3-piece Acrylic Intraocular Lenses Research Articles

Pediatric Cataract Surgery: Rate of Secondary Visual Axis Opacification Depending on Intraocular Lens Type

To assess the time course of secondary visual axis opacification (VAO) leading to additional surgery after primary intraocular lens (IOL) implantation in children and to describe further surgical outcomes. Comparison of lens types. Single-center, retrospective analysis of children aged 1 to 14 years who underwent cataract surgery with primary IOL implantation. The surgical technique was either in-bag IOL placement with primary posterior capsulotomy and anterior vitrectomy or bag-in-lens IOL placement. We excluded eyes with visually significant ocular comorbidities. Total of 135 eyes of 95 children. Of these, 64 had received an acrylic 3-piece IOL, 51 had an acrylic single-piece IOL, and 20 had an acrylic single-piece bag-in-lens IOL. The median ages at surgery were 53 months (interquartile range [IQR], 35-75), 52 months (27-65), and 60 months (40-84) in the 3-piece, 1-piece, and bag-in-lens groups, respectively. Analysis of medical records. We used the Kaplan-Meier method and a Cox proportional hazards model with predefined adjustments for age at surgery, year of surgery, and the German Index of Socioeconomic Deprivation (score by postal code) to analyze VAO-free survival by lens type. Patients were invited to attend a clinical visit to achieve longer follow-ups. The rate of survival without VAO that required clearing of the visual axis after cataract surgery with primary IOL implantation. Any other surgical complications. The overall median follow-up was 19 months (IQR, 3-58). There were 13 cases of VAO, occurring at a median of 10 months (IQR, 10-12) after surgery. Of these, 1 eye had a 3-piece in-bag IOL, 10 eyes had 1-piece in-bag IOLs, and 2 eyes had bag-in-lens IOLs. The adjusted hazard ratio was 32.8 (95% confidence interval [CI], 3.3-327, P= 0.003) for 1-piece acrylic IOLs and 19.6 (CI, 1.22-316, P= 0.036) for bag-in-lens IOLs, compared with 3-piece acrylic in-bag IOLs. Two eyes with bag-in-lens surgery (10%) had an iris capture. There was 1 case of endophthalmitis. We found no cases of postoperative retinal detachment or new glaucoma. Children with secondary VAO who required a procedure to clear the visual axis generally presented within 15 months. Opacification rates were lowest when a 3-piece acrylic IOL was used.

Clinical and histopathological findings in the dead bag syndrome.

To describe the findings of a recently described syndrome, the dead bag syndrome, in which the capsular bag appears to be clear many years postoperatively, becoming diaphanous and floppy and unable to support the intraocular lens (IOL) within it. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. Case series with clinicopathological correlation. Of 10 cases suspected to represent a dead bag syndrome, 8 IOLs and 7 capsular bags were removed because of subluxation or dislocation. The 7 capsular bags available for analysis were fixed in formalin and submitted to histopathological examination (hematoxylin-eosin and Masson trichrome stains). The associated explanted IOLs in 5 cases were also examined microscopically. Histopathologic examination of the 7 capsular bags showed capsular thinning and/or splitting. Lens epithelial cells (LECs) were completely absent on 2 specimens, whereas the other 5 specimens had rare LECs on the inner surface of the capsule. Explanted IOLs were 3-piece silicone IOLs or single-piece hydrophobic acrylic IOLs. 1 IOL optic showed a small amount of granular pigment deposition, but the optics of the other 4 IOLs were unremarkable. In this syndrome, there seems to be an absence of secondary proliferation of LECs and fibrotic changes. The capsule shows some signs of degradation, such as thinning and/or splitting. Weakness of zonular attachments seems to be an associated finding, with subsequent in-the-bag IOL dislocation. Further studies are necessary to ascertain the etiology of this condition.

Management of Irvine-Gass syndrome with a scleral intraocular lens

Pseudophakic cystoid macular edema is a common complication when placing an intraocular lens (IOL) in the sulcus (8%). The vitrectomy with implantation of a new scleral-fixated IOL with self-blocking plugs permits to resolve the chronic pseudophakic cystoid macular edema resulting from the implantation of a 3-piece acrylic IOL placed in the sulcus. This new type of IOL seems to have multiple potential advantages compared with glued IOL or iris-claw IOL in the management of Irvine-Gass syndrome secondary to the placement of IOL in the sulcus.

