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Maguire MJ, Munro DJ, Merz P, Laidlaw A, Auffarth GU. Intraocular lens calcification in a patient with Ehlers-Danlos syndrome. Am J Ophthalmol Case Rep 2024; 35:102080. [PMID: 38827999 PMCID: PMC11143781 DOI: 10.1016/j.ajoc.2024.102080] [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: 11/17/2022] [Revised: 03/12/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Calcification of hydrophilic intraocular lenses (IOL) is a rare complication following cataract surgery. Secondary calcification is described as due to host factors or changes in the IOL environment and uveitis, proliferative diabetic retinopathy and sequelae of ocular surgery are recognised potentiators. The impact of systemic connective tissue disease on IOL opacification is yet to described. Purpose To describe the clinical presentation and management of a young patient, with a rare subtype of Ehlers-Danlos syndrome, who presented with secondary IOL calcification 14 years after primary IOL insertion. Observations Floret-like lesions were observed on the IOL surface. Positive staining for calcification was observed with Alizarin red and von Kossa method on laboratory analysis. Conclusions and importance Patients with systemic connective tissue disease, such as a subtype of Ehlers-Danlos, may present with secondary IOL calcification many years after primary lens insertion. This poses an additional consideration when implanting IOLs in these patients.Good visual acuity can be achieved with IOL exchange.
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Khoramnia R, Naujokaitis T, Łabuz G, Auffarth GU. Are There Patient-Relevant Differences in the Material Properties of Intraocular Lenses? Klin Monbl Augenheilkd 2024; 241:602-604. [PMID: 38776928 DOI: 10.1055/a-2261-1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
- Ramin Khoramnia
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
| | - Tadas Naujokaitis
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
| | - Grzegorz Łabuz
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
| | - Gerd U Auffarth
- Augenklinik, Universitätsklinikum Heidelberg/Department of Ophthalmology, University Hospital of Heidelberg
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Chychko L, Khoramnia R, Son HS, Schickhardt SK, Lieberwirth I, Auffarth GU, Yildirim TM. Material Analysis of Explanted Calcified Silicone Intraocular Lenses in Association with Asteroid Hyalosis. Ophthalmol Ther 2024; 13:791-800. [PMID: 38244181 PMCID: PMC10853093 DOI: 10.1007/s40123-023-00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The aim of this study was to analyze posterior surface opacification in explanted silicone intraocular lenses (IOLs) with clinicopathologic correlation to asteroid hyalosis. METHODS In a laboratory setup, 12 explanted silicone IOLs underwent laboratory analyses, including light microscopy, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy for elemental composition (EDX). Relevant clinical data were obtained for each case, including gender, age at IOL implantation, dates of implantation and explantation, as well as history of neodymium-dopped yttrium aluminum garnet (Nd:YAG) laser treatments or other opacification removal attempts. High-resolution optical coherence tomography (OCT) images were obtained in vitro with an anterior segment OCT device (Anterion, Heidelberg Engineering, Heidelberg, Germany). RESULTS Calcification located at the posterior optic surface of each lens was identified through SEM and EDX analyses, revealing deposits composed of hydroxyapatite. In all cases, IOL polishing using Nd:YAG laser had been attempted prior to IOL exchange. The clinical functional data showed that this type of IOL opacity led to increase in straylight and subjective symptoms of glare. CONCLUSIONS Silicone IOLs can develop posterior surface calcification in eyes with asteroid hyalosis. There are mechanical techniques of cleaning the IOL surface but in many cases, IOL explantation is the only sustainable way to reduce the patients' straylight levels and glare symptoms. Due to the risk of posterior surface calcification, silicone IOL implantation should be avoided in eyes with asteroid hyalosis.
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Affiliation(s)
- Lizaveta Chychko
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Hyeck-Soo Son
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Sonja K Schickhardt
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Germany
| | - Gerd U Auffarth
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
- Department of Ophthalmology, International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Timur M Yildirim
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Yamashita K, Hayashi K, Hata S. Clinical performance and shape analysis of trifocal intraocular lenses via scanning electron microscopy. BMC Ophthalmol 2024; 24:86. [PMID: 38409015 PMCID: PMC10895732 DOI: 10.1186/s12886-024-03355-3] [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: 02/22/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND To evaluate visual performance after implantation of the TFNT (Acrysof Panoptix, Alcon, Fort Worth, Texas, USA) and CNWT (Clareon Panoptix, Alcon, Fort Worth, Texas, USA) intraocular lens (IOL), and compare the lens shape observed by scanning electron microscope (SEM). METHODS Eighteen patients (18 eyes) received implantation of the CNWT and Twenty patients (20 eyes) received implantation of the TFNT. Exclusion criteria were previous ocular surgeries, ocular pathologies, or corneal abnormalities. Intervention or Observational Procedure(s): Postoperative examination at 1 months including manifest refraction; evaluation of refractive error, distance-corrected visual acuity (DCVA) at 5 m, 1 m, 70 cm, 50 cm, 40 cm, and 30 cm, slit-lamp examination; defocus curve testing; contrast sensitivity (CS) was performed. The lens shape of the TFNT and the CNWT was examined under SEM. RESULTS Mean spherical equivalent was 0.11 ± 0.41 D (CNWT group) and 0.12 ± 0.34 D (TFNT group) 1 month postoperation. DCVA and defocus curve showed no significant difference between the two groups. CS was significantly higher in CNWT group than TFNT group at spatial frequencies of 6 cycles per degree (cpd). Observation of the IOL with a scanning electron microscope (SEM) revealed that CNWT group had improved diffraction structure and edge processing accuracy compared to TFNT group. CONCLUSION There was no significant difference between the two groups in the defocus curve and visual acuity at all distances. CS was better in the CNWT group than in the TFNT group. IOL surface features may affect CS.
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Affiliation(s)
- Kazuya Yamashita
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Yokohama Nishi-ku , 220-8521, Yokohama City, Kanagawa, Japan.
- Sky-building Eye Clinic, Yokohama City, Kanagawa, Japan.
| | - Koji Hayashi
- Sky-building Eye Clinic, Yokohama City, Kanagawa, Japan.
| | - Seiichiro Hata
- Sky-building Eye Clinic, Yokohama City, Kanagawa, Japan.
