3-piece Intraocular Lens Research Articles

Inverse atoll sign as preoperative indicator of posterior capsular defects in posterior lenticonus

Two children with unilateral posterior lenticonus and cataract underwent lens matter aspiration with implantation of a 3-piece intraocular lens. Posterior capsular defect (PCD) was suspected on preoperative slitlamp examination, which was supported by swept-source optical coherence tomography and subsequently confirmed intraoperatively. Based on the findings observed in these 2 cases, an inverse atoll sign for preoperative detection of a PCD is described.

Differences in intermediate vision: Monofocal intraocular lenses vs. monofocal extended depth of focus intraocular lenses

Abstract Purpose The purpose of this study was to analyse whether an extended depth of focus (EDOF) monofocal intraocular lens (IOL) (TECNIS Eyhance) provides better intermediate visual acuity (VA) than another monofocal IOL (TECNIS 1-piece) from the same platform. Methods Randomised prospective observational study. Patients who required cataract surgery in both eyes were included. Patients in one group were implanted with Tecnis 1-piece IOL and those in the other group with Eyhance EDOF monofocal IOL. One month after surgery in the second eye, we assessed the corrected intermediate VA (66 cm) and obtained defocus curves. We also explored the correlation of: high-order and spherical aberrations with intermediate VA, pupil size with intermediate VA and age with intermediate VA. Results We analysed 30 patients (60 eyes), 15 patients in the TECNIS 1-piece group and 15 in the Eyhance group. Both groups achieved a far VA of 0.00 logMAR. In contrast, for intermediate vision, VA was better with the Eyhance EDOF monofocal IOLs (0.16 ± 0.12 LogMAR), the difference being statistically significant (p Conclusions The new EDOF monofocal IOL (Eyhance) offers sufficient depth of focus to provide patients with comfortable vision without impairing far vision.

The forceps-needle: Combining needle and grasping functions in a single instrument.

A new forceps-needle to facilitate intrascleral haptic fixation surgery is described. In an initial series of 10 cases, the forceps-needle was used to grasp and externalize the haptic of a 3-piece intraocular lens (IOL) for transscleral fixation. The site of perforation was marked at 180 degrees 2.0 mm away from the limbus. Then, the IOL with polypropylene haptics was folded and implanted partially into the anterior chamber. A transconjunctival, scleral tunnel of about 2.0 mm length parallel to the limbus was prepared with the forceps-needle on 1 side, with the second hand holding the leading haptic through a side-port incision. The end of the first haptic was grasped and externalized after which the end of the haptic was flanged. Subsequently, a second scleral tunnel was prepared with the forceps-needle, and the second haptic was externalized and flanged. All procedures could be performed without any intraoperative complication.

Diferencias en la visión intermedia: lente intraocular monofocal vs. lente intraocular monofocal de rango extendido

PurposeThe purpose of this study was to analyse whether an extended depth of focus (EDOF) monofocal intraocular lens (IOL) (TECNIS Eyhance™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) provides better intermediate visual acuity (VA) than another monofocal IOL (TECNIS 1-piece™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) from the same platform. MethodsRandomised prospective observational study. Patients who required cataract surgery in both eyes were included. Patients in one group were implanted with Tecnis 1-piece IOL and those in the other group with Eyhance EDOF monofocal IOL. One month after surgery in the second eye, we assessed the corrected intermediate VA (66 cm) and obtained defocus curves. We also explored the correlation of: high-order and spherical aberrations with intermediate VA, pupil size with intermediate VA and age with intermediate VA. ResultsWe analysed 30 patients (60 eyes), 15 patients in the TECNIS 1-piece group and 15 in the Eyhance group.Both groups achieved a far VA of 0.00 logMAR. In contrast, for intermediate vision, VA was better with the Eyhance EDOF monofocal IOLs (0.16 ± 0.12 LogMAR), the difference being statistically significant (p < 0.001). In addition, binocular intermediate VA was found to be significantly correlated with corneal (6 mm) RMS high-order aberrations (ρ 0.476) and Z40 (ρ 0.483) with the Eyhance IOL. ConclusionsThe new EDOF monofocal IOL (Eyhance) offers sufficient depth of focus to provide patients with comfortable vision without impairing far vision.

