AcrySof Intraocular Lens Research Articles

Comparative evaluation of the results of phacoemulsification using domestic and foreign viscoelastics

BACKGROUND: Phacoemulsification, being the safest technique, is the golden standard of cataract surgery worldwide. However, as any surgery, it is accompanied by inevitable damage to intraocular structures. The most prevalent among them is the loss of corneal endothelial cells. In order to prevent these complications, various viscoelastics with particular features and characteristics are widely used.
 AIM: To compare the anatomical and functional state of ocular structures after standard phacoemulsification with monofocal posterior chamber intraocular lens (IOL) implantation using domestic (Kogevisc and Adgevisc) and foreign (Viscoat and Amvisc Plus) viscoelastics.
 MATERIALS AND METHODS: 60 cataract patients (60 eyes) were included in the clinical study, which were divided into two equal groups. In the first group (30 patients, 30 eyes), Adgevisc and Kogevisc (Solofarm, Russia) were used during the procedure. The mean age of the patients was 66 11 years. In the second group (30 patients, 30 eyes), Viscoat (Alcon) and Amvisc Plus (BauschLomb) were used. The mean age of the patients was 69.03 10.44 years. All patients underwent phacoemulsification with the implantation of the AcrySof IOL (model SA60AT, Alcon) according to the standard technique. Visual acuity, IOP level, CCT, corneal endothelial cell density were assessed. All studies were performed before surgery, the next day, 7 days and 1 month after surgery.
 RESULTS: In patients of the second group, on the 1st (p 0.05) and 7th day (p 0.01) after surgery, a statistically significant increase in IOP was revealed compared to the first group. The central cornea thickness in the early postoperative period was higher in patients of the second group, however, it was not statistically significant. The loss of corneal endothelial cells 1 month after surgery was 8.5 7.0% (p 0.01) in the first group and 6.6 6.4% in the second group (p 0.01). The mean value of endothelial cell loss in patients of the first group was higher, however, it was not statistically significant. The best corrected visual acuity in both groups at all stages of follow-up after surgery (days 1, 7 and 30) was comparable, there was no significant difference between the groups.
 CONCLUSIONS: The clinical efficacy of domestic adhesive and cohesive viscoelastics Adgevisc and Kogevisc (Solofarm, Russia) in phacoemulsification using the soft-shell technique is comparable to the foreign analogues Viscoat (Alcon) and Amvisc Plus (Bausch Lomb), which is confirmed by the absence of statistically significant differences in the studied parameters of the postoperative state of ocular structures and explained by their similar composition, molecular weight and viscosity.

Longitudinal evaluation of trifocal and extended depth of focus lenses implantation using standard automated perimetry parameters.

To evaluate reliability and global indices parameters from standard automated perimetry (SAP) in normal eyes undergoing phacoemulsification cataract surgery with implantation of trifocal or extended depth of focus intraocular lens (IOL). Prospective study to evaluate the effect of trifocal IOL AcrySof IQ PanOptix® and extended depth of focus intraocular lens (EDOF) Tecnis Symfony® IOL implantation on visual field parameters. Patients underwent SAP pre- and postoperatively. Reliability indices (false negative rate-FN, false positive rate-FP), global indices (foveal sensitivity threshold, visual field index-VFI, standard pattern deviation-PSD, mean deviation MD) and test duration were analyzed. A total of 23 eyes from 13 patients were in the trifocal IOL group and a total of 22 eyes from 14 patients were in the EDOF group. The following results were obtained by analyzing pre- and postoperative SAP of EDOF IOL: the rate of change of FN was 1.95/1.41% (p = 0.61); FP 1.64/1.27 (p = 0.60); MD -1.60/-1.08dB (p = 0.15); foveal sensitivity was 34.5/33.9dB (p = 0.41); VFI 98.5/98.4% (p > 0.99); PSD 1.85/1.86 (p = 0.07); and for test duration 305.81/298.36s (p = 0.35); all respectively. Analysis of pre- and postoperative parameters of trifocal IOL were the rates of change of FN 1.22/1.83% (p = 0.29); FP 1.65/1.48% (p = 0.95); MD -1.55/-1.37dB (p = 0.19); foveal sensitivity 33.9/34.9dB (p = 0.47); VFI 98.6/98.3% (p = 0.62); PSD 1.58/2.05 (p = 0.02); and test duration 297.17/298.57s (p = 0.87); all respectively. We identified a change in the PSD parameters in the trifocal IOL group. No other significant changes were identified in SAP parameters after implantation of trifocal AcrySof IQ PanOptix® and EDOF Tecnis Symfony® IOL. Longitudinal evaluation showed no changes in SAP after Trifocal and EDOF IOL implantation in normal subjects.

