Safety and effectiveness of a glistening-free single-piece hydrophobic acrylic intraocular lens (enVista)

Scleral Fixated Secondary IOLs: An Outcomes Comparison Between the Yamane and Gore-Tex-Sutured Techniques

BACKGROUND AND OBJECTIVE

Among secondary intraocular lens (IOL) techniques, scleral fixated IOLs (SFIOLs) offer advantages in cases without capsular support. In this article, we compare outcomes between two types of Gore-Tex scleral sutured IOLs with the Yamane technique.

PATIENTS AND METHODS

This study was a retrospective chart review of patients who underwent SFIOL implantation.

RESULTS

Analysis revealed a statistically significant improvement in final postoperative visual acuity (VA) for sutured SFIOLs (P < 0.001, Envista (n = 29) 95% CI 0.47 to 1.04, Akreos (n = 23) 95% CI 0.32 to 0.81) with no statistical improvement in the Yamane group (P = 0.44, n = 15, 95% CI -0.33 to 0.71). Outcomes analysis revealed greater incidences of cystoid macular edema (CME) in the Yamane cohort (P < 0.05) and a higher rate of reoperations in the Akreos cohort (P < 0.02). All complications related to suture material (n = 4) and IOL decentration (n = 2) occurred in the sutured SFIOL group.

CONCLUSIONS

The sutureless Yamane technique offered fewer subsequent surgeries and suture-specific complications while revealing diminished VA improvement in long-term follow-up compared to the sutured SFIOLs. [Ophthalmic Surg Lasers Imaging Retina 2024;55:384-390.].

Glistening on intraocular lenses: A review

The glistening in intraocular lenses (IOLs) is a phenomenon in which tiny water-filled microvacuoles (MVs) form within the IOL material, causing light to scatter and create a sparkling or shimmering effect. The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence, risk factors, evolution, and possible clinical relevance. Classically, it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp, but these were techniques that required either specific technology or an expert explorer, complex image processing, and required a lot of time. In recent years, proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs. It has been described that the manufacturing process, the hydrophobic acrylic material, or the time since surgery are risk factors for the appearance of glistening. In addition, many issues related to this phenomenon are still unknown, such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs.

One-year multicenter evaluation of a new hydrophobic acrylic intraocular lens with hydroxyethyl methacrylate in an automated preloaded delivery system

PURPOSE

To assess a single-piece monofocal hydrophobic acrylic intraocular lens (IOL) with hydroxyethyl methacrylate (HEMA) (Clareon) contained in automated preloaded delivery system (AutonoMe).

SETTING

18 surgical sites in Japan.

DESIGN

Observational study.

METHODS

In patients undergoing phacoemulsification and IOL implantation of a new hydrophobic acrylic IOL using an automated injector, clinical data were collected preoperatively and at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively. The degree of glistenings was graded on a 4-point scale. The surgeons rated usability and performance of the IOL delivery system on a 5-point scale.

RESULTS

The study enrolled 384 eyes of 384 patients, ranging in age from 41 to 93 (73.8 ± 8.2, mean ± SD) years. The percentage of eyes with corrected distance visual acuity of 20/25 or better at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively was 82.6%, 91.9%, 92.8%, 96.6%, and 95.2%, respectively. Refractive error was within 1.0 diopter in approximately 90% of cases. No glistenings were found in all cases throughout the study period. The rate of Nd:YAG laser posterior capsulotomy was 0.9% at 1 year. The IOL delivery system received high ratings on its usability and performance by the surgeons.

CONCLUSIONS

The new hydrophobic acrylic IOL with HEMA showed excellent visual and refractive outcomes without developing glistenings throughout the 1-year study period. The surgeons gave high marks for usability and performance of the automated preloaded delivery system.