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Britz L, Schickhardt SK, Yildirim TM, Auffarth GU, Lieberwirth I, Khoramnia R. [Hydrophobic surface properties of hydrophilic acrylic lenses do not protect against calcification]. DIE OPHTHALMOLOGIE 2023; 120:1022-1028. [PMID: 37171476 DOI: 10.1007/s00347-023-01862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Opacification through calcification of hydrophilic acrylic intraocular lenses is a serious complication of cataract surgery, which usually results in explantation of the lens. In the process of calcification, the intraocular lens material plays a crucial role: calcification only occurs in hydrophilic acrylic lenses. Hydrophobic acrylic lenses show no crystal formation within the polymer. Hydrophilic acrylic lenses from some manufacturers have hydrophobic surface properties. The question arises as to what influence these surface properties have on the risk of calcification. OBJECTIVE The present study investigated whether the hydrophobic surface properties of hydrophilic acrylic lenses can prevent calcification. MATERIAL AND METHODS Using an electrophoretic in vitro model of calcification, two hydrophilic lenses with hydrophobic surface properties were compared to two hydrophilic lenses and a hydrophobic negative control to determine the risk of calcification. The lenses were then analyzed by optical microscopy, Alizarin Red and Von Kossa staining, scanning electron microscopy (SEM) and energy dispersive X‑ray spectroscopy (EDX). RESULTS All four hydrophilic lens models showed calcification within the polymer. No difference was found between the hydrophilic lenses and the hydrophilic lenses with hydrophobic surface properties in terms of crystal formation. The hydrophobic negative control showed no calcification. CONCLUSION The investigation conducted in this study under standardized conditions could show that hydrophobic surface properties of hydrophilic acrylic lenses do not protect against calcium phosphate crystal formation within the polymer. There also is a risk of calcification in these lens models.
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Affiliation(s)
- Leoni Britz
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Sonja Katrin Schickhardt
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Timur Mert Yildirim
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Gerd Uwe Auffarth
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Deutschland
| | - Ramin Khoramnia
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland.
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Liu X, Dai Y, Huang Y, Zheng S, Wei Y, Teng Y, Wu X. New exploration of ions and fatty acids in hydrophilic acrylic intraocular lens calcification. J Cataract Refract Surg 2023; 49:970-975. [PMID: 37184462 DOI: 10.1097/j.jcrs.0000000000001197] [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: 02/02/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To conduct a new exploration and analysis of the ion and fatty acid levels of a medium in which calcified hydrophilic intraocular lenses (IOLs) are present. SETTING Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. DESIGN Retrospective, laboratory observational case series. METHODS 11 patients (11 eyes) who had implantation of foldable hydrophilic acrylic posterior IOLs were found to have opacification of the IOLs. In vivo and in vitro analyses included the evaluation of patients' clinical characteristics, microscopy, histological staining, energy dispersive X-ray spectroscopy (EDS), the ion level of the aqueous humor (AH) and preserving fluid (PF), and the fatty acid content of AH. RESULTS 10 of 11 cases were female with unilateral opacification, and 7 cases had both-eye cataract surgery, including 1 first eye and 6 second eyes with IOL opacification. 4 types of similar serial numbers were counted. The analysis of AH showed that the concentrations of phosphorus and silicon were elevated but that of calcium decreased, and an increased level of silicon was detected in 3 random PFs. The palmitic (C16:0) and stearic (C18:0) fatty acids were higher than the others in the AH. The EDS confirmed that the IOL surface deposits were composed of calcium, phosphate, and a small amount of silicon. CONCLUSIONS More silicon and higher C16:0 and C18:0 were found in the AH of patients with IOL opacification. New ideas and avenues have been proposed in the study of IOL opacification.
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Affiliation(s)
- Xiaomin Liu
- From the Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu); State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu); Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu)
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Britz L, Schickhardt SK, Auffarth GU, Khoramnia R. Opacification of Hydrophilic Acrylic Intraocular Lenses: Overview of Laboratory Methods for Histological Analysis and Replication of IOL Calcification. Klin Monbl Augenheilkd 2023; 240:960-970. [PMID: 37391183 DOI: 10.1055/a-2073-8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Opacification of intraocular lenses (IOLs) due to material changes is a serious complication that can compromise the good visual outcomes of uncomplicated cataract surgery. In hydrophobic acrylic IOLs, opacification can result from glistening formation, while in hydrophilic acrylic IOLs, there is a risk of calcification due to the formation of calcium phosphates within the polymer. Over time, various methods have been developed to investigate calcification in hydrophilic acrylic IOLs. The aim of this article is to provide an overview of standard histological staining and models used to simulate IOL calcification. Histological staining can be used to detect calcification and assess the extent of crystal formation. The development of in vivo and in vitro replication models has helped to identify the underlying pathomechanisms of calcification. In vivo models are suitable for assessing the biocompatibility of IOL materials. Bioreactors as an in vitro model can be used to investigate the kinetics of crystal formation within the polymer. The replication of IOL calcification under standardized conditions using electrophoresis allows for the comparison of different lens materials with respect to the risk of calcification. The combination of different analytical and replication methods can be used in the future to further investigate the pathomechanisms of calcium phosphate crystal formation and the influence of risk factors. This may help to prevent calcification of hydrophilic acrylic IOLs and associated explantation and complications.
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Affiliation(s)
- Leoni Britz
- Universitäts-Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
| | | | - Gerd U Auffarth
- Universitäts-Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Univ.-Augenklinik Heidelberg, Deutschland
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Yildirim TM, Auffarth GU, Henningsen N, Łabuz G, Augustin VA, Son HS, Mackenbrock LHB, Khoramnia R. Differential Diagnosis of Changes in Intraocular Lenses. Klin Monbl Augenheilkd 2023; 240:952-959. [PMID: 37567234 DOI: 10.1055/a-2130-6944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Differentiating between various intraocular lens (IOL) changes can be a challenge. In particular, certain IOL models carry the risk of late postoperative calcification. A major cause of IOL exchange surgery could be avoided if appropriate modifications were made during the IOL manufacturing process. The use of a hydrophilic acrylate carries the risk of IOL calcification, especially when a secondary procedure, such as a pars plana vitrectomy or other procedures using gas or air, is performed. In secondary IOL calcification, there is a wide range of opacification patterns, which are usually located in the centre on the anterior surface of the IOL or sometimes elsewhere. Often, granular deposits accumulate just below or on the surface of the IOL, leading to significant deterioration in visual quality and eventually requiring IOL exchange surgery. Therefore, in the case of eyes requiring secondary surgical intraocular intervention in the future, the use of hydrophilic IOLs should be critically evaluated. With regard to hydrophobic IOL materials, there are clear differences in the susceptibility to the formation of glistenings. Over time, there has been a significant decrease in glistening formation over the past 30 years due to optimisation of the material. With hydrophobic IOLs, special care should also be taken to avoid mechanical damage. In general, the only treatment option for functionally-impairing IOL opacification is surgical lens exchange, which carries potential risks of complications. In cases with a low degree of functional impairment, and especially in eyes with additional ocular diseases, it may be difficult to weigh the risk of additional surgery against the potential benefit. In some cases, it may be more appropriate not to perform an IOL exchange despite the IOL opacification. Recent visualisation methods that allow high-resolution analysis of the opacities in vivo and in vitro may be used in the future to estimate the functional effects of various IOL material changes on the optical quality.