Academy IRIS® Registry Analysis of Incidence of Laser Capsulotomy Due to Posterior Capsule Opacification After Intraocular Lens Implantation.

PurposeAcademy IRIS® (Intelligent Research in Sight) Registry was used to determine the incidence of postoperative neodymium-doped yttrium aluminum garnet laser capsulotomy (Nd:YAG) and time to posterior capsular opacification (PCO) diagnosis based on intraocular lens (IOL) type and brand.MethodsThis retrospective analysis included eyes implanted with 1 of 2 IOL brands, with ≥365 days of follow-up available in the IRIS Registry, and ≥2 visits within 180 days of surgery. Analyses included Nd:YAG incidence due to PCO within 1 year after surgery by IOL type and brand, mean time to PCO diagnosis, and mean time to Nd:YAG.ResultsOf 89,947 eyes after cataract surgery, 24,834 (28%) had PCO diagnosis within 365 days, and 9262 (10%) underwent Nd:YAG; 4.1% of 57,523 eyes with monofocal and 21.2% of 32,424 eyes with diffractive multifocal (MF) or diffractive extended depth of focus (EDOF) IOLs had Nd:YAG. Nd:YAG was 3.2 times more likely in eyes with diffractive MF or diffractive EDOF IOLs versus monofocal. For monofocal IOLs, 3.2% of eyes with AcrySof® and 8.1% of eyes with Tecnis® had Nd:YAG (P<0.0001). For diffractive MF or diffractive EDOF IOLs, 13.0% of eyes with AcrySof and 21.7% of eyes with Tecnis had Nd:YAG (P<0.0001). Nd:YAG risk was 2.4 times higher in eyes with Tecnis versus AcrySof IOLs. Overall, mean time to PCO diagnosis and Nd:YAG was 150.7 and 180.7 days. Mean time to PCO for monofocal versus diffractive MF or diffractive EDOF IOLs was 165.3 versus 139.7 days (P<0.0001). Mean time to Nd:YAG for monofocal versus diffractive MF or diffractive EDOF IOLs was 196.4 versus 175.3 days (P<0.05).ConclusionReal-world data for AcrySof and Tecnis IOLs revealed lower Nd:YAG rates and longer time to PCO diagnosis and Nd:YAG after monofocal versus diffractive multifocal or diffractive EDOF implantation. Nd:YAG rates were significantly lower with AcrySof versus Tecnis IOLs.

Costs and Healthcare Resource Utilization Associated with Posterior Capsule Opacification After Cataract Surgery with Five Different Intraocular Lenses: An Economic Analysis for Spain

PurposeTo estimate the economic impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its related complications for five different intraocular lenses (IOLs) from the payer and hospital perspectives in Spain.Materials and MethodsThe three-year incidence rates of Nd:YAG laser capsulotomy after cataract surgery with five different single-piece acrylic monofocal IOLs (AcrySof IOLs, AJL LLASY60, IOL Tech Stabibag, Medicontur Bi-flex, Zeiss Asphina) for 8293 patients were derived from odds ratios of multivariate analysis adjusted for age, gender, and diabetic retinopathy. A cost-consequence model for a hypothetical cohort of 2000 eyes was then developed to quantify the potential impact of Nd:YAG capsulotomy in terms of costs and time for each of the included IOLs, from the payer and hospital perspectives.ResultsThe adjusted three-year Nd:YAG laser capsulotomy incidence was 5.0% (95% CI 3.9 to 6.1) for AcrySof and ranged from 26.0% to 44.0% for the other four IOLs. The average costs of Nd:YAG treatment and related complications were €261.90 for payers and €19.99 for hospitals. The average time needed for Nd:YAG treatment and related complications was 32.82 minutes. Model estimates based on 2000 hypothetical cataract surgeries showed that AcrySof IOLs could lead to cost savings between €110,259.90 and €205,591.50 for payers. For hospitals, time, and cost savings with AcrySof ranged from 230.29 hours and €8415.79 compared to Zeiss Asphina to 429.40 hours and €15,692.15 compared to AJL LLASY60 IOLs.ConclusionPost cataract surgery, AcrySof IOLs were associated with a significantly lower incidence of Nd:YAG treatment and its subsequent complications compared to other IOLs. Our analysis shows that IOL choice is an important factor that can reduce the burden for patients, payers, and hospitals.