The Aravind Pseudoexfoliation Study: 5-Year Postoperative Results. The Effect of Intraocular Lens Choice and Capsular Tension Rings

We compared rates of intraocular lens (IOL) decentration, neodymium-doped yttrium aluminum garnet capsulotomy for posterior capsule opacification (PCO), and visual acuity (VA) in eyes with and without pseudoexfoliation (PEX) 5 years after undergoing cataract surgery. Prospective comparative interventional study. This multicenter study population included 1 eye of both 930 cataract patients with and 470 cataract patients without uncomplicated PEX (no small pupils or phacodonesis) all undergoing phacoemulsification by experienced Aravind Eye Care System surgeons. Eyes were randomized to either 1- or 3-piece intraocular lenses (IOLs). PEX eyes were also randomized to either receive or not receive a capsule tension ring. The main outcome measures included IOL decentration and PCO. Secondary outcomes included postoperative best-corrected VA. Follow-up was 86.2% in the PEX group and 86.7% in the control group at 5 years. The PEX group was older (P < .001) and had more men (P= .01). IOL decentration at 5 years was equally prevalent in PEX and control eyes (1.0% vs 1.1%, respectively, P= .8). Neodymium-doped yttrium aluminum garnet posterior capsulotomy rates for PCO were similar in the PEX group when compared with control subejcts (5.3% compared with 3.2%, respectively, P= .07). Best corrected VA was better at baseline and years 2 and 3 in the control group (P= .0001, P= .0005, and P= .02); however, there was no difference in BCVA at years 1, 4, and 5 between the PEX and control groups (P= .09, P= .29, and P= .5). In a large-scale, long-term, prospective comparative study of cataract surgery in eyes with uncomplicated PEX, the risks of IOL decentration and PCO were low and comparable to that in control subjects. When approaching cataract surgery in eyes with relatively uncomplicated PEX, neither IOL choice (1- vs 3-piece acrylic IOL) nor the presence/absence of a capsule tension ring affects outcomes at 5 years.

Comparison of posterior capsule folds following intracapsular implantation of three types of intraocular lenses with different haptic design

AIM: To compare the incidence of posterior capsule folds among different types of intraocular lens (IOL) to determine risk factors of posterior capsule folds. METHODS: It was a retrospective study. We collected the cases in which the patients underwent phacoemulsification (PHACO) and IOL implantation and at least one of the three types of IOL was implanted, including 2-haptic 3-piece IOLs (HOYA PY60AD), 4-haptic 1-piece IOLs (Bausch&amp;Lomb AO), 2-haptic 1-piece IOLs (AMO Tecnis ZCB00). The posterior capsule folds were measured using slit lamp microscope 2d after the surgery. Information of patient’s age, gender, length of ocular axis, intraocular pressure, types of IOL were recorded. Posterior capsule fold risk indicators were identified by using logistic regression analysis. RESULTS: One hundred eighty-seven patients (242 eyes) had been collected, including 80 eyes implanted with HOYA PY60AD IOLs, 81 eyes implanted with Bausch&amp;Lomb AO IOLs, 81 eyes implanted with AMO Tecnis ZCB00 IOLs. The incidence of posterior capsule folds of patients implanted with HOYA PY60AD IOLs was significantly higher than those of patients implanted with AMO Tecnis ZCB00 IOLs. While the incidence of patients implanted with Bausch&amp;Lomb AO IOLs was significantly lower than those of patients implanted with AMO Tecnis ZCB00 IOLs. Multi-factor logistics regression analysis demonstrated that independent risk factors were type of IOLs and length of ocular axis. Compared with AMO Tecnis ZCB00 IOLs, using HOYA PY60AD IOLs increased the risk of posterior capsule folds [P=0.020, OR (95%CI)=2.145 (1.129, 4.073)], while using Bausch&amp;Lomb AO IOLs reduced the risk [P=0.001, OR (95%CI)=0.274 (0.127, 0.591)]. Shorter ocular axis might increase the risk of posterior capsule folds [P=0.012, OR (95%CI)=0.669 (0.489, 0.915)]. CONCLUSION: Haptic design should be an important consideration in IOL design. Compared with AMO Tecnis ZCB00 IOLs, using HOYA PY60AD IOLs is more likely to lead to posterior capsule folds formation, while using Bausch&amp;Lomb AO IOLs is less likely to lead the formation. The posterior capsule folds are more engendered in eyes with shorter ocular axis.