Multifocal IOL explantation in patients with opaque lentis after refractive lens exchange.

We describe the outcomes of intraocular lens (IOL) explantation in a cluster of opaque multifocal Lentis LS-313 following refractive lens exchange (RLE). Single-centre, single-surgeon, retrospective case series. The study enrolled 10 eyes of 10 patients, 6 male and 4 female. All patients had uneventful RLE with multifocal IOL implantation. The mean patient age at the time of RLE was 53years ± 2.52 (SD). Two eyes had YAG laser capsulotomy prior to explantation. The mean interval between the initial RLE and IOL explantation was 5.4years ± 1.4 (SD). IOL exchange was performed in all eyes in one procedure. Five eyes had in the bag hydrophobic acrylic IOL (3 multifocal and 2 monofocal), three eyes had 3-piece hydrophobic acrylic IOL in the ciliary sulcus and two had an anterior chamber IOL. Intraoperatively one patient had weak zonules and two patients had zonular dehiscence and required anterior vitrectomy. The mean preoperative CDVA was 0.25 ± 0.15 (SD) logMAR and at the final follow-up, improved to 0.00 ± 0.07 (SD) logMAR (p < 0.01). Light microscopy with von Kossa stain confirmed IOL calcification. No postoperative complications were recorded. IOL exchange appears to be a feasible and safe surgical option for multifocal IOL opacification. However, patients must be warned of additional intraoperative risks including zonular dialysis, vitreous loss, retinal detachment and need for potential scleral or iris fixated IOL or anterior chamber IOL (ACIOL) with its associated sequel of complications. Moreover, YAG laser capsulotomy should be considered carefully as it increases the chances of intraoperative complications and restricts the surgical options of secondary IOL insertion such as in-the-bag IOL exchange with MFIOL.

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.

Haptic tuck for reverse optic capture of a single-piece acrylic toric or other single-piece acrylic intraocular lenses

We describe a new technique for capsule fixation of 1-piece acrylic toric intraocular lens (IOL) or other 1-piece acrylic IOLs in the presence of a large posterior capsule tear resulting in an open capsule. To keep the thick haptics out of the sulcus, reverse optic capture is necessary, with the haptics below the capsule and the optic edges above the capsule. This is done by placing the IOL in the sulcus and if it is a toric IOL, with the toric marks on the optic aligned with the corneal marks. Then, each haptic is separately tucked through the anterior continuous curvilinear capsulorhexis (CCC) opening, leaving the optic edges above the capsule. This technique achieves reverse optic capsulorhexis capture without the challenge of injecting the IOL through the CCC with an open posterior capsule. We propose the term haptic tuck for reverse optic capture for this technique.

Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases

To report clinical findings and light microscopic results of 71 opacified hydrophilic acrylic intraocular lenses (IOLs). Vivantes Klinikum Neukoelln, Ophthalmology Department, Berlin, Germany. Retrospective case series. Sixty-three patients (71 eyes) were referred to the clinic because of vision-impairing IOL opacification between December 2012 and September 2016 after routine cataract surgery elsewhere. The explanted IOLs were analyzed with light microscopy at the John A. Moran Eye Center (University of Utah, Salt Lake City, Utah, USA). Medical records were reviewed for visual acuity, comorbidities, and complications. Clinical follow up was 6months. Seventy-one opacified 1-piece or 3-piece hydrophilic acrylic IOLs (Lentis) of different designs from 2009 to 2012 (LS-502-1, LS-402-1Y, LS 312-1Y, LS-313-1Y, L-402, L-312) were found. Morphological findings were surface, subsurface, or deep calcifications of the IOL material. Explantation was performed 4years±1.2 (SD) after initial phacoemulsification. The mean patient age was 78.6±8.2years. Ocular and systemic comorbidities were found without statistical correlation: the most frequent were diabetes, uveitis, and glaucoma. The preoperative mean corrected distance visual acuity changed from 0.63±0.47 logarithm of the minimum angle of resolution (logMAR) to 0.20±0.28 logMAR postoperatively (P<.001). Different designs of IOLs by the same manufacturer, implanted between 2009 and 2012, developed late calcification with significant visual loss after routine cataract surgery. No medical, surgical, or ophthalmologic trigger could be determined. A manufacture issue might be the reason for the opacification.