Nd:YAG capsulotomy incidence associated with five different single-piece monofocal intraocular lenses: a 3-year Spanish real-world evidence study of 8293 eyes

ObjectivesTo investigate the associations between different single-piece monofocal intraocular lenses (IOLs) and neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy incidence 3 years after cataract surgery in a Spanish cohort.MethodsThis is a longitudinal retrospective cohort study. Data were extracted from the electronic medical records of two large regional hospitals in Spain. Patients aged ≥65 years receiving cataract surgery with placement of five different IOLs and with ≥6 months of baseline data were included. We report the Nd:YAG capsulotomy incidence 3 years post cataract surgery, and the survival plot over the 3 years of follow-up time. The associated adjusted (age, gender, and diabetic retinopathy) multivariate analysis with odds ratios (ORs) and 95% CIs is also presented.ResultsThe cohort (53% female, mean age 75 ± 5.9 years) included 14,519 eyes (Alcon AcrySof = 2968, AJL LLASY60 = 1776, Medicontur Bi-flex = 5176, Zeiss Asphina = 4478, and IOL Tech Stabibag = 121). Of these, 8293 were retained until 3-year follow-up. At 3 years after cataract surgery, the Nd:YAG capsulotomy incidence was 5% for Alcon AcrySof, while it ranged from 21.2% to 31.1% for the other IOLs (p < 0.0001 for each comparison). The odds for Nd:YAG capsulotomy were significantly higher (p < 0.0001) for other IOLs compared with those of Alcon AcrySof (ORs = 8.85, 5.86, 5.74, 5.21 for AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag, and Zeiss Asphina, respectively).ConclusionsThe lower Nd:YAG capsulotomy rates for Alcon AcrySof IOLs compared to the other IOLs support the importance of lens choice in reducing patient burden and treatment costs.

Silicone Oil Adhesion to Hydrophobic Acrylic Intraocular Lenses: A Comparative Laboratory Study of a New versus an Established Hydrophobic Acrylic Intraocular Lens Material.

Background In vitro assessment of silicone oil adhesion to a new hydrophobic acrylic intraocular lens (IOL) material, the Clareon model CNA0T0, compared with the established AcrySof model SN60WF was carried out. Methods Silicone oil adhesion was assessed for two types of IOLs, Clareon CNA0T0 (n = 10) and AcrySof SN60WF (n = 10). Lenses were immersed in an aqueous sodium chloride solution for 12 hours and then incubated at room temperature in silicone oil for 12 hours. The lenses were washed with distilled water and photographed at 25x magnification using a microscope. The percent coverage was calculated by dividing the area of oil coverage by the total surface area of the lens. Results Silicone oil adhesion to the surface of the CNA0T0 lens ranged from 4% to 22%, with a mean ± SD coverage of 8% ± 4%. Silicone oil adhesion to the surface of the SN60WF lens ranged from 1% to 17%, with a mean coverage of 9% ± 4%. The silicone oil adhesion of CNA0T0 was equivalent to that of SN60WF (P > 0.05). Conclusions The new Clareon model CNA0T0 IOL has silicone oil adhesion and interaction that are equivalent to the established AcrySof IOL.

Анализ влияния наклона и децентрации ИОЛ на индуцированный астигматизм при исследовании методом трассировки лучей на модели глаза

Purpose. Determination of the influence of the intraocular lens (IOL) inclination and decentration on the magnitude of induced astigmatism in a theoretical study using software on an eye model. Material and methods. An eye model with the specified parameters was performed to carry out the calculation. Modulation of the change in the wavefront was carried out using the Zemax program (LLC, USA). In the model eye, the probability of induction of astigmatism was analyzed depending on the change in the position of the aspherical IOL Acrysof IQ 16.0, 22.0 and 24.0 diopters and the toric model Acrysof IQ Toric SN6AT3, SN6AT4 and SN6AT5. The angle of inclination of the IOL relative to the horizontal plane was examined from 0° to 10° with a step of 1°, decentration from 0.1 to 1.5 mm with a step of 0.1 mm. At each IOL position, aberration data of the 2nd order Z (2, 2) were recorded. The obtained results were used to calculate the critical tilt angle and decentration. Results. The magnitude of induced astigmatism increased with the rise of the degree of inclination and decentration, corresponding to an increase in the optical power of the IOL. Accordingly, critically significant were the values of 3.0° inclination for the aspherical IOL with an optical power of 22.0 and 22.0 diopters and 3.5° for 16.0 diopters, decentration – 0.7 mm and 1.0 mm. The inclination of the TIOL relative to the horizontal plane revealed the induction of the magnitude of inverse astigmatism, according to an increase in the inclination angle of 0.3 diopters at a slope of 3–4°. Conclusions. The tilt and decentration of the aspherical and TIOL patterns induce astigmatism depending on the increase in IOL power. The inclination of the TIOL in relation to the horizontal plane set at 90 ° promotes the induction of astigmatism. Key words: astigmatism, toric intraocular lenses, tilt and decentration of the intraocular lens, ray tracing