Geometry of Acrylic, Hydrophobic IOLs and Changes in Haptic-Capsular Bag Relationship According to Compression and Different Well Diameters: A Bench Study Using Computed Tomography

Introduction

Characteristics of the haptics and optic–haptic junction (OHJ) of an intraocular lens (IOL) affect IOL position in the capsular bag, positional stability, and the development of posterior capsule opacification. Therefore, the haptics and OHJ have a role in determining initial and long-term visual outcomes after cataract surgery. Understanding differences in the haptics and OHJ of available IOLs and in the relationships between the haptics of each IOL and the capsular bag across a range of capsular bag sizes might inform selection of an IOL model for individuals.

Purpose

To evaluate the geometry of five currently marketed, commonly used one-piece hydrophobic acrylic monofocal IOLs and changes in haptic–capsular bag relationships according to capsular bag size using a range of compression well diameters.

Methods

AcrySof SN60WF, CT LUCIA 621PY, enVista MX60, TECNIS ZCB00, and Vivinex XY1 IOLs were scanned with computed tomography (CT) in a dry, uncompressed state for quantitative analyses of haptic and OHJ dimensions and qualitative assessment of geometry. CT scanning was done after IOL placement into a series of compression wells (11.5, 11.0, 10.0, and 9.0 mm) for analyses of haptic angle of contact (AoC) and capsular bag contact (CBC). IOL axial alignment and haptic–capsular bag relationships were assessed on side-view and 3-dimensional top-view images, respectively.

Results

The qualitative and quantitative evaluations highlighted differences in haptic and OHJ geometry and dimensions across the five IOLs. All haptic dimensions (length, thickness, surface area, volume) and all OHJ dimensions (surface area and volume) were greatest for the CT LUCIA 621PY IOL. Compared to the IOL that had the smallest measurement for each parameter, the value for the CT LUCIA 621PY IOL was 31–91% larger. The lens with the largest OHJ surface area and volume showed values that were 500% and 240% greater than the corresponding values for the lens with the smallest OHJ surface area and OHJ volume. The AoC and CBC values decreased with increasing well size for all IOLs. The CT LUCIA 621PY had the greatest AoC and CBC values for all well sizes and the smallest percentage change in AoC and CBC comparing the values from the 9.0 mm and 11.5 mm wells.

Conclusion

The in vitro evaluations in this study highlight differences in the haptic and OHJ geometric characteristics of the five IOLs studied. The collected evidence refutes opinions that all hydrophobic acrylic one-piece IOLs are the same and supports the idea that individual IOLs can have relative advantages and disadvantages that depend on the individual case. We believe the knowledge of geometry is necessary for the surgeon to have the opportunity to select the best “customized” option in the individual case as a result of anatomical conditions and secondary diagnoses. Our bench study shows how big the differences are in currently available monofocal hydrophobic acrylic lenses.

Comparative analysis of in vitro accelerated glistening formation in foldable hydrophobic intraocular lenses

PURPOSE

To analyse and compare the propensity to form glistenings in 4 different types of hydrophobic acrylic intraocular lenses (IOLs): Alcon AcrySof ® MA60AC, HOYA iSert® PC-60AD, Bausch&Lomb enVista, and Kowa Avansee™ PU6A.

METHODS

We used an accelerated laboratory method to create glistenings. IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h. Microvacuole (MV) density and size were documented and calculated using an image analysis program.

RESULTS

Median density of glistenings [MV/mm2] for Alcon AcrySof ® MA60AC was 623 (range 507-804), for HOYA iSert® PC-60AD 1358 (range 684-2699), for Bausch&Lomb enVista 2 (range 1-2), and for Kowa Avansee™ PU6A 1 (range 1-4). The prevailing MV size was: 0-5 µm for Hoya IOLs, 5-10 µm for Alcon IOLs, 20-50 µm for Bausch&Lomb IOLs, and 5-50 µm for Kowa IOLs.

CONCLUSIONS

Glistenings could be induced in all studied IOLs using the accelerated laboratory method. The Alcon AcrySof ® MA60AC and HOYA iSert® PC-60AD IOLs showed MV of high density, while the glistenings in the Hoya IOLs were smaller in size compared to the Alcon IOLs. The MV density was minimal in the Bausch&Lomb enVista and Kowa Avansee™ PU6A IOLs. The propensity of the Alcon AcrySof ® MA60AC IOLs to form glistenings in vitro correlated with the findings of clinical results that are already published.

