Hydrophobic Acrylic Intraocular Lens Research Articles

Quantification of Straylight Induced by Silicone Oil Adherent to Intraocular Lenses of Different Materials

PurposeA complication of using silicone oil as an intraocular endotamponade is its adhesion to intraocular lenses (IOLs). Forward light scattering is a measure to quantify the optical disturbance caused by adherent oil droplets. We tested the straylight caused by silicone oil adhesion to different IOLs and examined whether an approved cleaning solution, F4H5, reverses the induced straylight. DesignAn experimental study. MethodsTwo hydrophobic acrylic IOL models and one hydrophilic model with a hydrophobic surface (n=8 per model: twenty-four lenses) had straylight measured before contact with silicone oils, providing a baseline for subsequent testing: twelve lenses with lighter-than-water silicone oil (Siluron 2000) and twelve with heavier-than-water oil (Densiron 68). The final measurement was after cleansing with F4H5 when we used scanning electron and light microscopy to detect surface changes. ResultsStraylight was majorly increased in IOLs with adherent silicone oil. (Baseline vs adherent oil median 3.1 [2.1, 3.9] and 39.7 [22.7, 87.8] deg2/sr, respectively, p<0.001). No difference was seen between heavier- and lighter-than-water silicone oils. Between IOL types, induced straylight varied significantly, with one hydrophobic model reaching the highest average straylight. F4H5 significantly reduced straylight values in all IOL types (median 9.4 [5.4, 13.8] deg2/sr). The microscopy revealed surface changes on the IOLs even after cleaning. ConclusionsSilicone oil adhesion to IOLs can induce amounts of straylight known to cause severe optical disturbance. F4H5 cleansing solution reversed straylight values to only slightly increased values. We found no difference in straylight formation between the lighter- and heavier-than-water silicone oils.

Preparation of hydrophobic acrylic intraocular lens materials using various crosslinking agents to reduce glistening

Glistening is the condensation of water that forms within the intraocular lens (IOL) materials. In this study, a new approach was attempted to reduce the glistening using various types and content of crosslinking agents. Hydrophobic acrylic IOL materials were prepared from 2-phenoxyethyl acrylate using three different crosslinking agents: ethylene glycol dimethacrylate (EGDMA), 1,4-butanediol diacrylate (BDDA), and glycerol 1,3-diglycerolate diacrylate (GDGDA). The IOL material cross-linked with the GDGDA showed the least amount of glistening. However, the IOL materials exhibited the largest amount of glistening when cross-linked with the EGDMA, indicating that the glistening decreased in the order of GDGDA > BDDA > EGDMA.

Transmittance characteristics of transparent hydrophobic acrylic foldable intraocular lenses that were in vivo for a prolonged period of time: A UV visible spectrophotometric study.

To record experimental data on the spectral transmittance characteristics of transparent hydrophobic acrylic foldable IOLs, which were in vivo for a prolonged period of time and explanted under clinical indications and also to compare the data with that of corresponding control and crystalline lens along with review of the relevant literature. Material and make of each of the explanted intraocular lenses (IOLs) as well as pre-explantation clinical status of the eyes were confirmed from the medical record. The transmittance of wavelength from 185 to 900 nm of each of the selected IOLs was measured using Shimadzu UV 2600 UV visible (UV-Vis) spectrophotometer in double-beam configuration and probe version 2.16 software. The data obtained were statistically analyzed. The mean transmittance of 12 clinically explanted IOLs at spectral range 300-700 nm was 49.5% ± SD 6.9%. This value was 10% and 38% less than the corresponding clear (59% ± SD 0.4%) and yellow (87.5% ± SD 0.4%) control, respectively. The mean transmittance of the analytes in the UV range was 43.3 ± SD 6.9%, and it was almost similar to the control. The data showed wide variations without good correlation, and it matches with the human crystalline lens at the age range of 50-60 years. All eyes were otherwise healthy, and none had age-related macular degeneration. In comparison with fresh IOL with a yellow filter, light transmittance at the spectral range 300-700 nm was found decreased in all the IOLs, which were in vivo for an average period of 12.25 ± 4.4 years. All IOLs transmitted variable amounts of UV radiation. More data are required for further analysis on the subject.

Early Clinical Experience with a New Hydrophobic Acrylic Single-Piece Monofocal Intraocular Lens.