Real-world incidence of monofocal toric intraocular lens repositioning: analysis of the American Academy of Ophthalmology IRIS Registry.

To determine the 12-month incidence of reoperation to realign 2 commercially available types of implanted monofocal toric acrylic intraocular lenses (IOLs). American Academy of Ophthalmology IRIS (Intelligent Research in Sight) Registry. Registry retrospective study. Eyes that underwent cataract extraction and were implanted with a TECNIS or AcrySof monofocal toric IOL in 2016 and 2017 were identified. The rate of reoperation for IOL realignment (Current Procedural Terminology code 66825) within 365 days of implantation was determined for each IOL group. Risk factors for repositioning were evaluated using logistic regression modeling. A total of 6482 eyes were implanted with a monofocal toric IOL, including 2013 (31.06%) with a TECNIS and 4469 (68.94%) with an AcrySof IOL. During the first postoperative year, 87 (1.3%) eyes underwent surgical IOL repositioning. The incidence of repositioning was significantly higher (P < .0001) for TECNIS-implanted (3.1%, 62/2013) than for AcrySof-implanted (0.6%, 25/4469) eyes (odds ratio [OR] 5.6; 95% CI, 3.5-8.9). Younger age (OR 0.76; 95% CI, 0.67-0.86 per 5-year increase) was associated with a higher risk for IOL repositioning. Real-world analysis of U.S. patients in the IRIS Registry revealed that the rate of surgical IOL repositioning was 5 times higher in eyes implanted with TECNIS than with AcrySof monofocal toric IOLs for astigmatic correction at the time of cataract surgery. These findings should be considered when selecting a toric IOL for correction of astigmatism in cataract patients, particularly in younger patients with a higher risk for misalignment requiring repositioning.

Surface light scattering from 1-piece hydrophobic acrylic intraocular lenses with hydroxyethyl methacrylate: contralateral observation for 7 years.

To quantitatively and intraindividually compare surface light scattering for 7 years after implantation of Clareon and AcrySof intraocular lenses (IOLs). Miyata Eye Hospital, Miyazaki, Japan. Retrospective comparative case series. Clinical records of eyes that had contralateral implantation of SN60WF and SY60WF IOLs were reviewed. Light scattering on the anterior surface of IOLs, corrected distance visual acuity (CDVA), and mesopic and photopic contrast sensitivities were examined at 1 year, 3 years, and 7 years postoperatively, and they were intraindividually compared. 34, 19, and 16 patients visited at 1 year, 3 years, and 7 years postoperatively, respectively. Surface light scattering in eyes with SY60WF IOL was significantly reduced, and the rate of increase was 2.74 computer compatible tapes per year. Although there were prominent increases in eyes with SN60WF IOL, no statistically significant difference was found in their CDVA and contrast sensitivities. In eyes with Clareon IOLs, the development of surface light scattering was suppressed up to 7 years. The increase rate demonstrated that the visual acuity would be least deteriorated up to 12 years postoperatively, whereas the influence of straylight induced should be investigated.

Comparison of rotational stability and repositioning rates of 2 presbyopia-correcting and 2 monofocal toric intraocular lenses.