Penetrating Keratoplasty With Sutureless Intrasclerally Fixated Intraocular Lens.

In this retrospective study, we reviewed the use of penetrating keratoplasty with sutureless intrasclerally fixated intraocular lens implantation in a closed anterior chamber in patients with several corneal pathologies and aphakia. The medical records of 6 patients, who underwent the procedure, were reviewed. In the procedure, lamellar scleral tunnels at the 2- and 8-o'clock positions were created with a microvitreoretinal blade, 1.5 mm away from the limbus. Two 27-gauge bent needles were passed, first horizontally, through these tunnels, and then vertically, which allowed them to enter the posterior chamber and to be left in position. Partial thickness trephination was made, and anterior stroma was removed where necessary. An incision was made at the 11-o'clock position, where the trephination was made, which was then extended to both sides for about 6 mm with corneal scissors. From the superior incision, the anterior haptic of a 3-piece intraocular lens was pushed through the needle at the 2-o'clock position, then the posterior haptic was pushed through the needle at the 8-o'clock position, and both haptics were removed through the sclera. Both ends were cauterized and placed into the sclera. Residual stroma was removed, and the donor graft was sutured. At the last follow-up visit, the mean bestcorrected visual acuity was significantly increased. No serious complications were seen, with the exception of increased intraocular pressure in 3 patients. Penetrating keratoplasty with sutureless intrasclerally fixated intraocular lens implantation can be used safely in patients with aphakia. With this technique, the globe stabilization can be maintained, and the trauma to the donor graft endothelium can be minimized.

ONE-YEAR OUTCOMES OF A NOVEL SURGICAL TECHNIQUE FOR SUTURELESS INTRASCLERAL FIXATION OF A THREE-PIECE INTRAOCULAR LENS USING A 30-GAUGE NEEDLE.

To present the 1-year results of a surgical technique for the sutureless intrascleral fixation of a 3-piece intraocular lens using a 30-gauge needle. A retrospective chart review of a consecutive series of 9 eyes of 8 patients who underwent sutureless intrascleral fixation of posterior chamber intraocular lens using a 30-gauge needle was performed. Patients were required to have at least 1 year of follow-up to be included in the analysis. Short-term data were collected 1 month after surgery, and long-term data were collected 1 year after surgery. Data collected included visual acuity, lens stability, intraocular pressure, and the development of complications. Visual acuity improved from Snellen 20/309 preoperatively to Snellen 20/27 at postoperative Month 12 (P = 0.03). Short-term complications included increased intraocular pressure (n = 4) and corneal edema (n = 2). Long-term complications included exposed superior haptic (n = 1) and recurrent anterior chamber inflammation (n = 1). The novel surgical technique for sutureless intrascleral fixation of a 3-piece intraocular lens is well tolerated 1 year after surgery.

Visual Axis Opacity after Intraocular Lens Implantation in Children in the First 2 Years of Life: Findings from the IoLunder2 Cohort Study

Appropriate correction of aphakia is key to good outcomes. There may be clinical settings where and populations in whom accessing or managing aphakic contact lenses is challenging. Strategies to target the increased risk of visual axis opacity (VAO) after primary intraocular lens (IOL) implantation in infancy are necessary. We describe the predictors of VAO after primary IOL implantation for unilateral or bilateral congenital or infantile cataract in children younger than 2 years of age. Population-based (United Kingdom and Ireland), prospective, inception cohort study undertaken through a national clinical network. A total of 105 children (57 with bilateral cataract, 48 with unilateral cataract, total 162 eyes) undergoing primary IOL implantation in the first 2 years of life between January 2009 and December2010. Observational longitudinal study with multilevel, multivariable modeling to investigate associations between outcome of interest and child- and treatment-specific factors, including age, axial length, socioeconomic status, IOL model, and postoperative steroid use. Postoperative proliferative or inflammatory visual axis opacity (VAO) requiring surgical correction. Visual axis opacity occurred in 67 eyes (45%), typically within the first postoperative year. Use of a 3-piece IOL model (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.09-0.99, P= 0.03) and increasing age at surgery (OR, 0.97, 95% CI, 0.95-0.99, P= 0.02) were each independently protective against the development of proliferative VAO. Inflammatory VAO was independently associated with socioeconomic deprivation (OR, 5.39; 95% CI, 1.46-19.89; P= 0.01). Visual axis opacification is common after IOL implantation in early childhood. The findings of this prospective cohort study suggest that the use of 3-piece IOL models may reduce the risk of pseudophakic VAO in children younger than 2 years of age.

