1
|
Mao Y, Liang X, Zhao J, Jiang L, Liang Q, Ngai T, Gong X, Wu M. 3D monitoring of the microphase separations inside the intraocular lens. Acta Biomater 2024; 177:178-188. [PMID: 38307480 DOI: 10.1016/j.actbio.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
Glistenings often occur after implanting the intraocular lens (IOL) due to the formation of numerous microvacuoles (MVs) and may lead to deterioration of vision quality. Previous studies showed the formation of MVs was associated with the hydrophobicity of IOL materials. Yet, the mechanism remains an open question due to the complexity of IOL polymer networks. In this study, two commercialized IOLs with similar hydrophobicity are found distinct in the formation of MVs. The 3D growth kinetics of MVs during cooling processes are captured for the first time by digital holographic microscopy (DHM) and the components of MVs are measured by DHM and Raman spectroscopy. The results reveal that the growth of MVs stems from the microphase separation of water and surrounding IOL polymers. A polymer swelling model is thus proposed to describe the microphase separation process which is found dependent on the elasticity of IOL polymer networks. The total volume of MVs is determined by the IOL hydrophobicity, while the elastic force of IOL polymer networks determines the number density and size of MVs. This study demonstrates an approach for characterizing the phase separation of crosslinked polymeric materials in biosystems and sheds lights on the refinement of IOL materials. STATEMENT OF SIGNIFICANCE: Glistenings due to the formation of numerous microvacuoles (MVs) in intraocular lens (IOL) can occur after IOL implantation, which may induce poor quality of vision. However, the underlying mechanism of MVs formation is still an open question. This study establishes an in-situ 3D imaging platform to monitor growth kinetics of the MVs in IOLs, which allows to uncover the mechanism of glistenings formation resulting from the microphase separation. The findings imply the material hydrophobicity influences the total volume of MVs, while the local elasticity of IOL polymer networks determines the number density and the size of MVs. This study offers a new approach for characterizing phase separation in crosslinking biosystems and sheds lights on the refinement of IOL materials.
Collapse
Affiliation(s)
- Yan Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, PR China
| | - Xiao Liang
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China
| | - Junpeng Zhao
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China
| | - Lingxiang Jiang
- South China Advanced Institute for Soft Matter Science and Technology (AISMST), School of Emergent Soft Matter, South China University of Technology, Guangzhou 510640, PR China
| | - Qingyou Liang
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China; Analytical and Testing Center, South China University of Technology, Guangzhou 510640, PR China
| | - To Ngai
- Department of Chemistry, The Chinese University of Hong Kong, Hong Kong 999077, PR China
| | - Xiangjun Gong
- Faculty of Material Science and Engineering, South China University of Technology, Guangzhou 510640, PR China; Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, South China University of Technology, Guangzhou 510640, PR China.
| | - Mingxing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, PR China.
| |
Collapse
|
2
|
Bhattacharjee H, Das D, Bhattacharjee K, Buragohain S, Javeri H. Transmittance characteristics of transparent hydrophobic acrylic foldable intraocular lenses that were in vivo for a prolonged period of time: A UV visible spectrophotometric study. Indian J Ophthalmol 2023; 71:3663-3668. [PMID: 37991301 PMCID: PMC10788741 DOI: 10.4103/ijo.ijo_273_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To record experimental data on the spectral transmittance characteristics of transparent hydrophobic acrylic foldable IOLs, which were in vivo for a prolonged period of time and explanted under clinical indications and also to compare the data with that of corresponding control and crystalline lens along with review of the relevant literature. METHOD Material and make of each of the explanted intraocular lenses (IOLs) as well as pre-explantation clinical status of the eyes were confirmed from the medical record. The transmittance of wavelength from 185 to 900 nm of each of the selected IOLs was measured using Shimadzu UV 2600 UV visible (UV-Vis) spectrophotometer in double-beam configuration and probe version 2.16 software. The data obtained were statistically analyzed. RESULTS The mean transmittance of 12 clinically explanted IOLs at spectral range 300-700 nm was 49.5% ± SD 6.9%. This value was 10% and 38% less than the corresponding clear (59% ± SD 0.4%) and yellow (87.5% ± SD 0.4%) control, respectively. The mean transmittance of the analytes in the UV range was 43.3 ± SD 6.9%, and it was almost similar to the control. The data showed wide variations without good correlation, and it matches with the human crystalline lens at the age range of 50-60 years. All eyes were otherwise healthy, and none had age-related macular degeneration. CONCLUSION In comparison with fresh IOL with a yellow filter, light transmittance at the spectral range 300-700 nm was found decreased in all the IOLs, which were in vivo for an average period of 12.25 ± 4.4 years. All IOLs transmitted variable amounts of UV radiation. More data are required for further analysis on the subject.