To evaluate early clinical outcomes and adverse events (AEs) in cataract patients following implantation of a monofocal hydrophobic acrylic IOL with a new optimized non-constant aberration-correcting design (CT LUCIA 621P). This retrospective study included patients with visually significant cataracts who underwent implantation of the CT LUCIA 621P IOL. Refraction, corrected (CDVA) and uncorrected (UDVA) visual acuity of the last available visit were used in the analysis. Intraoperative and postoperative AEs of the cohort were reviewed. A total of 191 eyes of 133 patients with the mean age of 70.2±11.2 years were included in this study. The mean follow-up time of the last available visit was 1.7±1.3 months. The mean postoperative monocular UDVA was 0.09±0.16 logMAR (≈20/25), and 74.9% (143/191) eyes achieved ≥20/25 UDVA. The percentage of eyes with manifest spherical equivalent (MSE) within ±0.50D and ±1.00D of emmetropia was 84.8% (162/191) and 98.4% (188/191), respectively. Linear regression of attempted vs achieved MSE showed a tight relationship, with the coefficient of determination close to 1 (R2=0.99), indicating a very predictable refractive correction. The reported AEs were those typically expected after cataract surgery. There were no AEs related to intraoperative manipulation with the IOL/injector or to postoperative stability of the IOL in the capsular bag. No eye lost ≥2 lines of CDVA. The implantation of CT LUCIA 621P resulted in good refractive predictability and visual outcomes. No IOL-related adverse events were reported.

Hydrophilic Versus Hydrophobic Acrylic Intraocular Lens Implantation in Paediatric Cataract Surgery

Introduction: The selection of intraocular lens is still debatable in paediatric eye. Due to low cost and fewer intra-operative complication hydrophilic acrylic intraocular lens are implanted in volume in low income countries. There is lack of comparative study of this type of lens with hydrophobic lens in paediatric population.&#x0D; Aims: To compare the outcomes of hydrophilic acrylic lens and hydrophobic acrylic lens in paediatric cataract surgery.&#x0D; Methods: Out of 48 eyes included in the study, the Group A (n =24) eyes were implanted with acrylic hydrophilic intraocular lens, and the Group B (n =24) were implanted with acrylic hydrophobic intraocular lens. The children were evaluated pre, intra and postoperatively for different parameter.&#x0D; Results: The mean age was 6.6±2.7 years at the time of surgery. The most common type of cataract was zonular (58% in Group A and 50% in Group B). Postoperatively, corneal edema was seen in 7(29%) eyes in group A and in 2(8%) eyes in group B. The mean follow-up was 16.9±2.9 months. At one year, the position of the intraocular lens was in the capsular bag in 20 eyes (88.33%) and 24 eyes (100 %) in the group A and B, respectively. Clear visual axis was present in 22 eyes in Group A and 24 eyes in Group B. Posterior capsule opacification occurred in 12(50%) eyes in Group A and 6(25%) eyes in Group B. Two (8.3%) eyes in group A underwent surgical membranectomy due to visual axis opacification. The mean LogMAR visual acuity was 0.56 and 0.52 in group A and B respectively at one year.&#x0D; Conclusion: Hydrophilic acrylic intraocular lens are good alternative to hydrophobic intraocular lens in Nepal in the treatment of paediatric cataract.

Corneal astigmatic outcomes after femtosecond laser-assisted cataract surgery combined with surface penetrating arcuate keratotomies.

To evaluate corneal astigmatic outcomes of femtosecond laser-assisted arcuate keratotomies (FAKs) combined with femtosecond-laser assisted cataract surgery (FLACS) over 12mo follow-up. Totally 145 patients with bilateral cataracts and no ocular co-morbidities were recruited to a single-centre, single-masked, prospective randomized controlled trial (RCT) comparing two monofocal hydrophobic acrylic intraocular lenses. Eyes with corneal astigmatism (CA) of >0.8 dioptres (D) received unpaired, unopened, surface penetrating FAKs at the time of FLACS. Visual acuity, subjective refraction and Scheimpflug tomography were recorded at 1, 6, and 12mo. Alpins vectoral analyses were performed. Fifty-one patients (61 eyes), mean age 68.2±9.6y [standard deviation (SD)], received FAKs. Sixty eyes were available for analysis, except at 12mo when 59 attended. There were no complications due to FAKs. Mean pre-operative CA was 1.13±0.20 D. There was a reduction of astigmatism at all post-operative visits (residual CA 1mo: 0.85±0.42 D, P=0.0001; 6mo: 0.86±0.35 D, P=0001; and 12mo: 0.90±0.39, P=0.0001). Alpins indices remained stable over 12mo. Overall, the cohort was under-corrected at all time points. At 12mo, 61% of eyes were within ±15 degrees of pre-operative astigmatic meridian. Unpaired unopened penetrating FAKs combined with on-axis phacoemulsification are safe but minimally effective. CA is largely under-corrected in this cohort using an existing unmodified nomogram. The effect of arcuate keratotomies on CA remained stable over 12mo.