Quantitative evaluation of microvacuole formation in five intraocular lens models made of different hydrophobic materials

In this laboratory study, we assessed the resistance to microvacuole (glistening) formation in hydrophobic intraocular lenses (IOLs). Glistenings were induced in five lenses each of five different hydrophobic acrylic IOL models, using an established in vitro laboratory model: 800C (Rayner, Worthing, UK), AcrySof SN60WF (Alcon, Fort Worth, USA), Tecnis ZCB00 (Johnson & Johnson Vision, Santa Ana, USA), Vivinex XY1 (Hoya, Tokyo, Japan) and CT Lucia 611P (Zeiss, Oberkochen, Germany). We evaluated the number of microvacuoles per square millimeter (MV/mm2) in the central part of each IOL. Results were analyzed statistically, and mean glistening numbers were ranked, with the highest in the SN60WF which had 66.0 (±45.5) MVs/mm, followed by the 611P with 30.7 (±8.4) MVs/mm2. The 800C and XY1 showed comparable values of 2.0 (±3.6) and 2.7 (±2.4) MVs/mm2, respectively. ZCB00 had the lowest number with 0.9 (±0.6) MVs/mm2. This study shows that the resistance to glistening formation differs depending on the hydrophobic acrylic copolymer composition of the IOL material. Some IOLs from current clinical use are still prone to develop glistenings whereas others, including the ZCB00, 800C and XY1 show high resistance to microvacuole formation.

Scleral fixation of a single-piece foldable acrylic IOL through a 1.80 mm corneal incision

A new scleral fixation technique of a single-piece acrylic foldable intraocular lens (IOL) (enVista MX60, Bausch & Lomb, Inc.) through a 1.80 mm corneal incision, using the IOL eyelets as anchoring point, is described. It was a retrospective review of 26 cases. The preoperative mean corrected distance visual acuity was 0.51 ± 0.21 logarithm of the minimum angle of resolution (logMAR). It improved significantly to 0.25 ± 0.27 logMAR (P < .01), 0.18 ± 0.16 logMAR (P < .01), and 0.17 ± 0.16 logMAR (P < .01) (at 1 month, 3 months, and 6 months postoperatively, respectively, repeated measures analysis of variance, P < .0001). No astigmatism increase of more than 0.75 diopters was recorded at any time point. In all 26 patients, the IOL was well centered and stable for the entire monitoring period. No complications were observed during follow-up. Scleral fixation of the foldable IOL through a 1.80 mm corneal incision provided excellent IOL stability during the 6-month follow-up of this study and might be an effective and safe surgical technique.

Scleral-Sutured Intraocular Lens Dislocations Secondary to Eyelet Fractures

OBJECTIVE

To report clinical features and visual outcomes following eyelet fractures of scleral-sutured enVista MX60 (Bausch + Lomb) intraocular lenses (IOL).

DESIGN

Retrospective, multi-center, multi-surgeon, observational case series.

METHODS

Study Population: Patients with scleral-sutured enVista MX60 IOLs that experienced either an intraoperative or post-operative eyelet fracture associated with dislocation or subluxation.

PROCEDURES

All records were reviewed for patients with a dislocated or subluxed scleral-sutured enVista MX60 IOL. Clinical features and outcomes were gathered. Main Outcome Measures: Clinical setting, surgical technique, complications, and visual acuity.

RESULTS

A total of 25 scleral-sutured enVista MX60 IOLs displacements secondary to eyelet fractures in 23 eyes of 23 patients were included. There were 20 IOLs that sustained a postoperative fracture and 5 IOLs that sustained an intraoperative fracture. Of the postoperative fractures, 7 were dislocated and 13 were subluxed. Gore-Tex was the suture of choice for 19 of the postoperative fractures and all 5 of the intraoperative fractures, and Prolene was used for 1 postoperative fracture. The mean time until postoperative fracture was 96 ± 125 days, and the median time was 61 (IQR 48-144) days. Of the postoperative fractures, new MX60s were sutured in 10 patients, and 2 of them experienced repeat displacements due to a new eyelet fracture. In the intraoperative fracture group, new MX60s were sutured in 4 patients and an Akreos AO60 lens was placed in the 5th patient. The mean preoperative best-corrected logMAR visual acuity for all patients improved from 1.2 ± 0.8 (20/317 Snellen equivalent) to 0.5 ± 0.5 (20/63 Snellen equivalent) at most recent follow-up after lens replacement.