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Affiliation(s)
| | | | | | - Grzegorz Łabuz
- Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
| | | | - Hyeck-Soo Son
- Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
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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.
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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
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Naujokaitis T, Khoramnia R, Łabuz G, Choi CY, Auffarth GU, Tandogan T. Imaging Function and Relative Light Transmission of Explanted Opacified Hydrophilic Acrylic Intraocular Lenses. Diagnostics (Basel) 2023; 13:diagnostics13101804. [PMID: 37238287 DOI: 10.3390/diagnostics13101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
We evaluated the influence of intraocular lens (IOL) opacification on the optical performance of explanted hydrophilic acrylic IOLs. We performed a laboratory analysis of 32 Lentis LS-502-1 (Oculentis GmbH, Berlin, Germany) IOLs, explanted due to opacification, in comparison with six clear unused samples of the same IOL model. Using an optical bench setup, we obtained modulation transfer function (MTF), Strehl ratio, two-dimensional MTF, and United States Air Force (USAF) chart images. In addition, we assessed light transmission through the IOLs. The MTF values of opacified IOLs at 3-mm aperture were similar to those of clear lenses, with the median (interquartile range) values of 0.74 (0.01) vs. 0.76 (0.03) at the spatial frequency of 50 line pairs per millimeter in clear and opacified IOLs, respectively. The Strehl ratio of opacified lenses was not lower than that of clear lenses. The USAF-chart analysis showed a considerable reduction in brightness in opacified IOLs. The median (interquartile range) relative light transmission of opacified IOLs in comparison to clear lenses was 55.6% (20.8%) at the aperture size of 3 mm. In conclusion, the explanted opacified IOLs had comparable MTF values to those of clear lenses but significantly reduced light transmission.
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Affiliation(s)
- Tadas Naujokaitis
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Ramin Khoramnia
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Grzegorz Łabuz
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Chul Young Choi
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Gerd U Auffarth
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Tamer Tandogan
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
- Augenklinik Pallas, 4600 Olten, Switzerland
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Specifying Risk of Intraocular Lens Opacification After Endothelial Keratoplasty for Different Intraocular Lens Models: A Retrospective Monocentric Cohort Study. Cornea 2022:00003226-990000000-00119. [PMID: 36633939 DOI: 10.1097/ico.0000000000003087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE The aims of this study were to calculate the specific risk of opacification for different intraocular lens (IOL) models and to determine whether differences exist, even between lenses made of similar acrylic materials. METHODS This is a retrospective cohort study of all patients who underwent endothelial keratoplasty (EK), either after or in conjunction with cataract surgery, from June 2009 to October 2020 at Fundación Jiménez Díaz Hospital. RESULTS Three hundred seventy-two eyes of 308 patients with a median follow-up of 856 days [interquartile range (IQR): 384-1570] were included, of which 128 IOLs were hydrophobic, 120 hydrophilic, and 124 unknown. 12.9% of IOLs opacified after a median of 466 days (IQR: 255-743). Visual acuity (VA) was significantly lower in the opacified IOL group [0.51 (IQR: 0.36-1.13)] compared with the nonopacified group [0.22 (IQR: 0.11-0.65)] ( P < 0.001). IOL explantation and exchange was performed in 10 eyes, in which VA improved markedly, from 1.75 (IQR: 0.99-3.00) to 0.60 (IQR: 0.36-0.86) ( P = 0.004). IOL material and opacification events were not independent ( P < 0.001). Significant differences were found between the Akreos ADAPT AO and MI60P models and the Asphina 409M model ( P = 0.022). No significant differences were found in the opacification ratio for hydrophilic IOLs in the clinical diagnosis ( P = 0.11), the type of EK ( P = 0.25), the rebubbling rate ( P = 0.44), or the tamponade used ( P = 0.36). CONCLUSIONS Hydrophilic lenses should be avoided in patients at risk of requiring EK. It is important to know the probability of opacification of each IOL model to balance risk and benefits when planning an EK procedure because not all lenses opacify equally. Opacification is an unwanted event with a negative impact on VA, making IOL explantation and exchange the only viable treatment, although one that is not without risks.
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Singh P, Sinha A, Nagpal R, Chaurasia S. Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes. Indian J Ophthalmol 2022; 70:3222-3238. [PMID: 36018091 DOI: 10.4103/ijo.ijo_2933_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is the closest to the physiological replacement of endothelial cells. In the initial years, the technique was surgically challenging. Over the years, with better understanding and modifications in the surgical steps, the technique has evolved as an alternative to more popular procedure Descemet stripping endothelial keratoplasty. The article highlights the various preoperative, intraoperative, and postoperative nuances of DMEK. Additionally, it summarizes the various comparative and noncomparative studies on DMEK outcomes.
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Affiliation(s)
- Prabhakar Singh
- Department of Cornea and Anterior Segment, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Akanksha Sinha
- Cornea and Anterior Segment, Sankara Eye Hospital, Kanpur, Uttar Pradesh, India
| | - Ritu Nagpal
- Research Officer, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Britz L, Schickhardt SK, Yildirim TM, Auffarth GU, Lieberwirth I, Khoramnia R. Development of a standardized in vitro model to reproduce hydrophilic acrylic intraocular lens calcification. Sci Rep 2022; 12:7685. [PMID: 35538104 PMCID: PMC9090772 DOI: 10.1038/s41598-022-11486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Opacification through calcification of hydrophilic acrylic intraocular lenses (IOL) is a severe complication after cataract surgery. Causing symptoms that range from glare through to severe vision loss, the only effective therapy is explantation of the opacified IOL so far. Although IOL calcification is a well-described phenomenon, its pathogenesis is not fully understood yet. The purpose of the current study was to develop a laboratory model to replicate IOL calcification. Calcification could be reproduced using a horizontal electrophoresis and aqueous solutions of calcium chloride and disodium hydrogen phosphate. The analysis of the in vitro calcified IOLs was performed using light microscopy, Alizarin Red and Von Kossa staining, scanning electron microscopy, energy dispersive x-ray spectroscopy and electron crystallography using transmission electron microscopy and electron diffraction. The presented laboratory model could be used to identify hydrophilic IOLs that are at risk to develop calcification and to assess the influence of associated risk factors. In addition, it can serve as a research tool to further understand this pathology.