SCLERAL SUTURE FIXATION TECHNIQUE FOR ONE-PIECE ACRYLIC INTRAOCULAR LENS.

To apply a previously published scleral fixation technique to secure one-piece acrylic intraocular lenses (IOLs) to the sclera. Retrospective, consecutive, noncomparative case series. All patients (16 eyes of 15 patients) who underwent scleral fixation of 1-piece acrylic IOLs using the loop method from 2014 to 2016 were included. The mean follow-up was 8.1 months. Repositioning of dislocated 1-piece acrylic IOLs was performed in 8 eyes, a primary implantation in 5 eyes, and IOL exchange in 3 eyes. All IOLs remained well-centered postoperatively. The vision improved from an initial best-corrected visual acuity of 0.97 ± 0.74 logMAR (Snellen equivalent ≈20/190) to 0.47 ± 0.49 logMAR (≈20/60, P = 0.031) at the last follow-up. The postoperative complications were self-limited. The previously reported scleral suture fixation technique can be readily applied to one-piece acrylic IOLs.

Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery

To compare complications in children up to 4years old having cataract surgery with intraocular lens (IOL) implantation using2 techniques: in-the-bag IOL with anterior vitrectomy or optic capture of IOL with no anterior vitrectomy. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Prospective randomized control clinical trial. The study included children having cataract surgery with IOL implantation. Patients were randomized to Group 1 (in-the-bag 3-piece hydrophobic acrylic IOL [Acrysof MA60AC] with anterior vitrectomy) or Group 2 (optic capture of the same IOL without anterior vitrectomy). Intraoperative complications were documented. Postoperative visual axis obscuration (VAO), glaucoma, cell deposits on the IOL, and posterior synechiae were compared at 1, 3, 6, and 12months. The study comprised 61 children (61 eyes). The mean ages were 14.8months±11.47 (SD) in Group 1 (n=30) and 18.2±11.47months in Group 2 (n=31). Overall, only 1 eye in Group 1 developed a VAO requiring membranectomy 4months postoperatively,and 2 eyes in Group 1 developed glaucoma over 12months (P=.49). Intraocular lens cell deposits and posterior synechiaewere comparable between groups. The IOL could not becaptured in 5 eyes (16.1%); no complications occurred in these eyes. Optic capture of 3-piece hydrophobic acrylic IOLs could be achieved in most eyes. The VAO, glaucoma, and inflammation were comparable 12months postoperatively. Thus, optic capture of an IOL is an alternative surgical technique that can be used to avoid vitrectomy, even in children younger than 4years.

Iris reconstruction using artificial iris prosthesis for management of aniridia.

To discuss the limitations and benefits of the BrightOcular prosthetic artificial iris device in management of aniridia associated with aphakia or cataract. This is a retrospective study including 5 eyes of 4 patients who underwent implantation of the BrightOcular iris prosthesis (Stellar Devices) for total or partial aniridia. The cases included 2 eyes of 1 patient with congenital aniridia associated with congenital cataract and 3 eyes with traumatic aniridia: 1 with subluxated cataractous lens and 2 with aphakia. In all cases, the iris prosthesis was implanted after a 3-piece acrylic intraocular lens was implanted. We evaluated the clinical course with a minimum follow-up period of 6 months, the intraoperative and postoperative complications, and the cosmetic satisfaction of patients. All patients had improved uncorrected distance visual acuity and best-corrected distance visual acuity. All patients had a transient corneal edema that resolved within the first postoperative week. Only the patient with congenital aniridia had a permanent increase in intraocular pressure and developed a band keratopathy throughout a 2-year follow-up period. The prosthesis was well-centered in all eyes except for one case that required scleral suture fixation after 3 months. All patients had a satisfactory cosmetic appearance. BrightOcular iris prosthesis is a safe and useful tool to correct aniridia associated with pseudophakia or aphakia. Being foldable, it is easy to be implanted through a small incision and placed in the ciliary sulcus without sutures when properly sized. Cosmetic results are satisfactory. Sizing methods should be improved.