To compare the rotational stability of 2 commonly used toric presbyopia-correcting (PC) intraocular lenses (IOLs) and their monofocal toric counterparts. Single 2-surgeon private practice. Retrospective study. This study included 2 cohorts: (1) all eyes receiving a toric ReSTOR (n = 61 eyes, 49 patients) or toric Symfony (n = 779 eyes, 520 patients) IOL from September 2016 to January 2019; and (2) all eyes receiving an AcrySof (n = 2 393) or TECNIS (n = 731) monofocal toric IOL (TIOL) from April 2015 to January 2019. Eyes were only excluded if digital marking could not be used. All patients had image-guided digital marking to verify TIOL position at the conclusion of surgery. Postoperative rotation was determined by dilated examination performed later on the day of surgery or the following morning. The toric ReSTOR IOL was more likely to rotate 5 degrees or less than the toric Symfony IOL, 91.8% vs 79.0% (P = .01). This remained true for rotation of 10 degrees or less (100% vs 89.5%, P < 0.003). The mean rotation was 2.3 degrees for toric ReSTOR IOL compared with 4.5 for toric Symfony IOL (P = .01). Statistically significantly more eyes with toric Symfony IOL required a return to the operating room for repositioning (6.9% vs 0%, P < .03). More TECNIS monofocal TIOL eyes required surgical repositioning than AcrySof monofocal TIOL eyes (3.5% vs 1.2%, P < .001). Between these PC-TIOLs, the Symfony IOL was more likely to rotate and to require surgical repositioning than the ReSTOR IOL. The TECNIS TIOL built on the same platform as the Symfony IOL was more likely to require surgical repositioning than that by the AcrySof TIOL. Despite comparable rotational stability between the Symfony and TECNIS monofocal TIOLs, the Symfony was twice as likely to require surgical repositioning.

A Comparison of Refractive Accuracy Between Conventional and Femtosecond Laser Cataract Surgery Techniques Using Modern IOL Formulas.

PurposeTo compare the refractive outcome prediction accuracy between conventional (CCS) and femtosecond laser assisted (FLACS) cataract surgery techniques using optimized lens constants for modern intraocular lens (IOL) formulas.Patients and MethodsOur retrospective, comparative, interventional case series, compared data from 196 eyes undergoing CCS and 456 eyes undergoing FLACS with Acrysof IOL (Alcon laboratories, Inc) implantation. After optimizing IOL constants, the predicted refractive outcome was calculated for all formulas for each case. This was compared to the actual refractive outcome to provide the prediction error. The performance of CCS and FLACS was compared by the absolute prediction error and percentage of eyes within 0.25D, 0.5D and 1.0D of anticipated refractive outcome.ResultsThere was no statistically significant difference in median absolute error between the CCS and LACS groups for the Kane (0.256, 0.236; p=0.389), SRK T (0.298, 0.302, p=0.910), Holladay (0.312, 0.275; p=0.090), Hoffer Q (0.314, 0.289; p=0.330), Haigis (0.309, 0.258; p=0.177), Barrett Universal 2(0.250, 0.250; p=0.866), Holladay 2 (0.250, 0.258; p=0.860) and Olsen (0.260, 0.255; p=0.570) formulas. Similarly, there was no consistent difference between the two techniques for percentage of patients within 0.25, 0.50 and 1.0D of predicted refractive outcome for each formula.ConclusionThere was no difference in refractive outcome prediction accuracy between the CCS and FLACS techniques.

Quantification of the In Vitro Predisposition to Glistening Formation in One Manufacturer's Acrylic Intraocular Lenses Made in Different Decades.

IntroductionFoldable hydrophobic acrylic intraocular lenses (IOLs) are prone to develop a long-term postoperative material change called glistenings. The aim of this study was to investigate the changes in the predisposition for glistening formation in one type of hydrophobic acrylic IOL material from its introduction to the present day.MethodsIn a laboratory setup, an in vitro model was used to induce glistenings in hydrophobic acrylic IOLs manufactured by one company (Alcon, Fort Worth, TX, USA) in different years: 23 1990s-manufacture hydrophobic acrylic three-piece IOLs (MA30BA/MA60AC) that were explanted in 1996 and 1997, and five of each of the newer AcrySof IOL models (MA60AC, SA60AT, TFNT00 and SN60WF) from 2014 to 2017. Furthermore, five Clareon (SY60WF) IOLs were put through the same accelerated aging procedure. The number of microvacuoles per square millimeter (MV/mm2) was determined in the central part of each IOL optic and compared between the groups.ResultsThe mean number of MV was highest in the 1990s-manufacture Alcon acrylic IOLs, with 1289 (± 738) MV/mm2. The number decreased to 650 (± 101), 192 (± 105), 175 (± 112) and 47 (± 26) for MA60AC, SA60AT, TFNT00 and SN60WF, respectively. The lowest count was obtained in the Clareon group, with 1 (± 1) MV/mm2. ConclusionsA high number of glistenings was induced in the explanted IOLs from the 1990s. The propensity for glistening formation decreased considerably after that decade and now in current use. Even though in vitro glistening formation in today’s AcrySof material was low, the Clareon material was essentially glistenings-free.