CONCLUSIONS

Scleral-sutured MX60 intraocular lenses can experience intraoperative or postoperative eyelet fractures, resulting in lens subluxation or dislocation. Surgeons should be aware of this complication when evaluating secondary intraocular lens options.

Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in comparison to commercially available IOLs

PURPOSE

To perform in vitro assessments of surface haze and roughness, subsurface nanoglistenings (SSNGs), and glistenings of a new hydrophobic acrylic intraocular lens (IOL) in comparison to commercially available IOLs.

SETTING

Universities of Utah and Alcalá, and Alcon Vision, LLC.

DESIGN

Experimental study.

METHODS

The IOLs used were Clareon CNA0T0, Tecnis ZCB00 and Tecnis OptiBlue ZCB00V, Eternity W-60, enVista MX60, and Vivinex XY1. Surface haze was assessed by the pixel intensity units (PIU) from cross-sectional slitlamp images, and it was correlated to atomic force microscopy roughness. For SSNGs, the IOLs were artificially aged up to 10 years, followed by Scheimpflug densitometry (computer-compatible tape unit [CCTU]) measurements. For glistenings, the IOLs were immersed in a water bath and subjected to temperature changes before analysis.

RESULTS

The surface haze (n = 10, PIU) was 4.25 ± 0.87 (SD) (CNA0T0), 9.50 ± 1.66 (ZCB00), 39.48 ± 1.97 (ZCB00V), 46.68 ± 3.16 (W-60), 44.70 ± 4.00 (MX60), and 4.42 ± 0.71 (XY1) (P < .001), which showed a strong correlation with surface roughness measurements (R = 0.94, P = .006). The densitometry (n = 10, CCTU at 10 years) was 7.30 ± 1.36 (CNA0T0), 11.88 ± 3.10 (ZCB00), 38.12 ± 2.24 (ZCB00V), 48.13 ± 9.44 (W-60), 20.20 ± 3.84 (MX60), and 6.75 ± 6.66 (XY1) (P < .001), with no significant differences between CNA0T0 vs. ZCB00 and XY1. The glistenings density (n = 30) was the lowest for the CNA0T0, W-60, and MX60 IOLs.

CONCLUSIONS

The new Clareon CNA0T0, which is manufactured from a hydrophobic acrylic material, exhibited among the lowest levels of surface haze and roughness, SSNGs, and glistenings compared with other commercially available hydrophobic acrylic IOLs.

Incidence of posterior capsular opacification requiring Nd:YAG capsulotomy after cataract surgery and implantation of enVista® MX60 IOL

PURPOSE

To evaluate incidence of posterior capsule opacification requiring Nd:YAG capsulotomy over 3 years in a large series of eyes implanted with the enVista^® MX60 Intraocular Lens (IOL).

METHODS

A university-based, single-center, observational study of patients' medical records was conducted. Uneventful cataract surgery patients with in-the-bag implantations of the enVista^® MX60 IOL with a minimum of 24 months follow-up were included in the study. Exclusion criteria were insufficient follow-up (<24 months), intraoperative complications and combined surgery. The primary outcome measure was rate of YAG laser capsulotomy, while secondary outcome measures were time to YAG laser capsulotomy and rate of glistenings.