Uveal and capsular biocompatibility of a new hydrophobic acrylic microincision intraocular lens

To evaluate uveal biocompatibility and capsular bag opacification of a new hydrophobic acrylic microincision intraocular lens (IOL) in comparison with a commercially available 1-piece hydrophobic acrylic IOL. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Eight New Zealand rabbits underwent bilateral phacoemulsification and implantation of the preloaded Nanex multiSert IOL in one eye and a commercially available preloaded lens (AcrySof IQ in UltraSert, model AU00T0) in the contralateral eye. A slitlamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes were subjected to histopathologic evaluation. Postoperative inflammatory reactions were similar between the test and control eyes in the 8 New Zealand rabbits. The mean postmortem central posterior capsule opacification (PCO) was 0.93 ± 0.73 in the test group and 1.19 ± 0.53 in the control group. The mean postmortem peripheral PCO was 1.75 ± 0.92 in the test group and 2.06 ± 0.77 in the control group. Central and peripheral PCO scores were not statistically different between the test and control groups (P = .41 and P = .35, respectively, 2-tailed t test: paired 2-sample for means). A new 1-piece hydrophobic acrylic microincision IOL incorporating an ultraviolet-ozone treatment on the posterior surface performed similarly to a commercially available 1-piece hydrophobic acrylic IOL in terms of uveal and capsular biocompatibility in the rabbit model. To our knowledge, this is the first hydrophobic acrylic microincision IOL to demonstrate similar PCO performance when compared with a conventional, commercially available IOL.

Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl methacrylate.

To investigate the clinical outcomes after implantation of a new hydrophobic acrylic intraocular lens (IOL) with hydroxyethyl methacrylate (HEMA) at 1 year and 9 years postoperatively. Three surgical sites in Japan. Prospective case series and retrospective review. In 110 eyes of 110 patients who underwent phacoemulsification and implantation of a new hydrophobic acrylic IOL (Clareon CNA0T0), clinical data were collected preoperatively and at 1 day, 1 week, 1 month, 6 months, and 12 months postoperatively. Of these eyes, 20 eyes of 20 patients were examined at 9 years postoperatively, and corrected distance visual acuity (CDVA) and clarity of the IOL were evaluated. All 110 patients (110 eyes) completed every follow-up examination up to 12 months postoperatively. At 12 months, a CDVA of 20/30 and 20/20 was obtained in 110 (100%) and 101 (91.8%) of 110 eyes, respectively. The contrast sensitivity function was better than or similar to the age-matched normal controls, and there was no case of posterior capsule opacification requiring a laser treatment. Glistenings and surface light scattering were not seen in any of these cases. At 9 years postoperatively, a CDVA of 20/40, 20/30, and 20/20 was attained in 20 (100%), 19 (95%), and 14 (70%) of 20 eyes, respectively. One eye (5%) was treated with laser capsulotomy for posterior capsule opacification. There was no case of glistenings and surface light scattering. This mid-term and long-term study indicated that the new hydrophobic acrylic IOL with HEMA was safe and effective with excellent postoperative vision. Glistenings and surface light scattering did not develop with this IOL in contrast to its predecessor.

Comparison of Different IOL Types in the Flanged IOL Fixation Technique.