Rotation Characteristics of Three Toric Monofocal Intraocular Lenses.

PurposeTo evaluate the rotational stability of the three monofocal toric intraocular lenses (IOLs) via data from an online toric IOL back-calculator.MethodsA retrospective data review of an online toric IOL back-calculator, which allows users to input preoperative toric planning information, postoperative lens orientation, and subjective refraction. Inputted data were used to determine the optimal orientation of the toric IOL to minimize residual refractive astigmatism. Aggregate data from 3/11/2019 to 3/10/2020 were extracted and validated. Only data with ≥0.5D of residual refractive astigmatism were used in the study. Pre-operative intended IOL orientation and post-operative IOL orientation were used to calculate IOL rotation.ResultsAfter validation, 5397 entries were determined to represent patient eyes, of which 3238 represented the three monofocal IOLs evaluated. The rate of rotation for AcrySof, TECNIS, and enVista Toric IOLs was 72.7%, 83.4%, and 83.0%, respectively, and location only significantly impacted TECNIS IOLs. The magnitude of rotation for rotated IOLs was similar for all models and was significantly more for IOLs initially placed in the oblique axis. All IOL models tended to rotate in a counterclockwise direction (53.2%, 73.0%, 69.7%, respectively; p<0.05), and the tendency was greater for IOLs initially located horizontally.ConclusionThe AcrySof IQ Toric IOL was more rotationally stable than both the TECNIS and enVista Toric IOLs; there was no significant difference in rotational stability of the latter two.

PMD40 Comparing the LONG-TERM Costs Associated with Intraocular LENS Selection and ND:YAG Laser Capsulotomy Post-Cataract Surgery: A Cost-Consequence Analysis from a Spanish Healthcare System Perspective

Posterior capsule opacification (PCO) is the most common post-surgical complication of cataract surgery, incidence figures ranging from <5% to as high as 50%. Visually significant PCO is treated by Nd:YAG laser capsulotomy, which bears a cost and its provision can place a burden on health care systems. The objective of this research was to estimate costs from a budget holders perspective associated with PCO related post-cataract surgery resource use in a typical hospital setting – comparing different single-piece intraocular lenses (IOLs) and utilizing findings from a real-world evidence (RWE) study in Spain This research adapts the findings of the aforementioned RWE study to include a cost-consequence analysis. The model is underpinned by the Nd:YAG rates of the included IOLs at 3 years: AcrySof (5%), Zeiss Asphina (21.2%), IOL Tech (23.2%), Medicontur (23.1%) and AJL IOLs (31.1%). The 2 associated consultations required within the first 6 months period post Nd:YAG, were also included as variables of efficiency in the model. Costs were sourced from Valencian Community tariffs (2016-2018). AcrySof was associated with significantly lower Nd:YAG procedures and additional consultations, 3 years post-cataract surgery compared to all other lenses included in the model. Assuming 2,000 cataract surgeries carried out in one year, this translated into potential cost savings for the eAcrySof lens, over 3 years, ranging from €108,060 (versus Zeiss Asphina) to €174,097 (versus AJL). Moreover, assuming 20 minutes for the Nd:YAG laser appointment and associated consultations, the time saved estimate ranged from 40.2 to 64.8 working days for the hospital. This economic analysis of real world treatment outcomes highlights that the appropriate choice of IOL for cataract surgery, as a direct consequence of lower ND:YAG capsulotomy rates - may translate into significant savings both financially and with respect to resource use for Spanish hospitals and the national healthcare system.