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Affiliation(s)
- Leoni Britz
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Sonja Katrin Schickhardt
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Timur Mert Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
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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.
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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
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Choi HJ, Han DJ, Shin JY, Lee DH, Seo JW, Chung IK, Lee JH. Clinical Features of Patients with Opacification of Hydrophilic Acrylic Intraocular Lens in Neovascular Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.11.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To report the clinical features of patients with opacification of hydrophilic acrylic intraocular lens (IOL) after cataract surgery in neovascular glaucoma.Methods: This retrospective case series included 11 eyes of 10 patients with IOL opacification and neovascular glaucoma (NVG) between January 2006 and December 2010. We included and analyzed cases with opacification of hydrophilic acrylic IOL. An IOL exchange was performed in three cases, and the explanted IOLs were examined grossly and evaluated by light microscopy. Sagittal sections of the optics of the IOLs were evaluated by Von Kossa staining, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX).Results: All 11 eyes of 10 patients were implanted with hydrophilic acrylic IOLs. In addition, there were no cases of hydrophobic acrylic IOL opacification. Nine patients of the 10 patients had diabetic retinopathy and one patient had central retinal artery occlusion. The mean period of IOL opacification after IOL implantation was 19.45 ± 8.52 months and the mean period of IOL opacification after the occurrence of NVG was 14.37 ± 8.51 months. The deposits of the explanted IOLs were shown to consist of calcium by von Kossa staining. The explanted IOLs showed fine whitish irregular granular deposits on the entire anterior surface of the optics by SEM and the presence of calcium deposition was confirmed by EDX analysis.Conclusions: Care is required when using hydrophilic acrylic IOLs in patients with risk of neovascular glaucoma, such as those with diabetic retinopathy or central retinal artery occlusion.
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16
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Optical function of intraocular lenses in different opacification patterns: metrology analysis of 67 explants. J Cataract Refract Surg 2021; 47:1210-1217. [DOI: 10.1097/j.jcrs.0000000000000553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022]
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Son HS, Łabuz G, Khoramnia R, Yildirim TM, Choi CY, Knorz MC, Auffarth GU. Visualization of Forward Light Scatter in Opacified Intraocular Lenses and Straylight Assessment. Diagnostics (Basel) 2021; 11:diagnostics11081512. [PMID: 34441445 PMCID: PMC8393541 DOI: 10.3390/diagnostics11081512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Qualitative visualization of forward light scatter and quantitative straylight measurement of intraocular lenses (IOLs). Methods: We analyzed two calcified IOL-explants, the Euromaxx ALI313Y (Argonoptics GmbH) and the LS-312 MF30 (Oculentis BV), one IOL with artificially induced glistenings (PC-60AD, Hoya), and one control (CT Asphina 409MP, Carl Zeiss Meditec AG) free of any opacification. Analysis included light microscopy, qualitative light scatter visualization using ray propagation imaging technique, and quantitative straylight measurement using C-Quant (Oculus). Results: More light scattering effect—visible as increased light intensity outside the IOL’s main focus—was evident in all opacified IOLs than the control. The highest straylight levels were observed in the Euromaxx (289.71 deg2/sr), which showed extensive granular deposits throughout its optic, followed by the MF30 (78.58 deg2/sr), which only showed opacification in its center. The glistenings-IOL demonstrated numerous microvacuoles within the optic and had straylight levels of 22.6 deg2/sr, while the control showed the lowest straylight levels (1.7 deg2/sr). Conclusions: Ray propagation imaging technique allowed qualitative assessment of off-axis veils of light that result from increased forward light scattering. Straylight was increased in all opacified lenses compared to the clear control lens. The IOL opacifications are significant sources of glare.
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Affiliation(s)
- Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Grzegorz Łabuz
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Timur M. Yildirim
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Chul Young Choi
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Michael C. Knorz
- FreeVis LASIK Center, Medical Faculty Mannheim of the University of Heidelberg, 68167 Mannheim, Germany;
| | - Gerd U. Auffarth
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
- Correspondence:
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18
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Kanclerz P, Yildirim TM, Khoramnia R. Microscopic Characteristics of Late Intraocular Lens Opacifications. Arch Pathol Lab Med 2021; 145:759-767. [PMID: 33091924 DOI: 10.5858/arpa.2019-0626-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The increases in overall life expectancy and in lens surgeries performed on younger patients have resulted in a significant increase in the anticipated duration of artificial intraocular lenses (IOLs) in the eye. Thus, the physicochemical properties of the IOL become a critical issue, and several types of postoperative IOL opacifications have been reported. OBJECTIVE.— To describe the microscopic characteristics of opacified IOLs. Glistenings and subsurface nanoglistenings are fluid-related phenomena developing mainly in hydrophobic acrylic IOLs and are associated with aqueous influx into the IOL matrix. Calcification presents in hydrophilic acrylic or silicone IOLs as deposits of hydroxyapatite or other phases of calcium. Snowflake degeneration is less common, and it manifests in older polymethyl methacrylate IOLs. DATA SOURCES.— PubMed and ScienceDirect databases were searched for the following keywords: intraocular lens, IOL, cataract surgery, phacoemulsification, opacification, glistening, subsurface nanoglistenings, calcification, snowflake degeneration. English-language articles published up to October 15, 2019 were included in the study. The manuscript contains mainly a literature review; however, it was supplemented with original investigations from the David J. Apple International Laboratory for Ocular Pathology. CONCLUSIONS.— Glistenings and subsurface nanoglistenings should be evaluated in a hydrated state and at room temperature; they manifest as microvacuoles sized from 1.0 to greater than 25.0 μm and less than 200 nm, respectively. Calcification deposits are situated on or underneath the surface of the IOL and can be stained with a 1% alizarin red solution or with the von Kossa method. Snowflake degeneration manifests as "particles" or "crystals," causing whitish IOL discoloration. Scanning electron microscopy or energy dispersive X-ray spectroscopy may improve the diagnostic accuracy.