RESULTS

A total of 245 eyes of 143 patients received the MX60 IOL and were followed in the same center. Of these, 226 eyes were included in the study. Mean age was 80.7±8.3 years and M/F ratio was 42/101 (29.4/70.6%). The mean preoperative distance (logMAR) visual acuity was 0.67±0.5, while postoperatively it was 0.31±0.5 and 0.32±0.5 at the last visit. The Mean±SD follow-up time (min-max) was 35.2±7.2, (24-48.4) months. The incidence of Nd:YAG capsulotomy over 3 years was 5/226 (2.2%). Average time between surgery and Nd:YAG capsulotomy was 32.17 months. Univariate analysis of age, gender, presence of comorbidity and baseline visual acuity found no predictive factors for capsulotomy. No glistenings were reported at any postoperative visit.

CONCLUSION

The three-year cumulative incidence of PCO requiring Nd:YAG laser capsulotomy was 2.2% for the enVista^® MX-60 IOL, with no glistenings observed during follow-up. This low rate confirms the excellent safety profile of this IOL.

In vivo evaluation of a new hydrophobic acrylic intraocular lens in the rabbit model

PURPOSE

To evaluate the uveal and capsular biocompatibility as well as positioning stability of a new hydrophobic acrylic intraocular lens (IOL) in vivo in the rabbit model and compare it with a commercially available IOL.

SETTING

John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN

Experimental study.

METHODS

Fifteen New Zealand rabbits had the new test IOL (Clareon CNA0T0) implanted in one eye and a control IOL (Acrysof SN60WF) implanted in the contralateral eye. The test IOL is manufactured from a new hydrophobic acrylic material incorporating ultraviolet blocker and blue light filter. Its design is based on the control IOL's platform. The rabbits were followed up with weekly slitlamp evaluations, which assessed inflammatory reactions as well as capsular bag opacification. Anterior chamber depth was measured at 1 and 4 weeks post-implantation (high-frequency ultrasound). After 4 weeks, the rabbits were killed humanely and the eyes were enucleated. The anterior segment was evaluated from the posterior or Miyake-Apple view, and was then processed for complete histopathology.

RESULTS

There were no statistically significant differences between test and control eyes in terms of postoperative inflammation and capsular biocompatibility, including posterior capsule opacification (P = .34, paired t test), and anterior capsule opacification (P = .53, paired t test), as observed during clinical and pathological evaluation. In vivo axial positioning for the test IOL was comparable to the control IOL and stable over time (P = .531 versus P = .788).

CONCLUSIONS

The new IOL showed biocompatibility and stability comparable to the control IOL.

Prospective multicenter clinical trial to evaluate the safety and effectiveness of a new glistening-free one-piece acrylic toric intraocular lens

Purpose

Glistening formation in the intraocular lens (IOL) optic has the potential to impact quality of vision. The enVista One-Piece Hydrophobic Acrylic Spherical IOL Model MX60 (MX60 IOL) is currently the only US Food and Drug Administration-approved IOL with a label of “no glistenings”. The purpose of this prospective, multicenter, partially randomized, partially controlled, double-masked, pivotal study was to evaluate the safety and effectiveness of the enVista One-Piece Hydrophobic Acrylic MX60T Toric IOL (enVista MX60T Toric IOL).

Patients and methods

Subjects (n=191) were implanted with the enVista MX60T Toric IOL (cylinder powers 1.25, 2.00, or 2.75 D) or the parent MX60 IOL (control). Eyes within the lowest range of corneal astigmatism were randomized to receive either Toric 1.25 D IOL or control IOL in a 1:1 ratio. All subjects with corneal astigmatism requiring 2.00 or 2.75 D cylinder IOLs received toric IOLs. Rotational stability, cylinder reduction, and best-corrected distance visual acuity were primary effectiveness endpoints measured at Visit 4 (120–180 days postoperatively).

Results

Visit 4 mean absolute axis misalignment in the All Toric group was 4.68°±7.33°, and all subjects had ≤5° absolute rotation from Visit 3 to Visit 4. The 1.25 D group had significantly greater improvement in dioptric cylinder reduction (P<0.001), percent cylinder reduction (P<0.001), and mean uncorrected distance visual acuity (P<0.001), compared to control at Visit 4. Most adverse events (AEs) were mild, with no serious AEs in the study eyes. The rates of cumulative AEs through Visit 4 were below International Organization for Standardization (ISO) standard 11979-7 AE rates.