Collapse
Affiliation(s)
| | - Dipankar Das
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | | | | | - Henal Javeri
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| |
Collapse
|
3
|
Fernández-Vigo JI, Serrano González-Peramato MT, Nunila Gómez-de-Liaño C, Sánchez-Guillén I, Fernández-Vigo JÁ, Macarro-Merino A. Glistening on intraocular lenses: A review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:493-506. [PMID: 37369324 DOI: 10.1016/j.oftale.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
The glistening in intraocular lenses (IOLs) is a phenomenon in which tiny water-filled microvacuoles (MVs) form within the IOL material, causing light to scatter and create a sparkling or shimmering effect. The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence, risk factors, evolution, and possible clinical relevance. Classically, it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp, but these were techniques that required either specific technology or an expert explorer, complex image processing, and required a lot of time. In recent years, proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs. It has been described that the manufacturing process, the hydrophobic acrylic material, or the time since surgery are risk factors for the appearance of glistening. In addition, many issues related to this phenomenon are still unknown, such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs.
Collapse
Affiliation(s)
- J I Fernández-Vigo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | | | - C Nunila Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - I Sánchez-Guillén
- Servicio de Oftalmología, Hospital Perpetuo Socorro, Badajoz, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain
| | - J Á Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain; Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - A Macarro-Merino
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Badajoz, Spain
| |
Collapse
|
4
|
Xie J, Zang X, Mao S, Sun J, Liu T, Dai Y. Late postoperative opacification of a new type hydrophilic acrylic intraocular lens. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:134-140. [PMID: 37846363 PMCID: PMC10577844 DOI: 10.1016/j.aopr.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 10/18/2023]
Abstract
Background To report the clinical consequences and laboratory characteristics of late postoperative opacification of a hydrophilic acrylic intraocular lens (US-860UV IOL) as well as the prognosis of IOL replacement. Methods Forty medical records (42 eyes) of patients with US-860UV IOL opacification reporting decreased or lost vision who underwent IOL explantation between 2017 and 2019 were reviewed. Explanted IOLs were analyzed by slit-lamp examination, confocal microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) at the Shandong Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, and Qingdao University of Science and Technology, Qingdao, China. Results The mean age of the 40 patients was 74.83 ± 7.57 (63-92) years. The mean interval between cataract surgery and diagnosis of opacification was 32.38 ± 8.76 (17-48) months. Systemic diseases were found without statistical correlations, the most frequent being arterial hypertension, coronary heart disease, and diabetes mellitus. Visual acuity improved from 1.42 ± 1.03 to 0.31 ± 0.16 (logMAR) after IOL replacement. SEM, EDS and alizarin red staining showed uniformly distributed, diffuse, milk-white opacification, with calcium and phosphorus deposits on the optic and haptic surfaces that could be dissolved in 1% HCl. Conclusions Calcium and phosphorus deposition was the main cause of hydrophilic acrylic US-860UV IOL opacification. IOL replacement can safely and effectively improve the visual acuity of patients.