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Affiliation(s)
- Piotr Kanclerz
- From the Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland (Kanclerz)
| | - Timur Mert Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany (Yildirim, Khoramnia)
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany (Yildirim, Khoramnia)
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19
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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.
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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
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20
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Yildirim TM, Łabuz G, Hammer M, Son HS, Schickhardt SK, Auffarth GU, Khoramnia R. A Novel Approach for Assessing Visual Impairment Caused by Intraocular Lens Opacification: High-Resolution Optical Coherence Tomography. Am J Ophthalmol 2021; 226:108-116. [PMID: 33571474 DOI: 10.1016/j.ajo.2021.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To quantify in vitro straylight induced by intraocular lens (IOL) localized opacification using an anterior segment optical coherence tomography (OCT) device. DESIGN Laboratory investigation. METHODS We obtained high-resolution OCT cross-section images of 44 explanted IOLs using a new in vitro application for an anterior segment OCT device, the Anterion (Heidelberg Engineering, Heidelberg, Germany). In 24 cases, the reason for IOL explantation was a centrally localized opacification, the sequela of a secondary ocular surgery. As a control, we used 20 IOLs removed after an IOL (sub-)luxation. Using image analysis, we found a threshold area value representing a metric for the amount of opacification in a region of interest in the IOL's central optic. We used a modified C-Quant straylight meter (Oculus, Wetzlar, Germany) to quantify light scattering. We derived a linear regression from calculating the correlation between the amount of opacification and straylight. RESULTS We visualized different amounts of IOL opacification using the OCT device. The opacified lenses showed a mean threshold area of 6.7% ± 3.3% and mean straylight was 95.1 ± 75.6 deg2/sr. The clear group's mean threshold area was 2.0% ± 0.8% and 5.0 ± 3.4 deg2/sr mean straylight. Straylight correlated statistically significantly with the threshold area, with a correlation coefficient of R2 = 0.80, P < .001. CONCLUSIONS This high-resolution OCT imaging technique can be used to visualize IOL opacities. The amount of opacification correlated well with the straylight induced by the lens. Anterior segment OCT imaging might be used in the future as a tool for predicting the extent of visual impairment and aid clinicians to quantify patients' complaints.
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21
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Łabuz G, Yildirim TM, Auffarth GU, Son HS, Khoramnia R. Laboratory evaluation of higher-order aberrations and light scattering in explanted opacified intraocular lenses. EYE AND VISION 2021; 8:14. [PMID: 33883039 PMCID: PMC8061033 DOI: 10.1186/s40662-021-00235-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022]
Abstract
Background Intraocular lens (IOL) calcification is a serious condition that can only be treated by removing the clouded lens. Since explantation bears the risk of complications, it is often deferred until the patient finds the symptoms intolerable. Usually, as the IOL opacifies, visual acuity is minimally affected early on. In this study, we assessed the impact of IOL opacification on optical quality. Methods We analyzed ten opacified explanted IOLs (Oculentis GmbH). Wavefront aberrations were obtained with a SHSOphthalmic device (Optocraft GmbH), which features a Hartmann-Shack sensor. The root mean square (RMS) of higher-order aberrations (HOAs) was compared. The effect of calcification on image quality was assessed through the Strehl ratio (SR). We detected light scattering with a C-Quant (Oculus GmbH) and expressed it as a straylight parameter. Results At 2 mm, 3 mm and 4 mm, the mean RMS (±standard deviation) was 0.033 μm (±0.026 μm), 0.044 μm (±0.027), and 0.087 μm (±0.049), respectively. The mean SR value was 0.81 ± 0.15 at 3 mm, with four IOLs showing a nearly diffraction-limited performance, but in two explants, opacification precluded reliable measurements. Increased straylight was found in all opacified IOLs with a mean value of 150.2 ± 56.3 deg2/sr at 3 mm. Conclusions We demonstrated that IOL opacification induces HOAs. However, the RMS remained low, which resulted only in a slight reduction of the SR-derived optical quality. On the other hand, we found a severe straylight elevation in the opacified lenses, which may result in dysphotopsia, such as glare, and subjective complaints, despite good visual acuity.
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Affiliation(s)
- Grzegorz Łabuz
- David J Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur M Yildirim
- David J Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- David J Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Hyeck-Soo Son
- David J Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- David J Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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22
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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.
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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.
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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.
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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
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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.
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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
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26
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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.
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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
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Tarnawska D, Balin K, Jastrzębska M, Talik A, Wrzalik R. Physicochemical Analysis of Sediments Formed on the Surface of Hydrophilic Intraocular Lens after Descemet's Stripping Endothelial Keratoplasty. MATERIALS 2020; 13:ma13184145. [PMID: 32957729 PMCID: PMC7560278 DOI: 10.3390/ma13184145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
An intraocular lens (IOL) is a synthetic, artificial lens placed inside the eye that replaces a natural lens that is surgically removed, usually as part of cataract surgery. The opacification of the artificial lens can be related to the formation of the sediments on its surface and could seriously impair vision. The physicochemical analysis was performed on an explanted hydrophilic IOL and compared to the unused one, considered as a reference IOL. The studies were carried out using surface sensitive techniques, which can contribute to a better understanding of the sedimentation process on hydrophilic IOLs’ surfaces. The microscopic studies allowed us to determine the morphology of sediments observed on explanted IOL. The photoelectron spectroscopy measurements revealed the presence of organic and inorganic compounds at the lens surface. Mass spectroscopy measurements confirmed the chemical composition of deposits and allowed for chemical imaging of the IOL surface. Applied techniques allowed to obtain a new set of information approximating the origin of the sediments’ formation on the surface of the hydrophilic IOLs after Descemet’s stripping endothelial keratoplasty.