Stainability of Acrylic Intraocular Lens With Brilliant Blue G: An In Vitro Study

To evaluate the stainability of several acrylic intraocular lens (IOLs) with Brilliant Blue G (BBG) in vitro. Clinically relevant, laboratory, experimental study. LS313MF15 as a hydrophilic acrylic IOL and X-70, W60R, CP2.2R, YP2.2R, XC1, and XY1 as hydrophobic acrylic IOLs were included in this study. Prepared acrylic IOLs were evaluated for staining via immersion for different periods in BBG solution with adjusted concentrations. In cases where IOLs were stained blue, the sustained release of BBG and IOL cross-sectional images were evaluated, as well as changes in the optical properties of the IOLs via spectrophotometry. All acrylic IOLs were stained with BBG in a BBG concentration- and staining time-dependent manner, with almost no sustained release of BBG observed. Lenses with a higher water content exhibited more pronounced staining, and BBG penetrated into the IOLs. A decrease in light transmittance with a peak wavelength of 610 to 620 nm was observed in blue-stained IOLs. LS313MF15 was markedly blue stained even with a short period of staining. Any acrylic IOL can be stained with BBG, but hydrophilic IOLs are particularly susceptible to blue staining. Precautions should be taken in surgeries requiring the use of BBG staining, and efforts should be made to ensure that BBG components are sufficiently washed out intraoperatively.

Evaluation of Visual Outcomes and 3-Month Refractive Stability of a New Hydrophobic Acrylic Intraocular Lens.

To determine the refractive stability of a new hydrophobic acrylic intraocular lens (IOL) when implanted bilaterally. This was a prospective, evaluator masked, single surgeon study of 58 eyes of 29 patients. Patients were bilaterally implanted with the Clareon monofocal IOL (CNA0T0, Alcon Vision LLC). Refractive stability was evaluated between 1 and 3 months postoperatively. At 3 months postoperatively, data were also collected for binocular uncorrected and distance corrected visual acuities at distance (4 m) and intermediate (80 cm and 66 cm) and binocular defocus curve. Postoperative refraction was statistically equivalent between 1 and 3 months postoperatively (p < 0.001). Mean postoperative uncorrected distance visual acuity was -0.01 ± 0.10 logMAR, and mean corrected distance visual acuity was -0.04 ± 0.06 logMAR. Mean postoperative uncorrected intermediate visual acuity was 0.16 ± 0.13 logMAR and 0.24 ± 0.14 logMAR at 80 cm and 66 cm, respectively. With distance correction in place, mean visual acuity at 80cm and 60cm was 0.16 ± 0.13 logMAR and 0.23 ± 0.14 logMAR, respectively. The Clareon monofocal IOL can provide stable refraction, excellent distance vision, and functional intermediate vision postoperatively.

Opacification of Hydrophilic Acrylic Intraocular Lenses: Overview of Laboratory Methods for Histological Analysis and Replication of IOL Calcification.

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.

Results of Implantation of a New Hydrophobic Acrylic Monofocal Intraocular Lens in a Preloaded Injector