Purpose To compare short-term clinical outcomes between two different intraocular lens (IOL) types in the flanged IOL fixation technique. Methods This study was a retrospective case series and included the patients who underwent flanged IOL fixation between June 2017 and July 2018 at the Hiroshima University Hospital. Two different 3-piece IOLs (NX-70 and PN6A) were used. Recipients of NX-70 and PN6A IOLs were classed into groups 1 (15 eyes) and 2 (25 eyes), respectively. Patient characteristics, surgical results, and postoperative complications were analyzed. We excluded patients with a postoperative follow-up of <1 month. Results The mean follow-up period was 13.3 ± 11.7 weeks. The postoperative best corrected visual acuity, in logarithm of the minimum angle of resolution (logMAR), was 0.10 ± 0.33 in group 1 and 0.26 ± 0.42 in group 2. The mean operation times for groups 1 and 2 were 11.2 ± 4.54 minutes and 7.00 ± 2.20 minutes, respectively (p=0.0024). Detachment of the IOL haptic from the optic during surgery occurred in four eyes in group 2 (16%), but did not occur in group 1. Iris capture of the optic was observed in 3 of the 13 eyes (23%) without a peripheral iridotomy in group 2. No peripheral iridotomies were performed on group-1 eyes, but iris capture did not occur in that group. Conclusions There was a trend to fewer intraoperative and postoperative complications when using NX-70 IOLs. On the other hand, PN6A IOLs was easy to maneuver within the anterior chamber, and the operation time was shorter when using PN6A IOLs. Selection of optimal IOLs for flanged IOL fixation necessitates an understanding of their characteristics in terms of intraoperative and postoperative complications.

Late-onset single-piece foldable intraocular lens-induced pigmentary glaucoma: A new management strategy

Phacoemulsification with foldable intraocular lens (IOL) implantation is the standard of care offered for a cataract. Single-piece acrylic (SPA) IOL is designed to be placed in the bag and not suitable for sulcus implantation. If implanted in sulcus, it can lead to pigmentary glaucoma, due to constant friction with the iris, leading to pigment release, which blocks trabecular meshwork. We report the case of pigment dispersion glaucoma due to sulcus-implanted SPA presented 3 years after cataract surgery. It was managed successfully by an IOL exchange where we could implant a foldable three piece IOL into the intact capsular bag.

Posterior capsule opacification prevention by an intraocular lens incorporating a micropatterned membrane on the posterior surface.

To evaluate posterior capsule opacification (PCO) with a new hydrophobic acrylic intraocular lens (IOL) featuring a new micropatterned membrane, in comparison with a commercially available 1-piece hydrophobic acrylic IOL. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Twelve New Zealand rabbits had bilateral phacoemulsification and implantation of a ClearSight unpatterned IOL (Group 1), a ClearSight Sharklet-patterned IOL (Group 2), or a control, commercially available IOL (Group 3) (8 IOLs in each group). Slit-lamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely, and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes underwent histopathology. The mean postmortem central PCO was 1.87 ± 1.35 in Group 1, 1.06 ± 1.23 in Group 2, and 3.14 ± 0.89 in Group 3. Peripheral PCO was 2.18 ± 1.36 in Group 1, 1.5 ± 1.03 in Group 2, and 3.57 ± 0.53 in Group 3. When comparing central and peripheral PCO between Groups 1 and 3, the difference was not statistically significant, but it was statistically significant between Groups 2 and 3 (P = .003 and P = .0003, t test with Bonferroni correction). Unique discontinuous features comprising the micropattern allow for focal adhesions to be precisely guided and therefore controlling cell migration. The patterned membrane incorporated on the posterior surface of the IOL significantly reduced capsular bag opacification compared with a commercially available control IOL.

Novel technique of sutureless glueless intrascleral fixation of single piece intraocular lens

Novel technique of sutureless glueless intrascleral fixation of single piece intraocular lens

Comparative evaluation of re-use or replacement of dislocated 3-piece intraocular lenses with a scleral fixation technique

To compare the surgical outcomes of refixation and exchange in cases with 3-piece intraocular lens (IOL) dislocation which underwent scleral fixation. Between 2014 and 2017, 65 eyes of 65 patients diagnosed with 3-piece IOL dislocation were treated with scleral fixation, and their records were retrospectively evaluated. Our patients were divided into two groups based on the treatment - exchange (Group 1) and refixation (Group 2). Dislocated IOL removal and new IOL insertion was performed with scleral fixation in group 1, and in group 2, scleral fixation of the dislocated intraocular lens performed without removal. Visual results, intraoperative and postoperative complications and lens induced astigmatism secondary to scleral fixation were compared between two groups. Patients in both groups were followed for an average of 13.62±3.4 months. Twenty-six patients were in group 1 and 39 patients were in group 2. All of the scleral fixation lenses were 3-pieced. Increased visual acuity was observed in both groups, and no difference was detected between the two groups (P˂0.01). Intraocular lens-induced astigmatism was similar in both groups (P=0.68). Intraocular hemorrhage as an intraoperative complication was seen in two patients in group 1 and one patient in group 2. Redislocation in three patients in group 2 and cystoid macular edema in one patient in each groups were observed. Refixation and exchange are both effective in IOL dislocation, and no significant difference between the methods was detected in terms of the results obtained.