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Affiliation(s)
- Dorota Tarnawska
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, 41-200 Sosnowiec, Poland;
- Department of Ophthalmology, District Railway Hospital, Panewnicka 65, 40-760 Katowice, Poland
| | - Katarzyna Balin
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
- Correspondence:
| | - Maria Jastrzębska
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
| | - Agnieszka Talik
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
| | - Roman Wrzalik
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
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Variation in intraocular lens calcification under different environmental conditions in eyes with supplementary sulcus-supported lenses. Am J Ophthalmol Case Rep 2020; 19:100797. [PMID: 32760851 PMCID: PMC7390754 DOI: 10.1016/j.ajoc.2020.100797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose Analysis of explanted intraocular lenses (IOLs) from pseudophakic eyes with supplementary sulcus-supported IOLs. Methods In this laboratory investigation, ten supplementary and capsular bag IOLs were analyzed. All lenses were received between January 2012 and March 2018. Explants were examined morphologically with histological and electron microscopic techniques and patients’ medical history was evaluated. Additionally, we used a technique new to this field: Transmission Electron Microscopy and electron diffraction pattern analysis was performed to investigate the structure of the opacifying crystals in detail. Results Eleven lenses were explanted due to IOL opacification from seven polypseudophakic eyes: In three cases the supplementary lens calcified, in three cases the capsular bag IOL (both lenses analyzed) and in one case both IOLs (only the supplementary was received). Additional surgical procedures and comorbidities included pars plana vitrectomy or Descemet stripping endothelial keratoplasty and diabetes mellitus. For each opacified lens, a varying layer of a Calcium phosphate beneath the optic surface was apparent. Crystal characterization revealed its composition to be Hydroxyapatite. Conclusions and Importance We report on a series of secondary calcification in lenses explanted from polypseudophakic eyes. In some cases, calcification occurred in the capsular bag lens, in other cases in the supplementary lens, or in both. The severity of the morphological change could be related to the comorbidities and the presence of surgery subsequent to the lens implantations. Detailed morphology of the opacifying crystals was revealed. Intraocular lenses exhibited calcification in a series of polypseudophakic eyes. Pathology occurred in the capsular bag lens, the supplementary lens, or in both. Calcification was associated with different environmental factors. Depending on the factor, morphology and pattern of the opacity differed. Transmission Electron Microscopy revealed the opacifying crystals' ultrastructure.
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29
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Bhattacharjee H, Buragohain S, Javeri HJ, Das D. Scanning electron microscopic features of explanted degraded hydrophobic acrylic intraocular lenses which were in vivo for a prolonged period. Indian J Ophthalmol 2020; 68:1086-1089. [PMID: 32461435 PMCID: PMC7508145 DOI: 10.4103/ijo.ijo_2168_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: To study and document electron microscopic features in explanted hydrophobic microvacuoles affected acrylic intraocular lenses (IOL) which were in vivo for an average duration of 11 years. Methods: Scanning electron microscopic (SEM; Hitachi S 3000 N EXAX Genesis VP SEM) study of five explanted hydrophobic acrylic IOL which had clinically evident microvacuoles prior to explantation, was done. The IOLs were in vivo for a prolonged period and needed explantation for various indications. Only those hydrophobic acrylic IOLs which fulfilled the inclusion criteria were included. The findings were compared with control specimens. Results: The IOLs were in vivo for an average duration of 11.6 ± 4.21 years. The cause of explantation of IOL was subluxation in four cases and low visual acuity in one case. Bulk degradation and microvacuoles on cut sections throughout the IOL optics and undulating surface patterns over both the surfaces of the IOL has been documented in all the specimens. No such findings were noted in the control specimens where the surface and texture were homogenous. Conclusion: SEM findings of the structural changes in explanted IOL documented in the study demonstrate that hydrophobic acrylic IOL is degradable in vivo. Microvacuoles are a clinical manifestation of the structural changes that occur at a microscopic and molecular level. These changes are not seen in IOLs which have not undergone intraocular implantation. To our knowledge, a similar study of this kind has not been done.
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Affiliation(s)
| | | | - Henal J Javeri
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Dipankar Das
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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30
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Yildirim TM, Labuz G, Khoramnia R, Son HS, Schickhardt SK, Lieberwirth I, Knorz MC, Auffarth GU. Impact of Primary Calcification in Segmented Refractive Bifocal Intraocular Lenses on Optical Performance Including Straylight. J Refract Surg 2020; 36:20-27. [DOI: 10.3928/1081597x-20191119-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/14/2019] [Indexed: 11/20/2022]
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31
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Gupta G, Goyal P, Bal A, Jain AK, Malhotra C. Pearly white intraocular lens opacification - "Tertiary cataract". Indian J Ophthalmol 2019; 68:188-189. [PMID: 31856508 PMCID: PMC6951185 DOI: 10.4103/ijo.ijo_205_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gaurav Gupta
- Department of Ophthalmology, Advanced Eye Centre, Chandigarh, India
| | - Parul Goyal
- Department of Ophthalmology, Advanced Eye Centre, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Jain
- Department of Ophthalmology, Advanced Eye Centre, Chandigarh, India
| | - Chintan Malhotra
- Department of Ophthalmology, Advanced Eye Centre, Chandigarh, India
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32
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Stanojcic N, Hull C, O'Brart DP. Clinical and material degradations of intraocular lenses: A review. Eur J Ophthalmol 2019; 30:823-839. [PMID: 31387387 DOI: 10.1177/1120672119867818] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To review the published scientific literature concerning clinical and material degradations of intraocular lenses after implantation in cataract surgery. METHODS A search was undertaken using the following databases: CENTRAL (including Cochrane Eyes and Vision Trials Register; The Cochrane Library: Issue 2 of 12 February 2019), Ovid MEDLINE (R) without Revisions (1996 to February week 2, 2019), Ovid MEDLINE (R) (1946 to February week 2, 2019), Ovid MEDLINE (R) Daily Update 19 February 2019, MEDLINE and MEDLINE non-indexed items, Embase (1980-2019, week 7), Embase (1974-2019, 19 February), Ovid MEDLINE (R) and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to 19 February 2019), Web of Science (all years), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and the WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Only published articles in English were selected. Search terms/keywords included 'IOL' or 'intraocular lens', combined with 'opacification', degradation, glistenings, nanoglistenings, whitening, transmittance, light scatter, discolouration/discoloration, performance, quality, material, biocompatibility, calcification, explantation and ultraviolet/UV radiation. Relevant in-article references not returned in our searches were also considered. RESULTS After review of the available articles, the authors included 122 publications in this review, based on the quality of their methodology and their originality. The studies included in this review were randomized controlled trials, cohort studies, case-controlled studies, case series, case reports, laboratory studies and review papers. Differing material degradations of intraocular lenses have been described and their associated pathophysiology studied. Reported anomalies include photochemical alterations, water vacuoles, internal and surface calcific deposits, surface coatings and discolouration. The nature of such changes has been shown to depend on the type of intraocular lenses material used and/or manufacturing processes and storage conditions employed. Changes in the intraocular lens can also be influenced by surgical technique, coexisting ocular pathologies and topical and systemic medications. The clinical significance of these degradations is variable, with some resulting in significant visual disturbance and the need for intraocular lens explantation and others producing only minimal visual impairments. Failure to recognize the precise nature of the problem may lead to unnecessary laser capsulotomy procedures. CONCLUSION Clinical degradations of intraocular lenses are uncommon but have been reported following the implantation of intraocular lenses made of differing biomaterials. Their correct identification and thorough investigation to determine the underlying cause is necessary for optimal patient management and the prevention of such problems. Choosing a lens made of a particular material may be important in patients with certain ocular conditions.
