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Buhl R, Yildirim TM, Schickhardt SK, Britz L, Lieberwirth I, Auffarth GU, Khoramnia R. Higher phosphate concentrations as in aqueous humor of diabetic patients increase intraocular lens calcification. BMC Ophthalmol 2024; 24:363. [PMID: 39179956 PMCID: PMC11342483 DOI: 10.1186/s12886-024-03553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/01/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Clinical evidence suggests an association between phosphate concentrations in aqueous humor and the risk of intraocular lens (IOL) calcification. To test this hypothesis the influence of different phosphate concentrations on IOL calcification was evaluated in an in vitro electrophoresis model. METHODS 20 IOLs of two hydrophilic IOL models (CT Spheris 204, Zeiss; Lentis L-313, Oculentis) and one hydrophobic control IOL model (Clareon CNA0T0, Alcon) were exposed to physiologic and elevated phosphate concentrations, similar to diabetic aqueous humor. IOL calcification was analyzed by alizarin red staining, von Kossa staining, scanning electron microscopy, energy dispersive x-ray spectroscopy and transmission electron microscopy with electron diffraction. RESULTS Higher phosphate concentrations were associated with IOL calcification. Analyses of IOL surfaces and cross-sections documented calcification in no CT Spheris and 4 Lentis IOLs following exposure to 10 mM Na2HPO4, compared with 7 and 11 positive analyses following exposure to 14 mM Na2HPO4, respectively. Furthermore, a clear association between IOL calcification and the duration of electrophoresis was demonstrated, confirming increased phosphate concentrations and duration of exposure as risk factors of IOL calcification. CONCLUSIONS Findings suggest that higher phosphate concentrations in aqueous humor, as seen in diabetic patients, contribute to an increased IOL calcification risk, potentially explaining clinical observations showing an increased risk of IOL calcification in patients with diabetes.
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Affiliation(s)
- Rebecca Buhl
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Timur Mert Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Sonja Katrin Schickhardt
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Leoni Britz
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Germany
| | - Gerd Uwe Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany.
- Heidelberg University , Heidelberg, Germany.
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany
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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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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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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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8
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Venter JA, Collins BM, Hannan SJ, Teenan D, Schallhorn JM. Outcomes of a Refractive Segmented Bifocal Intraocular Lens with a Lower Near Addition. Clin Ophthalmol 2022; 16:2531-2543. [PMID: 35974904 PMCID: PMC9375988 DOI: 10.2147/opth.s376323] [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: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate clinical and subjective outcomes of a segmented bifocal IOL with a 2.0 D near addition. Patients and Methods Retrospective analyses of patients who had undergone refractive lens exchange with bilateral implantation of the SBL-2 IOL (Lenstec, Inc., Christ Church, Barbados) were performed. The number of patients included in the study was 389 (778 eyes). Refractive, visual and patient-reported outcomes were presented for the last available visit (mean follow-up 2.05 ± 1.33 months). Results The percentage of eyes within ±0.50D and ±1.00D of emmetropia was 82.5% (642/778) and 97.8% (761/778), respectively. The mean uncorrected intermediate visual acuity (66 cm) of the last available visit was 0.08 ± 0.15 logMAR monocularly and 0.04 ± 0.14 logMAR binocularly. The mean monocular and binocular uncorrected near visual acuity (40 cm) were 0.30 ± 0.15 logMAR and 0.24 ± 0.14 logMAR, respectively. Of all patients, 97.2% (378/389) claimed never to use any correction for distance vision, while 93.1% (362/389) of patients did not require any correction for near vision. The mean scores for visual phenomena (on the scale from 1 – no difficulty to 7 – severe difficulty) were 1.8 ± 1.3, 1.7 ± 1.2, 1.7 ± 1.2 and 1.6 ± 1.2 for glare, halo, starburst, and ghosting/double vision, respectively. Conclusion Despite the lower near addition of SBL-2 segmented bifocal IOL, patients achieved reasonable rates of spectacle independence and a low incidence of visual phenomena.
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Affiliation(s)
- Jan A Venter
- Optical Express, Glasgow, UK
- Eye and Laser Institute, Port Elizabeth, South Africa
- Correspondence: Jan A Venter, Eye and Laser Institute, 205 Cape Road, Newton Park, Port Elizabeth, South Africa, Tel +44 7713 480975, Email
| | | | | | | | - Julie M Schallhorn
- University of California, San Francisco, Department of Ophthalmology, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California, San Francisco, CA, USA
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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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Laboratory Investigation of Preclinical Visual-Quality Metrics and Halo-Size in Enhanced Monofocal Intraocular Lenses. Ophthalmol Ther 2021; 10:1093-1104. [PMID: 34689301 PMCID: PMC8589924 DOI: 10.1007/s40123-021-00411-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction This study aims to compare preclinical visual-quality metrics and halo size of intraocular lenses (IOL) with enhanced intermediate vision to a standard monofocal lens. Methods Three monofocal- IOL models with an extended-depth-of-focus (EDoF) intended for monocular implantation (Tecnis ICB00, AE2UV/ZOE, and IsoPure) and one for monovision (RayOne EMV) were compared against a standard monofocal lens (Tecnis ZCB00). An optical-metrology station was used in the assessment of IOLs' optical quality in polychromatic light. The imaging quality was compared with metrics derived from the optical transfer function. Halo size was estimated from the projection of the point spread function under scotopic pupil. Results The monofocal IOL showed the highest image quality at the far focus. The ICB00’s, the AE2UV/ZOE’s, and the IsoPure’s performance at − 1D was superior to that of the monofocal lens. The monocular defocus tolerance of the RayOne EMV was comparable with that of the ZCB00. The RayOne EMV’s intermediate range was improved in a monovision configuration (− 1D offset). This approach, however, yielded the largest halo area, i.e., 53% of the ZCB00’s halo, compared to 34% for the IsoPure, 14% for the AE2UV/ZOE, and 8% for the ICB00. Conclusion The mono-EDoF models have a clear advantage over the standard monofocal lens by expanded imaging capability beyond − 0.5D. Although the RayOne EMV provided the largest (binocular) visual-range extension, it was at the expense of monocular vision and higher susceptibility to halo. The ICB00’s and the AE2UV/ZOE’s halo-profile was similar to that of the ZCB00, indicating their low potential to induce photic phenomena. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00411-9.
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12
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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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14
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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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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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16
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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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17
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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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19
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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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20
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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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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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