 groups of lenses (ILO extension, P = .0013, and ILO extension x ILO quadrants, P = .0023; Kruskal-Wallis test). Pairwise post comparisons of ILO formation showed that the differences between the study IOL group and the silicone-plate lens group were not significant. Interlenticular opacification post comparisons between the hydrophobic acrylic lenses and the study lens or the silicone-plate lenses were significant (P = .002 and P = .001, respectively). Histopathologic examination showed extension of the proliferating cortical material from the peripheral Soemmering's ring into the interlenticular space, causing ILO, especially with the pairs of hydrophobic acrylic lenses. CONCLUSIONS In this rabbit model, ILO was significantly associated with pairs of hydrophobic acrylic lenses implanted in the bag. This study appears to confirm clinical observations that implantation of 2 silicone-plate lenses in the bag is not associated with ILO. There was also a relative lack of ILO with the dual-optic silicone lens.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
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Werner L, Mamalis N, Izak AM, Pandey SK, Davis BL, Nilson CD, Weight C, Apple DJ. Posterior capsule opacification in rabbit eyes implanted with 1-piece and 3-piece hydrophobic acrylic intraocular lenses. J Cataract Refract Surg 2005; 31:805-11. [PMID: 15899460 DOI: 10.1016/j.jcrs.2004.06.088] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2004] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the outcome of posterior capsule opacification (PCO) after implantation in rabbit eyes of currently available 3-piece and 1-piece hydrophobic acrylic intraocular lenses (IOLs) with square optic edges. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS The 3-piece designs evaluated were the AR40e (Advanced Medical Optics Inc.) and the MA60AC (Alcon, Inc.); the 1-piece designs were the SA60AT and the SA30AT (Alcon, Inc.). Nine lenses of each type were implanted in a randomized manner by the same surgeon in 18 Dutch Belted pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and analyses of the enucleated eyes were performed from the posterior or Miyake-Apple view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was scored from 0 to 4. The area of Soemmering's ring formation was also scored from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL anterior surface, IOL centration, fixation, and presence of striae. Results from the posterior view were complemented by histopathologic evaluation of the eyes. RESULTS No statistically significant difference was found between the 4 groups of IOLs in the parameters analyzed from the posterior view. When cell ingrowth occurred with the 1-piece designs, causing peripheral and central PCO formation, it was more likely to start at the optic-haptic junctions, as observed during the clinical follow-up with slitlamp examination and confirmed by gross and histopathologic analyses of the enucleated eyes. CONCLUSIONS The square, truncated optic edge is the most important IOL design feature for PCO prevention. The optic-haptic junctions of the 1-piece designs appear to be sites where the barrier effect of the truncated optic edge is less effective.
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Affiliation(s)
- Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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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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Werner L, Mamalis N, Pandey SK, Izak AM, Nilson CD, Davis BL, Weight C, Apple DJ. Posterior capsule opacification in rabbit eyes implanted with hydrophilic acrylic intraocular lenses with enhanced square edge. J Cataract Refract Surg 2004; 30:2403-9. [PMID: 15519096 DOI: 10.1016/j.jcrs.2004.02.085] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the development of posterior capsule opacification (PCO) after implantation of single-piece hydrophilic acrylic intraocular lenses (IOLs) with an enhanced square edge. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS The standard 570H Centerflex (Rayner Ltd.) design was compared to 2 new designs with enhanced square edges: the 570E and the 570C. Ten IOLs of each type were implanted in a randomized manner by the same surgeon in 15 pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and the eyes were analyzed from the posterior view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was graded from 0 to 4. The area of Soemmering's ring was graded from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL edge and IOL centration and fixation. Results from the posterior view were complemented by histopathological evaluation. RESULTS Posterior capsule opacification was lowest in the 570C group, highest in the 570H group, and intermediate in the 570E group. There was a statistically significant difference between the 3 groups in peripheral PCO (P = .039). No significant difference was found between the groups in the other parameters analyzed. When cell ingrowth occurred with the 570H, it started at the optic-haptic junctions, as observed during the clinical follow-up and confirmed by gross and histopathological analyses. CONCLUSIONS The square optic edge is the most important IOL design feature for PCO prevention. However, it should be present for 360 degrees around the IOL optic to provide an effective barrier effect.
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Affiliation(s)
- Liliana Werner
- David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
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Izak AM, Werner L, Pandey SK, Apple DJ. Pathological evaluation of postmortem human eyes implanted with a new single-piece hydrophobic acrylic lens. J Cataract Refract Surg 2004; 30:1537-44. [PMID: 15210235 DOI: 10.1016/j.jcrs.2003.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2003] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the pathological findings in 14 human cadaver eyes implanted with a single-piece AcrySof(Alcon Laboratories) posterior chamber intraocular lens (IOL). SETTING David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS Fourteen human autopsy eyes implanted with a single-piece AcrySof (SA30AL) IOL were evaluated. The eyes were sectioned at the equatorial plane, and the anterior segment containing the IOL in the capsular bag was evaluated from a posterior perspective (Miyake-Apple view) and from an anterior perspective (surgeon's view) after removal of cornea and iris. They were then processed through paraffin, sectioned, and stained with hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome and examined under light microscopy. RESULTS All IOLs had symmetric in-the-bag fixation. Slight decentration was measured in 1 eye, which also had an anterior capsule tear. Grade 1 anterior capsule opacification was present in 9 eyes. No central posterior capsule opacification or posterior capsule folds were observed in any eye. Soemmering's ring formation was observed in 5 eyes. Zonular stretch caused by different degrees of capsular bag contraction was present in 4 eyes without decentration of the IOL. CONCLUSIONS Analyses of pseudophakic cadaver eyes from the posterior (Miyake-Apple) view, complemented by microscopic analyses, proved useful in the evaluation of IOL-capsular bag interaction. These studies are more important in cases of newly introduced lens designs.
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Affiliation(s)
- Andrea M Izak
- David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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