Purpose. To evaluate clinical and functional results of implantation of a new hydrophobic acrylic monofocal IOL in a preloaded injector.Methods. The prospective study included 60 patients (66 eyes) after Hoya iSert® 250/251 IOL implantation (31 patients, 35 eyes, group 1) and a new Hoya Vivinex Multisert® XY1-SP IOL (29 patients, 31 eyes, group 2). The mean age was 75.1 ± 7.9 years. The mean follow-up period after surgery was 3.1 ± 0.4 months. IOL viscoimplantation was performed in 100 % of cases in group 1, in group 2 — in 45.1 % of cases, and in 54.9 % — hydroimplantation was performed. Intraoperatively, the size of the corneal incision was measured with a ruler before and after IOL implantation. IOL optic power was calculated with SRK/T and Barrett Universal formulas. In the postoperative period, surgically induced astigmatism was assessed.Results. In both groups, there was a statistically significant (p &lt; 0.05) increase of UCDVA from 0.28 ± 0.09 in the preoperative period to 0.70 ± 0.17 3 months after surgery in group 1 and from 0.24 ± 0.10 in the preoperative period to 0.84 ± 0.18 3 months after surgery in group 2. Slightly lower values of UCDVA in group 1 may be associated with a higher level of SIA in this group. Similar dynamics were shown for the BCDVA (from 0.52 ± 0.21 before surgery to 0.95 ± 0.19 after 3 months of follow-up in group 1 and from 0.55 ± 0.20 before surgery to 0.98 ± 0.21 after 3 months of follow-up in group 2). No differences were found between the studied groups. After IOL implantation, there was an increase in incision size to 2.40 ± 0.12 mm in group 1 and 2.10 ± 0.08 mm in group 2 (p = 0.04). In group 1, the mean SIA after 3 months of observation was 1.10 ± 0.16 D and in group 2, 0.48 ± 0.07 D (p = 0.0007).Conclusion. This study presents the first domestic experience with the implantation of a new monofocal hydrophobic acrylic Hoya Vivinex IOL in a Multisert® preloaded injector. A comparative analysis of implantation results with monofocal Hoya 250/251 IOLs in an Isert® injector was performed. The advantage of the new IOL implantation in reducing the incidence of surgically induced astigmatism was shown.

674 Cases of Late Postoperative Intraocular Lens Opacification of a Hydrophilic-Hydrophobic Acryl Intraocular Lens in Switzerland and Retrospective Opacification Risk Factor Assessment of 212 Cases

To report the prevalence of late postoperative opacification of a hydrophilic and hydrophobic acrylic intraocular lens (IOL) and to assess the risk factors in a subset of 212 eyes of patients referred to the University Eye Department in Basel, Switzerland. Retrospective case series. A survey was performed at all large ophthalmological clinics in Switzerland regarding exchanged Lentis LS-502-1 lenses, and the number of affected eyes was counted. Moreover, consecutive patients who were referred to a tertiary clinic between September 2015 and November 2016 with Lentis LS-502-1 opacification were investigated. Peri- and postoperative charts, medical history, and topical and systemic medications were assessed. A total of 674 opacified Lentis LS-502-1 lenses have been reported in Switzerland, and 212 consecutive eyes of 182 patients were included in the study. All IOLs had a similar pattern of opacification with a yellowish, diffuse appearance, and most of them showed a small, paracentral, roundish area that was less affected or not at all. Arterial hypertension (73%), hypercholesterolemia (34%), and diabetes (21%) were the main associated systemic diseases, and statins (34%) and betablockers (34%) were the main treatments used. The prevalence of IOL opacification was 9.9%. No associated systemic eye disease or medications could be detected, which was implicated in the opacification process. The reason for opacification remains unclear, but it seems to be unrelated to the patient's state; therefore, it is attributed to primary calcification.

Posterior capsule opacification following implantation of hydrophilic compared to hydrophobic intraocular lenses

Purpose The aim of this study was to compare the onset of posterior capsule opacification (PCO) in patients who underwent hydrophilic intraocular lens (IOLs) implantation compared with hydrophobic IOL implantation. Patients and methods This is a retrospective, comparative, observational study that was conducted on patients who sought medical advice at the Ophthalmology Outpatient Clinic of the Ophthalmology Department, Ain Shams University, Cairo, Egypt, and underwent uneventful phacoemulsification cataract surgery and hydrophilic or hydrophobic acrylic nonheparinized IOL implantation. The electronic medical records were searched for surgeries performed by equal-caliber experienced surgeons. All enrolled cases underwent ‘in-the-bag’ implantation of a square-edged IOL after continuous curvilinear capsulorhexis with cortical cleanup. The evaluated data included age, sex, medical history, date of phacoemulsification cataract surgery, type of implanted IOL, and the duration till Nd : YAG capsulotomy was needed. The patients were divided into two groups: group 1 (29 eyes of 29 patients), which underwent hydrophilic acrylic IOL implantation, and group 2 (27 eyes of 27 patients), which underwent hydrophobic acrylic IOL implantation. Results There was no statistically significant difference between the hydrophilic and hydrophobic IOLs regarding the time of onset of postoperative PCO development [median=1.92 years, interquartile range=1.17–2.75 in group 1 and 1.34 years (0.5–2.41) in group 2, P=0.192). In addition, there was no statistically significant relation between the onset of PCO and the general medical condition of the enrolled patients, including diabetes mellitus, hypertension, hepatitis C virus, renal disease, systemic lupus erythematosus, hypocalcemia, and patients on chemotherapy (P&gt;0.05). Conclusion There was no statistically significant difference in the onset of PCO development with different IOL materials. Moreover, the patients’ general medical condition did not show a significant association with PCO incidence.