Refractive predictability of a 3-piece intraocular lens platform versus its 1-piece counterpart

ObjectiveTo compare the refractive outcomes of a 3-piece acrylic intraocular lens (IOL) with its 1-piece counterpart after phacoemulsification with in-the-bag implantation. DesignRetrospective chart review. ParticipantsOne-hundred twenty-six eyes of 95 patients were analyzed in the study, including 60 eyes of 43 patients receiving a 3-piece IOL and 66 eyes of 52 patients receiving a 1-piece IOL. MethodsRandomized chart review of all patients who underwent uncomplicated phacoemulsification with in-the-bag IOL implantation with either a 3-piece hydrophobic acrylic IOL (Tecnis ZA9003) or a 1-piece hydrophobic acrylic IOL (Tecnis ZCB00) between 2006 and 2014 in a tertiary ophthalmology care centre in Mississauga, Ontario. Preoperative visual acuity and refraction, anterior chamber depth, axial length, IOL design and power, predicted refraction, postoperative visual acuity, and refraction were recorded. ResultsMean absolute error was 0.40 ± 0.27 in the ZA9003 group and 0.39 ± 0.35 in the ZCB00 group, with no statistically significant difference between the 2 IOLs (p = 0.86). Mean arithmetic error was 0.11 ± 0.47 D in the ZA9003 group and 0.01 ± 0.47 D in the ZCB00 group (p = 0.019). In the ZA9003 group, 23 (38%), 42 (70%), and 52 (87%) of 60 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction. In the ZCB00 group, 32 (48%), 46 (70%), and 56 (85%) of 66 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction (p = 0.2836, p = 1.00, p = 0.8044). ConclusionsThe ZA9003 and the ZCB00 have similar mean absolute error and thus appear to have similar refractive predictability.

New preventative approach for negative dysphotopsia

To evaluate whether positioning the intraocular lens (IOL) to decrease the entry of inferotemporal light would decrease the incidence of negative dysphotopsia. Private practices, Boston and Chelmsford, Massachusetts, USA. Prospective randomized case study. Patients had cataract surgery with implantation of either a silicone IOL inferotemporally or vertically (randomly assigned) or a 1-piece acrylic IOL with the optic-haptic junction inferotemporally or vertically (randomly assigned). Other patients received acrylic IOLs bilaterally and inferotemporally without randomization. Patients were asked about negative dysphotopsia symptoms postoperatively. Data were analyzed using the z test and a chi-square test for comparing the incidence of negative dysphotopsia between the 3 groups. The study comprised 305 patients (418 eyes). A silicone IOL was implanted inferotemporally in 39 eyes and vertically in 60 eyes. An acrylic IOL was implanted with the optic-haptic junction inferotemporally in 163 eyes and with the junction vertical in 114 eyes. Forty-two eyes had bilateral inferotemporal implantation of an acrylic IOL. For the acrylic IOL on the first postoperative day, the incidence of negative dysphotopsia was smaller for the inferotemporal IOL orientation (6%) than in the control group (14%) (P=.026). The rate of persistent negative dysphotopsia decreased in both groups over time, and the difference 1month after surgery was no longer statistically significant. The negative dysphotopsia rate for the silicone IOL was 0%. Positioning the optic-haptic junction of an acrylic IOL inferotemporally resulted in a 2.3-fold decrease in the incidence of negative dysphotopsia after cataract surgery. When implanted in the vertical position, Acrylic IOLs seemed to lead to a higher incidence of negative dysphotopsia than silicone IOLs. Dr. Henderson is a consultant to Abbott Medical Optics, Inc., Alcon Laboratories, Inc., and Bausch & Lomb, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.

Management of dislocated intraocular lenses with iris suture.

Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of logMAR units. The mean visual acuity improvement was 4.08 ± 5.33 lines on the logMAR scale. In this study, every IOL was stable at the last follow-up. As late complications, macular edema occurred in 1 patient and retinal detachment occurred in 2 patients. There were no cases of endophthalmitis. Iris suture fixation of subluxated IOL is a good treatment option for eyes with dislocated IOLs, leading to long-term stability of the IOL. The advantage of this procedure is using the same IOL in a closed eye surgery. No astigmatic difference is expected as no large corneal incision is needed.