Collapse
Affiliation(s)
- Jin Xie
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China
| | - Xinyi Zang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- Weifang Medical University, Weifang, Shandong, China
| | - Shilan Mao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China
- Shandong First Medical University, Jinan, Shandong, China
| | - Jie Sun
- People's Hospital of Yinan, Linyi, Shandong, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China
| | - Yunhai Dai
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China
| |
Collapse
|
5
|
Sharon T, Naftali Ben Haim L, Rabinowicz N, Kidron D, Kidron A, Ton Y, Einan-Lifshitz A, Assia EI, Belkin A. The effect of hypotensive drugs on intraocular lenses clarity. Eye (Lond) 2023; 37:1696-1703. [PMID: 36071178 PMCID: PMC10219955 DOI: 10.1038/s41433-022-02225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/19/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To assess the effect of hypotensive drugs on light absorbance, discoloration, opacification and precipitate formation of IOLs. METHODS In this laboratory study, four types of IOLs (two hydrophilic-acrylic-L1 and L2, and two hydrophobic-acrylic-B1 and B2) were soaked in solutions containing Timolol-maleate 0.5%, Dorzolamide 2%, Brimonidine-tartrate 0.2%, Latanoprost 0.005%, Brimonidine-tartrate/Timolol-maleate 0.2%/0.5% and Dorzolamide/Timolol-maleate 2%/0.5%. Non-treated IOLs and IOLs soaked in balanced salt solution (BSS) served as controls. All Treated lenses were sealed in containers and placed in an oven at 82 degrees Celsius for 120 days. Each IOL was examined using four different techniques: light microscopy imaging, light absorbance measurements at 550 nanometers through the optic's center, assessment of by a scanning electron microscope (SEM), and energy dispersive Xray spectrometry (EDX). RESULTS Ninety-eight IOLs were included. All BSS-soaked IOLs appeared clear with no significant discoloration or precipitate-formation. Light absorbance in these lenses was comparable to that of non-soaked, non-heated IOLs. No calcium or phosphate were detected in either of these groups. Light absorbance differed significantly between the four treated IOL types. The drops most affecting light absorbance differed between IOLs. Gross examination revealed brown and yellow discoloration of all IOLs soaked in Dorzolamide and Brimonidine-tartrate solutions, respectively. SEM demonstrated precipitates that differed in size, morphology and distribution, between different IOL-solution combinations. EDX's demonstrated the presence calcium and phosphor in the majority of precipitates and the presence of sulfur in brown discolored IOLs. CONCLUSIONS In vitro, interactions between hypotensive drugs and IOLs induce changes in light absorbance, discoloration and precipitate formation.
Collapse
Affiliation(s)
- Tal Sharon
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Ein-Tal Eye Center, Tel Aviv, Israel.
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rabinowicz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine E-Research Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Debora Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Arnon Kidron
- Department of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ein-Tal Eye Center, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ein-Tal Eye Center, Tel Aviv, Israel
| |
Collapse
|
6
|
Randomized multicenter trial to assess posterior capsule opacification and glistenings in two hydrophobic acrylic intraocular lenses. Sci Rep 2023; 13:2822. [PMID: 36805494 PMCID: PMC9938215 DOI: 10.1038/s41598-023-29855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof (p = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups (p < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof (p < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.
Collapse
|
7
|
Grzybowski A, Zemaitiene R, Markeviciute A, Tuuminen R. Should We Abandon Hydrophilic Intraocular Lenses? Am J Ophthalmol 2022; 237:139-145. [PMID: 34843687 DOI: 10.1016/j.ajo.2021.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize the features of hydrophilic intraocular lenses (IOLs) important in the clinical context of expected prolonged duration time of the IOL within the eye. DESIGN Perspective. METHODS Discussion includes possible factors and mechanisms associated with hydrophilic IOLs' susceptibility to calcification and posterior capsule opacification (PCO) formation. RESULTS Results of recently reported studies show that particular surgeries, such as pars plana vitrectomy, Descemet stripping (automated) endothelial keratoplasty, and Descemet membrane endothelial keratoplasty with intraocular gas or air injection, might predispose the calcification process of hydrophilic IOLs, leading to a significant decrease in visual quality and possibly explantation of the IOL. Hydrophilic IOLs are more susceptible than hydrophobic IOLs to PCO formation, which is the most common of late postoperative complications that are associated with significant side effects. CONCLUSIONS We believe that all patients should be informed about the higher risk of calcification and PCO associated with hydrophilic IOLs. We also recommend limiting the use of hydrophilic acrylic IOLs during cataract surgery, especially when it is combined with pars plana vitrectomy or endothelial keratoplasty, and in patients with endothelial diseases who will probably require operation on it in the future.