Highly myopic vitrectomized eye develops delayed subluxation of 3-piece PMMA intraocular lens after complicated cataract surgery: November consultation #1

Highly myopic vitrectomized eye develops delayed subluxation of 3-piece PMMA intraocular lens after complicated cataract surgery: November consultation #1

Surgical techniques of intraocular lens-capsular bag complex stabilization during cataract phacoemulsification in patients with lens subluxation

Aim. To develop and to assess the efficacy of the method of one-step upper fixation of a single-piece intraocular lens to the iris during cataract phacoemulsification in patients with lens subluxation.&#x0D; Methods. The study included 32 patients (37 eyes) with complicated cataract grade 23 combined with grade 12 lens subluxation. Both groups underwent cataract phacoemulsification with consequent implantation of a capsular tension ring and a single-piece intraocular lens. Group 1 (21 eyes) underwent intraoperative one-step upper haptic fixation of a single-piece intraocular lens in vertical position. In group 2 (16 eyes) in 13 cases 61.5 months later a single piece intraocular lens was repositioned and both haptics were sutured to the iris.&#x0D; Results. In both groups no intraoperative complications occured. Visual acuity in group 1 on days 13 after the surgery was 0.770.19 and was stable during the follow-up. Intraocular pressure was 17.20.99 mm Hg. In group 2 the obtained good functional results 0.780.18 declined due to intraocular lens decentration, the intraocular pressure increased by 6.01.25 mm Hg (up to 24.20.65 mm Hg) which required an intraocular lens reposition in 81.3% of cases. According to ultrasound biomicroscopy, in both groups intraocular lens in all cases had intracapsular fixation and was in a central position.&#x0D; Conclusion. The developed method of a one-step single piece intraocular lens fixation by suturing the upper haptic to the iris during cataract phacoemulsification in patients with lens subluxation is an effective and safe procedure that allows complete rehabilitation of patients with phacodonesis during a one-step surgical intervention.

Surgical Technique for Sutureless Intrascleral Fixation of a 3-Piece Intraocular Lens Using a 30-Gauge Needle.

Surgical Technique for Sutureless Intrascleral Fixation of a 3-Piece Intraocular Lens Using a 30-Gauge Needle.

Quantification of residual ophthalmic viscosurgical device after irrigation/aspiration in experimental cataract surgery in vitro

To determine the distribution and quantity of ophthalmic viscosurgical device (OVD) retained in the lens capsular bag after irrigation/aspiration (I/A) in experimental cataract surgery. Department of Ophthalmology, Kashiwa Hospital, Jikei University School of Medicine, Japan. Experimental study. Fifteen freshly enucleated porcine eyes were used. Sodium hyaluronate 1.0% (Healon) was mixed with a fixed concentration of silica nanoparticles encapsulating fluorescein isothiocyanate (labeled OVD), and it was injected separately into the capsular bag and injector cartridge for intraocular lens (IOL) insertion. After a 3-piece IOL (YA-60BBR) or a 1-piece IOL (iSert 255) was implanted within the capsular bag, OVD was removed by thorough I/A. Eyes that were injected with the labeled OVD into the capsular bag without IOL insertion were used as controls. The distribution of residual OVD in the capsular bag was observed under ultraviolet irradiation using Miyake-Apple view. Then, the excised capsular bag was dissolved in hydrogen fluoride, and silica concentration was measured quantitatively by elemental analysis. The quantity of residual OVD in the capsular bag was 243.1μg±1.3 (SD) in the 3-piece IOL-implanted group, 383.8±11.1μg in the 1-piece IOL-implanted group, and 99.0±1.3μg in the control group. In the 1-piece IOL-implanted eyes, OVD in the form of clumps tended to remain near the center of the optic on the posterior side, and the quantity of residual OVD was significantly greater than in 3-piece IOL-implanted eyes (P<.05). The quantity of residual OVD after I/A could be determined indirectly using labeled OVD, and the quantity was significantly greater in 1-piece IOL-implanted eyes than in 3-piece IOL-implanted eyes.