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Affiliation(s)
- Nick Stanojcic
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London Frost Eye Research Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Hull
- Division of Optometry and Visual Sciences, School of Health Science, City, University of London, London, UK
| | - David Ps O'Brart
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London Frost Eye Research Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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33
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Weindler JN, Łabuz G, Yildirim TM, Tandogan T, Khoramnia R, Auffarth GU. The impact of glistenings on the optical quality of a hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2019; 45:1020-1025. [DOI: 10.1016/j.jcrs.2019.01.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/25/2022]
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Otrošinová M, Novák J, Kvasnička J, Žídek O. Late postoperative opacification of a hydrophobic acrylic intraocular lens AcryNovaTMPC 610Y. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2019; 75:172-179. [PMID: 32397719 DOI: 10.31348/2019/4/1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report late postoperative opacification of a hydrophobic acrylic intraocular lens (IOL) AcryNovaTMPC 610Y as well as the clinical consequences in patients 10 years after uncomplicated cataract surgery. MATERIALS AND METHODS Medical records were reviewed of 23 patients (26 eyes) with AcryNovaTMPC 610Y implantated between years 2005 and 2007. Next clinical examination was performed 10 years after surgery. We assessed best corrected distance visual acuity (BCDVA), contrast sensitivity (CSV-1000E) and relative opacity of IOL material, (OCULUS Pentacam HR). Results of BCDVA and Pentacam were analysed statistically. One explanted IOL was analysed using anterior segment OCT in vitro and spectroscopic method EDX (Energy-dispersive X-ray spectroscopy). RESULTS Opacification led to a statistically significant reduction in the best corrected distance visual acuity (BCDVA) = (0,95 ± 0,10) versus (0,87 ± 0,20) and to increase of IOL opacity only in some lenses but statistically significant in the average (6,37 ± 2,16)% versus value of (14,22 ± 5,87)%. In the explanted IOL we have documented structural changes of primarily hydrophobic raw material leading to property of hydrophilic one. CONCLUSION Some batches of AcryNovaTMPC 610Y were produced from raw material of poor quality which is the cause of its structural changes and its progressive opacification.
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35
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Roland S, Khoramnia R, Auffarth GU, Son HS, Yildirim TM, Schoenherr U. Eintrübung einer hydrophilen Intraokularlinse nach multiplen Bevacizumab-Injektionen. Ophthalmologe 2018; 116:882-886. [DOI: 10.1007/s00347-018-0829-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Gurabardhi M, Häberle H, Aurich H, Werner L, Pham DT. Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases. J Cataract Refract Surg 2018; 44:1326-1332. [PMID: 30279087 DOI: 10.1016/j.jcrs.2018.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To report clinical findings and light microscopic results of 71 opacified hydrophilic acrylic intraocular lenses (IOLs). SETTING Vivantes Klinikum Neukoelln, Ophthalmology Department, Berlin, Germany. DESIGN Retrospective case series. METHODS Sixty-three patients (71 eyes) were referred to the clinic because of vision-impairing IOL opacification between December 2012 and September 2016 after routine cataract surgery elsewhere. The explanted IOLs were analyzed with light microscopy at the John A. Moran Eye Center (University of Utah, Salt Lake City, Utah, USA). Medical records were reviewed for visual acuity, comorbidities, and complications. Clinical follow up was 6 months. RESULTS Seventy-one opacified 1-piece or 3-piece hydrophilic acrylic IOLs (Lentis) of different designs from 2009 to 2012 (LS-502-1, LS-402-1Y, LS 312-1Y, LS-313-1Y, L-402, L-312) were found. Morphological findings were surface, subsurface, or deep calcifications of the IOL material. Explantation was performed 4 years ± 1.2 (SD) after initial phacoemulsification. The mean patient age was 78.6 ± 8.2 years. Ocular and systemic comorbidities were found without statistical correlation: the most frequent were diabetes, uveitis, and glaucoma. The preoperative mean corrected distance visual acuity changed from 0.63 ± 0.47 logarithm of the minimum angle of resolution (logMAR) to 0.20 ± 0.28 logMAR postoperatively (P < .001). CONCLUSIONS Different designs of IOLs by the same manufacturer, implanted between 2009 and 2012, developed late calcification with significant visual loss after routine cataract surgery. No medical, surgical, or ophthalmologic trigger could be determined. A manufacture issue might be the reason for the opacification.
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Affiliation(s)
- Maceda Gurabardhi
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA.
| | - Heike Häberle
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Henning Aurich
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Liliana Werner
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Duy-Thoai Pham
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
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Material Analysis and Optical Quality Assessment of Opacified Hydrophilic Acrylic Intraocular Lenses After Pars Plana Vitrectomy. Am J Ophthalmol 2018; 193:10-19. [PMID: 29890164 DOI: 10.1016/j.ajo.2018.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after pars plana vitrectomy (PPV) were assessed for material change and optical quality, in an in vitro laboratory study. DESIGN Retrospective observational case series. METHODS Ten opacified IOLs after PPV with intraocular gas injection were analyzed in a laboratory setting. Analyses included evaluation of patients' medical history, optical quality assessment, light microscopy, histologic staining, scanning electron microscopy, and energy dispersive x-ray spectroscopy. RESULTS In all 10 IOLs a thin layer of calcium phosphate that had accumulated underneath either the anterior or posterior optical surface in a central circular area of the IOL optic caused the opacification. The calcifications lead to deterioration of the modulation transfer function (MTF) across all spatial frequencies. CONCLUSION PPV with instillation of gas into a pseudophakic eye with an acrylic hydrophilic lens seems to increase the risk for secondary calcification irrespective of the manufacturer. In these cases, IOL exchange is the only treatment option available. Since IOL exchange is associated with a high intraoperative complication rate, our results suggest to consider the risk of IOL calcification when implanting hydrophilic acrylic IOLs.