Conclusion

enVista MX60T Toric IOL is safe and effective for patients with preoperative corneal astigmatism undergoing IOL implantation.

Biomaterial Influence on Intraocular Lens Performance: An Overview

There is strong evidence that the IOL material is the factor having the greatest impact on posterior capsule opacification (PCO), anterior capsule opacification (ACO) development, and glistening formation after cataract surgery, even though there are other IOL features—such as haptic material and design and edge and optic design—that also have some influence. We reviewed the published literature describing the adverse events that are mainly related to the intraocular lens (IOL) material, such as PCO, ACO, and the subsequent capsule contraction, as well as glistening formation. The adverse events presented in this overview are the most common ones in clinical practice, and therefore, they are generally included in the clinical protocols for IOL evaluation.

Glistenings, anterior/posterior capsular opacification and incidence of Nd:YAG laser treatments with two aspheric hydrophobic acrylic intraocular lenses - a long-term intra-individual study

PURPOSE

To compare two hydrophobic acrylic intraocular lenses (IOLs) regarding long-term anterior/posterior capsular opacification (ACO/PCO) development and need for neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment due to visually disturbing PCO, and to study development of glistenings in the IOL materials.

METHODS

In a prospective, randomized, intra-individual, comparative trial, 50 cataract patients received either an AcrySof IQ^® SN60WF (Alcon, Fort Worth, TX, USA) or a Tecnis^® ZCB00 (Abbott Medical Optics, Santa Ana, CA, USA) IOL in the first operated eye, and the second eye received the IOL type not implanted in the first eye. Anterior/posterior capsular opacification (ACO/PCO) and fibrosis were monitored with slit-lamp photography and semi-automated digital analysis 2 and 3 years postoperatively. Glistenings were semi-quantitatively assessed in slit-lamp photographs. Nd:YAG laser treatment for visually disturbing PCO was monitored.

RESULTS

Visual outcomes were similar for the two IOLs. Anterior capsular fibrosis and/or opacification developed more often in SN60WF eyes. Mean PCO area percentage was larger in ZCB00 eyes 3 years after surgery, but severity score did not differ with statistical significance between the two IOLs. Six ZCB00 eyes and 2 SN60WF eyes underwent Nd:YAG laser treatment during a mean of 4 years 8 months after surgery. This difference was not statistically significant. A high amount of glistenings developed in most SN60WF IOLs, while only few ZCB00 IOLs displayed a low degree of glistenings.

CONCLUSION

Visual outcomes, PCO development over time and need for Nd:YAG laser treatment were similar for the two IOLs. Anterior capsule fibrosis/contraction and glistenings were more pronounced with the SN60WF IOL.

Glistening Formation on a Single-Piece Prehydrated Hydrophobic Acrylic Intraocular Lens in a Diabetic Patient

PURPOSE

To report a case of intraocular lens (IOL) glistening after uneventful cataract surgery and in-the-bag implantation of an enVista MX60 IOL (Bausch & Lomb, Rochester, NY) in a patient with uncontrolled diabetes mellitus.

METHODS

Case report.

RESULTS

A 76-year-old woman with non-insulin-dependent diabetes mellitus underwent uncomplicated phacoemulsification with in-the-bag implantation of an enVista MX60 IOL. After 6 months, glistening formation within the IOL optic was observed. In the fellow pseudophakic eye, an acrylic hydrophilic Akreos Adapt AO IOL (Bausch & Lomb) was implanted without complications.

CONCLUSIONS

IOL glistening can develop with the enVista MX60 IOL, even after uneventful cataract surgeries in certain situations (eg, uncontrolled diabetes mellitus). Increased vascular permeability due to uncontrolled diabetes mellitus might have been responsible for the postoperative IOL glistening formation. [J Refract Surg. 2016;32(10):710-712.].