Collapse
Affiliation(s)
- Andrzej Grzybowski
- From the Department of Ophthalmology, University of Warmia and Mazury, (A.G.), Olsztyn; Institute for Research in Ophthalmology (A.G.), Poznan, Poland.
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences (R.Z., A.M.), Kaunas, Lithuania
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences (R.Z., A.M.), Kaunas, Lithuania
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki (R.T.), Helsinki; Department of Ophthalmology, Kymenlaakso Central Hospital (R.T.), Kotka, Finland
| |
Collapse
|
8
|
Alio JL, Arias A, D’Oria F, Toto F, Del Barrio JA, Duarte R, Artal P. Light scattering in intraocular lenses explanted 15 to 40 years after surgery. BIOMEDICAL OPTICS EXPRESS 2021; 12:3485-3494. [PMID: 34221674 PMCID: PMC8221949 DOI: 10.1364/boe.423652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/28/2021] [Accepted: 05/13/2021] [Indexed: 06/13/2023]
Abstract
The optical quality of intraocular lenses (IOLs) of different materials that have been implanted from 16 to 44 years in human eyes was studied. The IOLs were explanted due to other causes than loss of transparency. The scattered light from the IOLs was assessed in two angular regimes by using dark field images (for wide angles) and the optical integration method (for narrower angles). No evident differences were found in the scattering intensities processed from the dark images. The explanted lenses presented slightly increased amounts of straylight between 1 and 5.1° when compared to a reference new unused lens.
Collapse
Affiliation(s)
- Jorge L. Alio
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Augusto Arias
- Laboratorio de Óptica, Universidad de Murcia, Campus de Espinardo (Edificio 34), Murcia 30100, Spain
| | - Francesco D’Oria
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Francesca Toto
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge Alio Del Barrio
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Raul Duarte
- Laboratorio de Óptica, Universidad de Murcia, Campus de Espinardo (Edificio 34), Murcia 30100, Spain
| | - Pablo Artal
- Laboratorio de Óptica, Universidad de Murcia, Campus de Espinardo (Edificio 34), Murcia 30100, Spain
| |
Collapse
|
9
|
Abstract
The spectrum of complications in the use of intraocular lenses (IOL) is different today from at the time of their introduction. Opacities in the IOL material are increasingly described in the literature as a reason for IOL explantation. This paper provides an overview of the different forms of IOL material opacities. Currently relevant forms of IOL material opacities and their effects on optical quality are summarized. The main reason for opacification in hydrophilic IOLs is calcification, whereas in hydrophobic IOLs it is mainly the formation of so-called glistenings that is reported. Most material opacities affect various optical parameters and lead to increased intraocular straylight. In case of a disturbing material opacification, the only therapeutic option is to replace the opacified IOL.
Collapse
|
10
|
Khoramnia R. Eintrübung von Intraokularlinsen. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1250-3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas Spektrum an Komplikationen und die Explantationsgründe bei der Verwendung von
Intraokularlinsen (IOL) haben sich durch die Weiterentwicklung der
Kataraktchirurgie verändert. Eintrübungen des Materials beeinflussen dabei
unterschiedlich stark die optische Qualität. Im Fall einer störenden Eintrübung
des Materials ist auch heute noch – trotz aller Fortschritte auf dem Gebiet der
IOL-Materialien – ein Austausch der IOL die einzige Behandlungsoption.