Comparison of Long-Term Rotational Stability of Three Commonly Implanted Intraocular Lenses

To compare rotational stability and its influencing factors in 3 different widely used hydrophobic acrylic intraocular lenses (IOLs) from the end of surgery (EoS) to 4-7months (6months) in over 380 eyes. Prospective interventional comparative clinical study. Setting: Department of Ophthalmology, Medical University of Vienna. A total of 381 eyes of 199 patients with age-related cataract received an IOL Acrysof SN60WF, Tecnis ZCB00, or Envista MX60 in a consecutive order. Implantation of an Acrysof, Tecnis, or Envista IOL randomized to the 0 ± 10, 45 ± 10, 90 ± 10, or 135 ± 10° axis in 1 or both eyes. Baseline measurement was performed with patients supine still on the operating table. Postoperative follow-ups were conducted after 1 hour, 1week, 1month, and 6months. Difference of absolute rotation from the EoS to 6months. Absolute rotations from the EoS to 6months were 1.65 ± 2.1, 2.65 ± 4.1, and 3.18 ± 5.8° for the Acrysof, Tecnis, and Envista group, respectively. Rotational stability was statistically significantly superior in the Acrysof compared with the Envista group (P= .014), but not compared with the Tecnis group (P= .10). No significant difference was found between the Tecnis and Envista groups (P= .761). Maximum values of 15.8, 38.6, and 44.9° were observed for the Acrysof, Tecnis, and Envista group, respectively. The Acrysof IOL showed the least amount of absolute rotation compared with the Tecnis and Envista IOLs. Outliers possibly requiring secondary intervention were observed in all groups. The amount of rotation was greatest during the first postoperative hour.

Evaluation of posterior capsule opacification of the Alcon Clareon IOL vs the Alcon Acrysof IOL using a human capsular bag model

BackgroundPosterior capsule opacification (PCO) after cataract surgery is influenced by intraocular lens (IOL) design and material. The following is an ex vivo comparison of PCO between the Clareon vs. the AcrySof IOL in human capsular bags.MethodsTwenty cadaver capsular bags from 10 human donors were used, with the novel hydrophobic IOL (Clareon, CNA0T0) being implanted in one eye and the other eye of the same donor receiving the AcrySof IOL (SN60WF) following phacoemulsification cataract surgery. Five capsular bags of 3 donors served as controls without IOL. Cellular growth of lens epithelial cells was photo-documented daily. The primary endpoint was the time until full coverage of the posterior capsule by cells. Furthermore, immunofluorescence staining of capsular bags for the fibrotic markers f-actin, fibronectin, alpha smooth muscle actin, and collagen type 1 were performed.ResultsThe new Clareon IOL did not show any disadvantages in terms of days until full cell coverage of the posterior capsule in comparison to the AcrySof (p > 0.99). Both, the Clareon (p = 0.01, 14.8 days) and the AcrySof IOL (p = 0.005, 15.7 days) showed a slower PCO development in comparison to the control (8.6 days). The fibrotic markers f-actin, fibronectin, alpha smooth muscle actin, and collagen type 1 were equally distributed between the two IOLs and differed from the control.ConclusionsA comparable performance has been found in the ex vivo formation of PCO between the two IOLs. Long-term clinical studies are necessary to reach final conclusions.

Comparison of glistenings formation and their effect on forward light scatter between the Acrysof SN60WF and Eternity Natural Uni NW-60 intraocular lenses

AimsTo compare the characteristics of glistenings and forward light scatter between the Alcon Acrysof SN60WF and Santen Eternity Natural Uni NW-60 intraocular lenses (IOLs).MethodsFive Acrysof SN60WF and five Eternity Natural...

5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes

ObjectivesTo evaluate the 3- and 5-year incidence of posterior capsule opacification (PCO) and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy in patients following cataract surgery, comparing results for different single-piece acrylic hydrophilic and hydrophobic monofocal intraocular lens (IOL) models and other patient factors.Patients and methodsElectronic medical record data collected from seven United Kingdom (UK) National Health Service (NHS) ophthalmology clinics for routine, age-related (≥65 years) cataract surgeries that implanted single-piece acrylic monofocal IOLs during 2010–2013 were used to calculate 3- and 5-year incidence of Nd:YAG and PCO. IOL models of Alcon Acrysof, AMO Tecnis, Bausch & Lomb (B & L) Akreos, LenStec Softec, and Rayner Flex were analyzed. Pairwise comparisons were conducted between AcrySof IOLs and other IOLs using Bonferroni adjustment for multiplicity. Multivariate analyses were conducted adjusting for known confounders.ResultsThe incidence of Nd:YAG capsulotomy ranged between 2.4–12.6% at 3 years and 5.8–19.3% at 5 years post-cataract surgery. Similarly, the incidence of PCO ranged between 4.7–18.6% at 3 years and 7.1–22.6% at 5 years. When comparing all of the single-piece IOLs, AcrySof demonstrated the lowest incidence rates for both PCO and Nd:YAG (P < 0.001 for each comparison). From adjusted logistic regression analysis, AcrySof were associated with lower 3- and 5-year odds of Nd:YAG and PCO incidence.ConclusionsFollowing cataract surgery with single-piece monofocal IOLs different incidence rates of PCO were observed with different IOLs. AcrySof IOLs were associated with significantly lower incidence of PCO requiring Nd:YAG treatment over periods of 3 and 5 years.