Postoperative discoloration of a multifocal hydrophobic acrylic lens: case report with laboratory analyses

Introduction: A case of discoloration of a multifocal hydrophobic acrylic intraocular lens (IOL), which was explanted and exchanged as well as underwent laboratory analysis, is reported. Patient and Clinical Findings: The patient presented with a corrected distance visual acuity of 20/50 and glare in the right eye 8 years after implantation. Slitlamp examination revealed a nasally decentered IOL with a whitish-brownish haze throughout. Diagnosis, Intervention, and Outcomes: The discolored IOL (ZMB00) was explanted and exchanged for a 3-piece IOL (sulcus fixation). Grossly, the explanted IOL showed a whitish discoloration of the optic only after hydration, corresponding to a yellowish-brownish discoloration observed under light microscopy. Back light scattering revealed bulk scatter throughout the optic. Light transmittance (%T) showed a slight progressive decrease starting at 500 nm when compared with %T in the directions for use (DFUs). Although modulation transfer function analysis demonstrated similar values to the control lens, the contrast of U.S. Air Force targets appeared slightly decreased. Conclusions: To the authors' knowledge, this is the first reported case of a discolored ZMB00 IOL that underwent explantation and laboratory assessment. Although current analyses did not reveal the etiology of the discoloration, surgeons should be aware of this possible occurrence with this lens design and carefully assess signs and symptoms before explantation.

Post operative opacification of polymethylmethacrylate, hydrophilic and hydrophobic acrylic intraocular lenses: A retrospective observational study

: To evaluate post-operative opacification of hydrophobic, hydrophilic and polymethylmethacrylate intraocular lenses. We had performed a retrospective observational study on twenty-one patients in tertiary care hospital of North India and a private clinic from March 2020-January 2021. History of systemic diseases like diabetes mellitus, hypertension, gout, chronic obstructive pulmonary disease was noted. We had also evaluated the patients for ophthalmic conditions like recurrent uveitis, retinal surgery, paracentesis for hyphema, open globe injury repair. The diagnosis of intraocular lens opacification was made on careful slit lamp examination. The patients with severe loss of visual acuity had undergone intraocular lens exchange procedure. The explanted intraocular lenses were sent for light microscopy with special stain and scanning electron microscopy. Statistical analysis was performed using SPSS software, version 21 (SPSS, Inc.) We found that mean age of patients with intraocular lens opacification was 62.5±6.82 years. The occurrence was 16(76.19%) in hydrophilic IOL, 4(19.05%) in hydrophobic IOL and only one (4.76%) was PMMA IOL which showed that the occurrence if IOL opacification is more in hydrophilic IOL. Light microscopy and scanning electron microscopy of the explanted IOLs did not show any deposits over IOL surface. Special stains were used and it was noted that Alizarin red was positive while Von Kossa for calcium was negative. We concluded that intraocular lens opacification can occur in any type of intraocular lens, but is predominantly seen with hydrophilic acrylic intraocular lenses. Also we came to a conclusion that various ophthalmic pathologies and systemic comorbidities accelerated the process of opacification.

Randomized multicenter trial to assess posterior capsule opacification and glistenings in two hydrophobic acrylic intraocular lenses

To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof (p = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups (p < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof (p < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.