Collapse
|
11
|
Mackert M, Muth DR, Vounotrypidis E, Deger C, Goldblum D, Shajari M, Hasler PW, Priglinger S, Wolf A. Analysis of opacification patterns in intraocular lenses (IOL). BMJ Open Ophthalmol 2021; 6:e000589. [PMID: 33634210 PMCID: PMC7880112 DOI: 10.1136/bmjophth-2020-000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022] Open
Abstract
Objective Intraocular lens (IOL) opacification may cause severe visual impairment. The pathogenesis remains unclear. The aim of this study was to analyse opacification patterns in different IOLs. Therefore, this multicentre, retrospective, observational study was conducted at Ludwig-Maximilians-University, Munich, Germany and University-Hospital Basel, Switzerland. Methods and analysis In this study, 75 opacified IOLs were identified and classified after extraction. Macroscopical photo documentation, light and electron microscopic analysis were done. Results 68 acrylic-hydrophilic single-piece-IOLs, 1 acrylic-hydrophilic 3-piece-IOL, 6 acrylic-hydrophobic 3-piece-IOLs were extracted. The dataset comprised IOLs known for opacification and IOLs not having been reported yet. 67 IOLs showed a fine-granular and 8 IOLs a crust-like opacification pattern. According to literature, 62 of the fine-granular opacified IOLs were graded into type 1 (processing/packaging-induced primary opacification) and 13 into type 2 (secondary opacification of unknown aetiology). The anterior surface of the IOLs was affected in all 75 IOLs, the posterior surface only in 23 cases. Of all 67 fine-granular IOLs, 43 had a central defect and 21 had a zone without opacification (clear islet). Conclusion In our series, the morphology of IOL opacification did not follow the existing pathogenetic classification that strictly discriminates between primary and secondary causes. Fine-granular IOL opacification occurs with similar patterns in both type 1 and type 2 IOL opacification, while a crust-like pattern was only detected in type 2 IOL opacifications. Consequently, susceptibility of an IOL to opacification is caused by a multifactorial combination of material and processing properties as well as individual (pathological) conditions of the patient.
Collapse
Affiliation(s)
- Marc Mackert
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | | | - Constanze Deger
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - David Goldblum
- Department of Ophthalmology, University Hospital Basel, Universitatsspital Basel Augenklinik, Basel, Switzerland
| | - Mehdi Shajari
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Pascal Willy Hasler
- Department of Ophthalmology, University Hospital Basel, Universitatsspital Basel Augenklinik, Basel, Switzerland
| | - Siegfried Priglinger
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Armin Wolf
- Ophthalmology, Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Phacoemulsification cataract surgery is one of the most commonly performed surgical procedure worldwide. In the majority of cases, intraocular lenses (IOLs) are implanted. Due to the increasing life expectancy and the fact that cataract surgery is performed in earlier stages, the anticipated IOL duration in the eye has increased over the last decades. The aim of this study was to review the types and describe the characteristics of late intraocular lens opacifications. RECENT FINDINGS Calcification was the most commonly reported type of opacification in hydrophilic IOLs; it usually negatively impacted the visual function and required IOL explantation. Glistening manifested in hydrophobic acrylic lenses and was frequent in some IOL models. In most cases glistening and subsurface nanoglistenigs do not lead to a decline in visual acuity or require IOL exchange. Current studies indicate that fluid-related phenomena may induce straylight, leading to a decrease of comfort and quality of vision. SUMMARY Several reports on late IOL opacifications have been published in recent years. In some cases, particularly in glistening, the development of the opacifications might be related to IOL aging. The influence of the fluid-related microvacuoles on the quality of vision requires further research.