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Santander-García D, Dapena I, Baydoun L, Melles GRJ. DMEK complications: current treatment and recommendations. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1429917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Diana Santander-García
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Gerrit R. J. Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Amnitrans Eye Bank Rotterdam, Rotterdam, The Netherlands
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Konrad EM, Neuhann I, Gelisken F. [Opacification posterior to the intraocular lens - but no typical secondary cataract?]. Ophthalmologe 2017; 115:326-328. [PMID: 28884214 DOI: 10.1007/s00347-017-0567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- E-M Konrad
- Universitäts-Augenklinik Tübingen, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Deutschland.
| | - I Neuhann
- MVZ Prof. Neuhann, München, Deutschland
| | - F Gelisken
- Universitäts-Augenklinik Tübingen, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Deutschland
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40
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Giers BC, Tandogan T, Auffarth GU, Choi CY, Auerbach FN, Sel S, Mayer C, Khoramnia R. Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty - a material analysis with special reference to optical quality assessment. BMC Ophthalmol 2017; 17:150. [PMID: 28830376 PMCID: PMC5568293 DOI: 10.1186/s12886-017-0546-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Laboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK). Methods Thirteen opacified IOLs after posterior lamellar keratoplasty, 8 after descemet stripping automated endothelial keratoplasty (DSAEK), 3 after descemet membrane endothelial keratoplasty (DMEK) and 2 after both DSAEK and DMEK were analysed in our laboratory. Analyses included optical bench assessment for optical quality, light microscopy, scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS). Results In all IOLs the opacification was caused by a thin layer of calciumphosphate that had accumulated underneath the anterior optical surface of the IOLs in the area spared by the pupil/anterior capsulorhexis. The calcifications lead to a significant deterioration of the modulation transfer function across all spatial frequencies of the affected IOLs. Conclusions The instillation of exogenous material such as air or gas into the anterior chamber increases the risk for opacification of hydrophilic IOLs irrespective of the manufacturer or the exact composition of the hydrophilic lens material. It is recommended to avoid the use of hydrophilic acrylic IOLs in patients with endothelial dystrophy that will likely require procedures involving the intracameral instillation of air or gas, such as DMEK or DS(A)EK.
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Affiliation(s)
- Bert C Giers
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Tamer Tandogan
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Chul Y Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Florian N Auerbach
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Saadettin Sel
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Christian Mayer
- Eye Clinic, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
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41
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Tandogan T, Auffarth GU, Choi CY, Liebing S, Mayer C, Khoramnia R. In vitro comparative optical bench analysis of a spherical and aspheric optic design of the same IOL model. BMC Ophthalmol 2017; 17:9. [PMID: 28178942 PMCID: PMC5299728 DOI: 10.1186/s12886-017-0407-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/27/2017] [Indexed: 11/16/2022] Open
Abstract
Background To analyse objective optical properties of the spherical and aspheric design of the same intraocular lens (IOL) model using optical bench analysis. Methods This study entailed a comparative analysis of 10 spherical C-flex 570 C and 10 aspheric C-flex 970 C IOLs (Rayner Intraocular Lenses Ltd., Hove, UK) of 26 diopters [D] using an optical bench (OptiSpheric, Trioptics, Germany). In all lenses, we evaluated the modulation transfer function (MTF) at 50 lp/mm and 100 lp/mm and the Strehl Ratio using a 3-mm (photopic) and 4.5-mm (mesopic) aperture. Results At 50 lp/mm, the MTF values were 0.713/0.805 (C-flex 570 C/C-flex 970 C) for a 3-mm aperture and 0.294/0.591 for a 4.5-mm aperture. At 100 lp/mm, the MTF values were 0.524/0.634 for a 3-mm aperture and 0.198/0.344 for a 4.5-mm aperture. The Strehl Ratio was 0.806/0.925 and 0.237/0.479 for a 3-mm and 4.5-mm aperture respectively. A Mann–Whitney U test revealed all intergroup differences to be statistically significant (p < 0.01). Conclusion The aspheric IOL design achieved higher MTF values than the spherical design of the same IOL for both apertures. Moreover, the differences between the two designs of the IOL were more prominent for larger apertures. This suggests that the evaluated IOL provides enhanced optical quality to patients with larger pupils or working under mesopic conditions.
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Affiliation(s)
- Tamer Tandogan
- David J Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany.
| | - Gerd U Auffarth
- David J Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Chul Y Choi
- David J Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany.,Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Pyeong-dong, Jongno-gu, Seoul, South Korea
| | - Stephanie Liebing
- David J Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Christian Mayer
- Eye Clinic, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ramin Khoramnia
- David J Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
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Milojcic C, Latz C, Tandogan T, Auffarth GU, Holz FG, Choi CY, Khoramnia R. Eintrübung einer hydrophilen Acryl-Intraokularlinse nach DMEK. Ophthalmologe 2016; 114:832-837. [DOI: 10.1007/s00347-016-0394-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Posterior Capsule Opacification 9 Years after Phacoemulsification with a Hydrophobic and a Hydrophilic Intraocular Lens. Eur J Ophthalmol 2016; 27:164-168. [DOI: 10.5301/ejo.5000831] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/20/2022]
Abstract
Purpose To compare the development of posterior capsule opacification (PCO) and survival rate without capsulotomy after implantation of a hydrophobic or hydrophilic acrylic intraocular lens (IOL) at the 9-year postoperative follow-up. Methods One of 3 experienced cataract surgeons performed standard phacoemulsification in one eye of 120 patients with cataract. The patients were randomized to implantation of either a hydrophobic acrylic IOL or a hydrophilic acrylic IOL. Both IOLs had sharp posterior edges. Retroillumination images of PCO were obtained with a fundus camera 9 years postoperatively and analyzed semiobjectively using POCOman computer software. Results Seventy-eight of the 120 patients completed the 9-year follow-up examination. Patients implanted with the hydrophilic IOL had significantly (p<0.001) more and denser PCO. The survival rate without Nd:YAG capsulotomy was significantly higher (p<0.001) in eyes with the hydrophobic IOL. Conclusions After 9 years, more and denser PCO developed in eyes with the hydrophilic IOL than the hydrophobic IOL. The survival rate without the need for capsulotomy was higher in eyes with the hydrophobic IOL.
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