Rotational Stability, Decentration, and Tilt of a New Hydrophobic Acrylic Intraocular Lens Platform

To evaluate rotational stability, decentration and tilt of the monofocal intraocular lens (IOL) Nanex (NC1-SP; HOYA Surgical Optics). Prospective interventional case series. The study was performed at the Department of Ophthalmology, Medical University of Vienna. The study population comprised 130 eyes of 68 patients with age-related cataract who underwent cataract surgery with implantation of a Nanex IOL. Baseline image for rotational stability evaluation was obtained at the end of surgery (EoS) and compared to retroillumination images taken at 1 hour, 1 week, 1 month, and 6 months after surgery. Axis alignment was assessed using nonmovable landmarks on the sclera and the optic-haptic junctions of the IOL. Anterior segment OCT images were performed to evaluate decentration and tilt. The main outcome measure was absolute rotation from EoS to 6 months postoperatively. Median IOL rotation of all eyes from EoS to 6 months was 1.9° (interquartile range 0.1°-37.5°). Ten eyes (9.71%) rotated more than 5° and 2 eyes (1.94%), more than 10°. IOL rotation did not correlate with axial eye length (Spearman r=-0.042, P=.46), crystalline lens thickness (Spearman r=0.134, P=.19), and crystalline lens equatorial diameter (Spearman r=0.101, P=.325). IOL rotation positively correlated with anterior fibrosis severity (Spearman r=0.321, P=.002). Preoperative decentration (0.2 ± 0.12 mm) and tilt (5.7 ± 1.6°) did not change significantly after surgery (0.22 ± 0.12 mm and 5.62 ± 1.49°, respectively). The investigated IOL presented good rotational stability and low decentration and tilt values. Nevertheless, anterior capsule fibrosis development led to a higher tendency of IOL rotation after 1 week.

Evaluation of Nd:YAG laser capsulotomy results in patients who underwent cataract extraction and intraocular lens implantation with the endocapsular phacoemulsification method

Background/Aim: Posterior capsular opacification (PCO) is a common complication that develops after cataract surgery, and it can be treated neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. In this study, we aimed to investigate the effects of different intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO), to determine the time between surgery and Nd:YAG laser capsulotomy, and to evaluate the efficacy, effectiveness, and complications of capsulotomy in patients who underwent cataract surgery with the phacoemulsification method and subsequently developed PCO. Methods: The cohort study included one eye of each of 153 cases (63 males, 90 females) who underwent cataract surgery with the phacoemulsification method in our clinic from August 1, 2006, through August 1, 2008, and subsequently developed PCO. According to the type of IOL implanted, the cases were divided into three groups: polymethylmethacrylate IOL (Group 1), hydrophilic acrylic IOL (Group 2), and hydrophobic acrylic IOL (Group 3). The control examinations of the patients who underwent Nd:YAG laser capsulotomy were undertaken before capsulotomy and at the first week, first month, and third month after capsulotomy. Results: Visual acuity improvement was detected in 96.7% of the 153 cases. It was determined that 9.1% of the cases had an intraocular pressure (IOP) increase of more than 5 mmHg at the third hour after capsulotomy and approached baseline values at the end of 1 week. The mean total energy used in all the cases was 37.20 (14.70) mjl. The mean total energy used in 14 patients with an IOP elevation of above 5 mmHg was 71.07 (10.59) mjl. Nd:YAG laser capsulotomy was performed at an average of 6.29 (4.91) months in Group 1, 7.81 (4.35) months in Group 2, and 17.7 (12.35) months in Group 3. After capsulotomy, clinically significant cystoid macular edema was observed in 1.9% of the cases, IOL damage in 3.9%, and vitreous hemorrhage in 0.6%. Conclusion: In this study, the incidence of PCO development was found to be lower in the patients who underwent hydrophobic acrylic IOL implantation; therefore, this type of lens should be preferred for implantation. Although Nd:YAG laser capsulotomy is an outpatient treatment method that can be applied quickly and can increase visual acuity, it can also lead to complications. To eliminate most of these complications, it would be beneficial to minimize the energy used during the laser procedure.

Do Lactobacillus rhamnosus-Originated Probiotic and Parabiotic Have Inhibitory Effects on Intraocular Lens Biofilm?

Objective: Our aim was to investigate the formation of Staphylococcus (S.) epidermidis biofilm on hydrophobic acrylic lenses and whether the inhibition of the formed biofilm is possible with probiotic Lactobacillus (L.) rhamnosus 312 and parabiotic prepared from it. Materials and Methods: The probiotic bacteria L. rhamnosus 312 and intercellular adhesion (ICA) gene-positive tested bacteria S. epidermidis KA15.8 were used in the study from stock. To obtain the parabiotic the cultures were developed in De Man Rogosa and Sharpe (MRS) broth for 48 hours and autoclaved at 121ºC for 15 minutes. Biofilms on hydrophobic acrylic intraocular lenses and the antibiofilm effects of parabiotic and probiotic L. rhamnosus were evaluated. Scanning electron microscopy photos of biofilms produced on intraocular lenses (IOLs) were taken. Results: Probiotic L. rhamnosus 312 and the parabiotic test showed antibacterial activity on test bacteria, ICA positive S. epidermidis KA15.8. However, the probiotic L. rhamnosus 312 zone diameter was found to be wider. After the biofilm was formed, the addition of parabiotic inhibited the biofilm formed by S. epidermis KA15.8 by 58.29%. The number of S. epidermidis KA15.8 in the biofilm also decreased. Conclusion: Parabiotic and probiotic L. rhamnosus 312 was found effective for its antibiofilm effect. However, further studies with different concentrations are needed.