Effect of four different intraocular lenses on posterior capsule opacification.

To evaluate the impact of 4 different intraocular lenses (IOLs) on posterior capsule opacification (PCO) by comparing the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy rates. This retrospective study included 4970 eyes of 4013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at one clinic. Four different IOLs were assessed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies. An Nd:YAG laser posterior capsulotomy was performed in 153 (3.07%) of the 4970 eyes. The mean follow-up time was 84mo for all of the IOL groups. The percentage of eyes developing PCO was significantly greater for the acrylic hydrophilic IOLs than for the hydrophobic IOLs, although eyes with acrylic hydrophilic IOLs did not require Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs. There was no difference between the long-term PCO rates when 1- and 3-piece acrylic hydrophobic IOLs were compared or when IOLs made of the same material but with different haptic angles were compared. In this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. The lens design (1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate.

Sleeveless-extrusion cannula for levitation of dislocated intraocular lens

Background/aimsTo characterise a sleeveless-extrusion cannula-based suction technique to levitate dislocated intraocular lens (IOLs) and review the surgical outcome.MethodsThis retrospective, non-comparative, single surgeon, interventional, consecutive case series examined 10 patients (10...

Pathologic Comparison of Asymmetric or Sulcus Fixation of 3-Piece Intraocular Lenses with Square Versus Round Anterior Optic Edges

To evaluate the pathologic findings of 3-piece intraocular lenses (IOLs) with asymmetric or sulcus fixation in pseudophakic cadaver eyes, comparing IOLs with square or round edges on the anterior optic surface. Comparative case series with pathology. A total of 661 pseudophakic cadaver eyes, obtained from eye banks within the United States, implanted with different IOLs. Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging followed by gross examination. Selected eyes were processed for complete histopathologic analysis. Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses. Of 661 pseudophakic cadaver eyes obtained, 13 had 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges, and 14 had 3-piece lenses with anterior round edges (13 silicone lenses and 1 hydrophobic acrylic lens) without symmetric in-the-bag fixation. These 27 selected eyes were processed for complete histopathologic analysis. Gross findings in both groups were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, and iris transillumination defects. Histopathology of the 14 eyes with 3-piece IOLs with round anterior optic edges showed mild focal disruption of the iris pigmented layer and loop protrusion/erosion in the ciliary sulcus. Additional changes observed in the 13 eyes with square anterior optic edge IOLs included iris changes, such as vacuolization, disruption and loss of the pigmented epithelial layers, iris thinning and atrophy, synechiae, and pigmentary dispersion within the trabecular meshwork. One eye also exhibited initial signs of optic nerve disc cupping. In this series, pathologic findings were more severe in eyes implanted with 3-piece IOLs with square anterior optic edges, suggesting that IOLs with round anterior edges are more suitable for sulcus fixation. Proprietary or commercial disclosure may be found after the references.

In Vivo Chromatic Aberration in Eyes Implanted With Intraocular Lenses

To measure in vivo and objectively the monochromatic aberrations at different wavelengths, and the chromatic difference of focus between green and infrared wavelengths in eyes implanted with two models of intraocular lenses (IOL). EIGHTEEN EYES PARTICIPATED IN THIS STUDY: nine implanted with Tecnis ZB99 1-Piece acrylic IOL and nine implanted with AcrySof SN60WF IOL. A custom-developed laser ray tracing (LRT) aberrometer was used to measure the optical aberrations, at 532 nm and 785 nm wavelengths. The monochromatic wave aberrations were described using a fifth-order Zernike polynomial expansion. The chromatic difference of focus was estimated as the difference between the equivalent spherical errors corresponding to each wavelength. Wave aberration measurements were highly reproducible. Except for the defocus term, no significant differences in high order aberrations (HOA) were found between wavelengths. The average chromatic difference of focus was 0.46 ± 0.15 diopters (D) in the Tecnis group, and 0.75 ± 0.12 D in the AcrySof group, and the difference was statistically significant (P < 0.05). Chromatic difference of focus in the AcrySof group was not statistically significantly different from the Longitudinal chromatic aberration (LCA) previously reported in a phakic population (0.78 ± 0.16 D). The impact of LCA on retinal image quality (measured in terms of Strehl ratio) was drastically reduced when considering HOA and astigmatism in comparison with a diffraction-limited eye, yielding the differences in retinal image quality between Tecnis and AcrySof IOLs not significant. LRT aberrometry at different wavelengths is a reproducible technique to evaluate the chromatic difference of focus objectively in eyes implanted with IOLs. Replacement of the crystalline lens by the IOL did not increase chromatic difference of focus above that of phakic eyes in any of the groups. The AcrySof group showed chromatic difference of focus values very similar to physiological values in young eyes.