Collapse
Affiliation(s)
- Piotr Kanclerz
- Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland
| | - Timur M Yildirim
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
13
|
Khoramnia R, Yildirim TM, Łabuz G, Mayer CS, Auffarth GU. [Opacification of intraocular lenses: laboratory and clinical findings]. Ophthalmologe 2020; 118:633-642. [PMID: 33188443 PMCID: PMC8260513 DOI: 10.1007/s00347-020-01259-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
Hintergrund Das Spektrum der Komplikationen beim Einsatz von Intraokularlinsen (IOL) ist heute ein anderes als zur Zeit ihrer Einführung. Trübungen im IOL-Material werden vermehrt als Explantationsgrund in der Literatur beschrieben. Ziel der Arbeit Diese Arbeit soll einen Überblick über die verschiedenen Formen von IOL-Materialeintrübungen geben. Material und Methoden Die heute relevanten Formen von IOL-Materialeintrübungen und deren Auswirkungen auf die optische Abbildungsqualität wurden zusammengestellt. Ergebnisse und Diskussion Als Grund für eine Eintrübung steht bei hydrophilen IOL die Kalzifikation im Vordergrund, während bei hydrophoben IOL v. a. über die Entstehung sog. „Glistenings“ berichtet wird. Die meisten Materialeintrübungen beeinflussen verschiedene optische Parameter und führen zu einem erhöhten intraokularen Streulicht. Im Falle einer störenden Materialeintrübung besteht die einzige Therapieoption in einem Austausch der eingetrübten IOL.
Collapse
Affiliation(s)
- Ramin Khoramnia
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Timur M Yildirim
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Grzegorz Łabuz
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Christian S Mayer
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Gerd U Auffarth
- The David J Apple Center for Vision Research, Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| |
Collapse
|
14
|
Grzybowski A, Markeviciute A, Zemaitiene R. A narrative review of intraocular lens opacifications: update 2020. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1547. [PMID: 33313292 PMCID: PMC7729367 DOI: 10.21037/atm-20-4207] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The opacifications of intraocular lenses (IOLs) can significantly impact patients visual quality. Despite the identification of specific risk factors, manufacturing changes, opacifications are not eliminated. Likewise, more attention in recent studies was paid to possible new risk factors, however one of the most important purposes of the studies remains opacifications effect on visual performance, which could be disturbed in different aspects. The aim of this review is to discuss the main risk factors of IOLs opacification in particular IOL types, and its impact on vision quality. Different risk factors were discussed in the study, including the material of IOLs, the impact of the breakdown of blood-aqueous barrier (BAB), and certain surgeries that can be associated with opacification formation. Glistenings occur more often in a hydrophobic material, however, the changes in water content of the IOLs can significantly reduce the formation of glistenings. The studies showed a significant effect of intraocular injection of exogenous air or gas during Descemet-stripping endothelial keratoplasty, Descemet-stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, and pars plana vitrectomy on calcification formation. It raises a concern, as the incidence of these surgeries is increasing. Visual acuity decreases significantly after the calcification in IOLs occurs, and it usually causes IOLs exchange. However, disability glare seems to be more affected in patients with IOLs, which were affected by glistenings than visual acuity. Disability glare is associated with increased levels of straylight, which was widely evaluated in recent studies and it was reported to be a susceptible measurement to detect the presence of IOLs pathology. For future researches, it should be noticed that disability glare and straylight are more appropriate in evaluating IOLs opacification effect on visual quality than visual acuity. While reviewing the main risk factors of IOLs opacifications particular attention must be paid on calcification occurrence in hydrophilic acrylic IOLs after surgeries with intraocular injection of exogenous air or gas.
Collapse
Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| | - Agne Markeviciute
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
15
|
Affiliation(s)
- Andrzej Grzybowski
- Professor of Ophthalmology, Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznan, Poland
| |
Collapse
|
16
|
Kanclerz P, Grzybowski A. Glistenings might be associated with disability glare. Eur J Ophthalmol 2020; 32:NP296. [PMID: 32188292 DOI: 10.1177/1120672120909758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznań, Poland
| |
Collapse
|