Transscleral fixation of single-piece foldable acrylic lens with eyelets at the optic-haptic junction

OBJECTIVE

To report the clinical outcomes of transscleral fixation using a single-piece foldable acrylic intraocular lens (IOL) with eyelets at the optic-haptic junction (enVista; Bausch & Lomb).

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

Sixty eyes of 60 patients who underwent transscleral fixation with an enVista IOL were reviewed.

METHODS

Preoperative patient status, postoperative visual and refractive outcomes, and postoperative complications were analyzed.

RESULTS

The study included 60 eyes of 60 patients (52 males, 8 females) with a mean age of 56.65 ± 15.57 years. At final follow-up visit, the mean follow-up was 11.40 ± 4.24 months. The mean uncorrected visual acuity (logMAR) improved from 1.95 ± 0.90 to 0.85 ± 0.77 (p < 0.001), and best corrected visual acuity (logMAR) improved from 1.11 ± 1.13 to 0.64 ± 0.70 (p = 0.006). The mean spherical equivalent improved significantly from 6.90 ± 6.10 to 0.21 ± 2.10 D postoperatively (p < 0.001). Complications included transient ocular hypertension (15%), transient hypotony (7%), and hyphema (5%), but no serious complications were observed. In all cases, the IOL remained stable and well centred.

CONCLUSIONS

Transscleral fixation using a foldable acrylic IOL with eyelets at the optic-haptic junction can be a safe and effective alternative technique to manage cases with broken capsular bag or weak zonular support.

Safety and effectiveness of a single-piece hydrophobic acrylic intraocular lens (enVista®) - results of a European and Asian-Pacific study

Purpose

To evaluate the safety and effectiveness of a single-piece hydrophobic acrylic intraocular lens (IOL) (enVista® MX60; Bausch and Lomb Incorporated, Rochester, NY, USA) following implantation to correct aphakia subsequent to extracapsular cataract extraction in adults.

Subjects and methods

This was an open-label, non-interventional, observational study conducted in 19 university and private-practice settings in Europe and the Asia-Pacific region to investigate clinical outcomes of the MX60 IOL in standard practice. Eligible subjects were at least 18 years of age and had undergone standard phacoemulsification and extracapsular cataract extraction with implantation of the MX60 IOL. The primary safety endpoint was the occurrence of adverse events, and the primary effectiveness endpoints included visual and refractive outcomes and stability, with data collected up to 2 years post-procedure.

Results

In this multicenter study, pooled data of 255 eyes were collected and analyzed. Excellent visual and refractive outcomes and stability were demonstrated. At postoperative visit 4 (61–180 days postoperative), 62.2% of subjects achieved a Snellen best-corrected distance visual acuity (CDVA) of 20/20 (decimal 1.00), and 97.8% of subjects achieved a CDVA of 20/40 (decimal 0.50) or better. One eye (1.0%) underwent neodymium:yttrium aluminum garnet capsulotomy at 12 months post-procedure. No glistenings of any grade were reported for any subject at any visit. Adverse events were infrequent and were consistent with incidences generally reported with cataract surgery.

Conclusion

This study, which enrolled all comers, provided evidence of the excellent safety and effectiveness of the MX60 IOL in standard practice. Favorable clinical outcomes included outstanding visual and refractive outcomes and stability. No glistenings were reported at any postoperative visit.

Clinical properties of a novel, glistening-free, single-piece, hydrophobic acrylic IOL

A new, single-piece, hydrophobic acrylic lens – the first constructed with a lens optic and haptics comprised of a hydroxyethyl methacrylate-polyethylene glycol phenyl ether acrylate–styrene copolymer, cross-linked with ethylene glycol dimethacrylate, and labeled as “glistening-free” – was recently introduced globally. Glistenings have been a significant source of clinical concern with previous hydrophobic lens designs. This new monofocal lens provides enhanced, clear optics for lens-based surgery. The superior optical clarity of this lens is achieved through the elimination of glistenings, enhanced surface durability, high refractive index, a high Abbe number, and an aspheric design. Additionally, the lens design reduces the risk of developing posterior capsule opacification.