Effect of a Single-Piece and a Three-Piece Acrylic Sharp-Edged IOL on Posterior Capsule Opacification

Background: To compare the intensity of posterior capsule opacification (PCO) between two intraocular lenses (IOLs) of the same optic material, but with different haptic design (1-piece vs. 3-piece).Methods: This prospective intraindividual controlled cohort study comprised eighty eyes of 40 patients with bilateral age-related cataract. Each patient received a Polylens Y10 (Polytech, Germany) 1-piece IOL in 1 eye and a Polylens Y30 (Polytech, Germany) 3-piece IOL in the contralateral eye. The IOL type in the first operated eye was randomly assigned before patient recruitment. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for regeneratory PCO. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.Results: The Polylens Y10 (1-piece) group showed significantly higher regeneratory and fibrotic PCO scores 1 year after surgery in subjective slitlamp evaluation, however not with objective evaluation using automated image-analysis software. Subjective PCO assessment resulted in a mean PCO score (scale = 0–10) of 1.6 in the Polylens Y10 group and 0.6 in the Polylens Y30 group at 1 year (p < 0.05). The mean automated image-analysis software PCO score was 1.5 in the Polylens Y10 group and 0.9 in the Polylens Y30 group (p = 0.6).Conclusion: Both investigated IOLs showed good clinical performance regarding PCO, BCVA and IOL-centration. The Polylens Y10 IOL showed slightly more regeneratory PCO than the 3-piece acrylic IOL 1 year after surgery.

A New Technique for Treating Posttraumatic Aniridia With Aphakia

We describe a new surgical technique for treating traumatic aniridia with aphakia and its results in a small consecutive case series. We attached a 3-piece acrylic intraocular lens through the haptics to a customized silicone iris prosthesis. The combined implant was inserted through a 5-mm incision and fixated with a transscleral suture in the ciliary sulcus using a knotless technique (Z suture). In all patients, the combined implant stayed firmly fixed within the sulcus and showed a stable and centered position without any tilt or torque during follow-up. Thus, managing posttraumatic aniridia with aphakia by means of haptic fixation of a foldable intraocular lens on a custom-tailored iris prosthesis is a promising approach for visual rehabilitation and cosmetic improvement.

Pathologic Assessment of Complications with Asymmetric or Sulcus Fixation of Square-Edged Hydrophobic Acrylic Intraocular Lenses

One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation because of complications, such as uveitis-glaucoma-hyphema syndrome. Similar complications may also be observed with 3-piece lenses that have a square optic edge on the anterior surface. The objective of this study was to provide pathologic evidence of complications related to out-of-the-bag fixation of 1- or 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges. Comparative case series with pathology. A total of 661 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs. Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathologic analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses. Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses. A total of 256 eyes were implanted with hydrophobic acrylic IOLs with anterior and posterior square optic edges; 18 of them exhibiting asymmetric or sulcus IOL fixation (six 1-piece and twelve 3-piece IOLs) underwent complete histopathologic evaluation and were compared with the contralateral eyes with symmetric in-the-bag IOL implantation. Pathologic findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, iris thinning, and iris atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the control contralateral eyes and were particularly evident in relation to the sulcus-fixated haptic in the case of 1-piece lenses. The majority of the eyes with 3-piece lenses showed signs of complicated surgery. This study provides pathologic correlation of complications that were clinically reported in the peer-reviewed literature in relation to sulcus fixation of 1-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidence of complicated surgery; therefore, all pathologic findings in those cases may not be strictly attributed to the out-of-the-bag fixation.