Comparing the long-term impact on health care resources utilization and costs due to various single-piece acrylic monofocal intraocular lens implantation during cataract surgery: a cost-consequence analysis for the United Kingdom, Italy, and Denmark.

PurposeThe objective of this study was to estimate the cost impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its complications due to single-piece acrylic monofocal intraocular lenses (IOLs) in the healthcare setting of United Kingdom, Italy, and Denmark.Materials and methodsA hypothetical cost-consequence model was developed to estimate economic burden of Nd:YAG laser capsulotomy due to different single-piece acrylic monofocal IOLs. Cumulative incidence of Nd:YAG laser capsulotomy at 3 years after cataract surgery with five single-piece monofocal acrylic IOLs was sourced from retrospective data analysis of electronic medical records of cataract patients in the United Kingdom. Risk probability of post-Nd:YAG laser complications, ie, retinal detachment, glaucoma, and cystoid macular edema at 3 years was derived using published literature. Unit costs were taken from publicly available sources with all costs converted to euro (€). Number of cataract procedures per year for each country was sourced from Eurostat statistics.ResultsFor the estimated cataract procedures carried out nationally every year, single-piece monofocal hydrophobic AcrySof IOL was associated with substantially lower cases of Nd:YAG laser capsulotomy procedures and subsequent complications in 3 years after cataract surgery when compared to other single-piece monofocal acrylic IOLs. The total cost savings with the use of AcrySof over other IOLs in countries assessed ranged from €0.5 to €4.7 million (vs AMO Tecnis) and €2.1 to €17.9 million (vs Rayner C-/Super-flex).ConclusionIncidence of Nd:YAG capsulotomy due to the choice of IOL could significantly affect healthcare budgets in the post-cataract surgery period. Our analysis indicates that single-piece monofocal AcrySof IOLs is the most cost-saving treatment option for health care systems when compared to other acrylic single-piece IOLs.

Virtiol - Simulation of Quality of Vision with Multifocal and Edof Intraocular Lenses.

This was an experimental study involving atotal of 20 volunteers with artephakia (35 eyes). Each volunteer rated 5 types of IOLs, 4 presbyopia-correcting IOLs - WIOL-CF, Tecnis Symphony ZXR00, Acrysof IQ PanOptix TFNT00, M-flex 630 F, and as areference lens, we used the monofocal IOL Acrysof SA60AT. The corrected distance visual acuity (CDVA), distance corrected intermediated visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were measured. Additionally, volunteers evaluated the quality of vision under normal or changed lighting conditions, and ranked IOL on scale from 1 to 5. The CDVA evaluated using the VirtIOL device was very good for all tested IOLs (0.04-0.09 log MAR) with minimum differences. However, CDVA without simulator (-0.01 logMAR) was statistically significantly better in all cases. DCIVA was also very similar in each of the investigated IOLs, surprisingly even with monofocal IOL (0.21-0.23 logMAR), without using simulator the DCIVA was statistically significantly worse (0.36 logMAR). The DCNVA was the best for PanOptix intraocular lens (0.22 logMAR); M-flex, Symphony and WIOL-CF lenses had comparable results (0.31-0.34 logMAR). Again, surprisingly similar results were obtained with the use of monofocal IOL (0.36 ± 0.14). Subjective perception of vision through the IOLs was best rated for the monofocal control IOL, whereas Symphony, WIOL-CF and M-flex did not show any statistically significant difference either with or without glare. All tested IOLs were statistically significantly better if compared to PanOptix with or without glare. Simulation of vision through IOLs using VirtIOL simulator allows to compare different models of multifocal IOLs from the viewpoint of visual acuity and subjective perception. However, some caution should be exercised when evaluating the results, given that in our experiments, the monofocal IOL achieved relatively good results at near distance, which does not correspond to clinical experience. On the contrary, from the comparison of the results of CDVA without and with VirtIOL, it is obvious that visual acuity is slightly adversely affected by added optics.