Clinical Performance of a Hydrophobic Acrylic Diffractive Trifocal Intraocular Lens in a Japanese Population.

In this study, clinical performance of a hydrophobic acrylic diffractive trifocal intraocular lens (IOL) with double C-loop haptics was evaluated in Japanese cataract eyes. Twenty-three patients had bilateral cataract surgery with the implantation of a trifocal IOL with double C-loop haptics. Postoperative examinations at 6months included assessing uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) at 5m, uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA) at 80cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40cm. Binocular defocus, contrast sensitivity, spectacle independence, symptoms of photic phenomena and quality of vision (QOV) were also observed. Twenty-three patients received 46 IOLs binocularly. Manifest refraction spherical equivalent was - 0.227 ± 0.385 D (mean ± standard deviation) at 6months postoperatively. Binocular UDVA, binocular UIVA and binocular UNVA were - 0.101 ± 0.065, - 0.021 ± 0.079 and 0.022 ± 0.095 logMAR units, respectively. Binocular CDVA, binocular DCIVA and binocular DCNVA were - 0.151 ± 0.044, - 0.042 ± 0.067 and - 0.011 ± 0.080 logMAR, respectively. Binocular CDVA of 0.00 logMAR or better was obtained in the defocus from - 3.0 D until + 0.5 D. Only 8.7% of patients required the use of spectacles postoperatively. There were no symptoms of glare, halo and light disturbance in 78.3%, 56.5% and 69.6% of patients, respectively. QOV scores significantly improved postoperatively (P < 0.0001). The hydrophobic acrylic trifocal IOL with double C-loop haptics provides good visual performance at all distances and produces high spectacle independence rate and patient satisfaction. NCT04699266 (Clinicaltrials.gov).

Early Lensectomy in Patients With Pseudoexfoliation: Long-Term Effectiveness and Safety Outcomes.

Early lensectomy in patients presenting pseudoexfoliation (PXF) in an asymmetric clinical stage resulted in effective, safe, and predictable long-term results. Good intraocular pressure (IOP) was found, thus it might be considered as a possible surgical approach in these patients. The purpose of this study is to assess the long-term effectiveness, predictability, and safety of cataract surgery performed in patients with capsular PXF at an early stage of the disease. This retrospective, comparative study included PXF patients who underwent phacoemulsification with hydrophobic acrylic intraocular lens implantation in both eyes with a postoperative follow-up ≥5 years. Patients were classified in 2 groups: symmetric PXF (n=102) and asymmetric PXF (n=59). Preoperative and postoperative uncorrected and corrected distance visual acuity, manifest refraction, IOP, number of hypotensive drugs, visual field mean deviation, and the incidence of complications were registered. The mean follow-up time was 8.5±2.8 years. Six months after cataract surgery, monocular uncorrected and corrected distance visual acuity were 0.3±0.4 and 0.1±0.3 logMAR, respectively, for the symmetric PXF, and 0.2±0.2 and 0.1±0.2 logMAR, respectively, for the asymmetric group. Total 95% and 96% of eyes were within ±1.00D in symmetric and asymmetric groups, respectively. At the final follow-up, IOP decreased only in the asymmetric group (P=0.004), with a reduction in the number of medications in both eyes (P<0.001). Mean deviation changed from -8.8 to -11.6dB in the symmetric group (P<0.001), and from -5.0±6.2 to -7.9±10.6dB (P=0.42) in the asymmetric group. Intraoperative complications were only registered in the symmetric group: 7 (3.4%; P=0.04). Ten cases (4.9%) of late intraocular lens dislocation were found, all from the symmetric group (P=0.03). Early lensectomy in patients with PXF before its symmetric presentation resulted in effective, safe, and predictable long-term results.