Adjustable Intraocular Lens Research Articles

Panuveitis after ultraviolet light treatments for light adjustable intraocular lens.

To resport a case of panuveitis after light adjustable intraocular lens (LAL) implantation and ultraviolet (UV) light treatment. Case report. A 68-year-old woman with a history of herpes zoster without ocular involvement presented with panuveitis in her right eye two weeks after a UV light lock-in treatment for a recently implanted LAL. An infectious and inflammatory workup was only notable for positive HSV-1 and VZV IgG, but the patient did not have any history of ocular HSV or VZV. Over the course of five months, the panuveitis resolved completely with topical steroids and the patient had a good visual outcome. Though causality cannot be established in this case, physicians should be aware of the possibility of uveitis after UV light treatments. Extra caution should be observed in patients with history of herpetic disease.

Thermo-sensitive Poloxamer based antibacterial anti-inflammatory and photothermal conductive multifunctional hydrogel as injectable, in situ curable and adjustable intraocular lens

Cataract patients look forwards to fewer postoperative complications and higher vision quality after surgery. However, the current intraocular lens (IOL) implanted after cataract surgery neither can adjust focal length in response to ciliary muscle contraction as natural lens nor have the ability to prevent postoperative complications. Herein, a thermosensitve Poloxamer based hybrid hydrogel with antibacterial anti-inflammatory and photothermal functional elements doping was designed and used as injectable, in situ curable, and adjustable IOL (FHTAB IOL). The FHTAB IOL was composed of thermosensitve triblock-polymer F127DA and a small amount of HAMA, combined with BP NS, TA, and Ag NPs. FHTAB IOL can be injected into the empty lens capsule after cataract surgery via an injectable thermos-gel under NIR illumination and then be rapidly cured to form a full-size IOL under short-time blue light irradiation. The designed injectable FHTAB IOL possesses high transparency and transmittance, with a refractive index similar to the natural lens and adjustable properties. It was stabilized as a refractive medium without any leakage in the eye. In addition, the TA and Ag NPs loaded in the FHTAB IOL displayed significant antibacterial and anti-inflammatory effects in vitro and vivo. This study presents a potentially effective new strategy for the development of multifunctional adjustable IOLs.

Two-way adjustable double-knots intrascleral fixation and single sclerotomy looping technique: a novel minimal invasive adjustable intraocular lens fixation technique

BackgroundIOL fixation without capsular support presents challenges for surgeons. Although innovative techniques were developed to address subluxated IOLs, adjustable IOL fixation methods are seldom reported. We introduce a novel two-way adjustable double-knots intrascleral fixation combined with single sclerotomy looping technique for fixing intraocular lenses (IOL) or IOL-capsular bags.MethodsA bent 30-gauge needle threaded with 8 − 0 polypropylene was introduced into the eye. A gripping forceps assisted the haptic looping. Two overhand knots were made with 8 − 0 polypropylene thread. The knots were incarcerated into a scleral tunnel made by a 30-gauge needle, with two ends of the thread left at each side of the tunnel. The IOL was adjusted to the premium position with adequate tension by pulling either end of the threads. The study included 19 eyes with aphakia, subluxated IOL-capsular bags, or subluxated crystalline lenses. The mean followed up period was 18.9 ± 7.1 months with evaluations of uncorrected visual acuity (UCVA), intraocular pressure, slit-lamp examination, and swept-source optical coherence tomography of the anterior segment.ResultsUCVA increased from 1.28 ± 0.74 at baseline to 0.44 ± 0.51 (logMAR) at final visit (P < 0.001). All IOLs were fixed well-centered. The mean IOL tilt was 3.5°±1.1°. Postoperative complications included transient IOP elevation (15.8%), hypotony (10.5%), and cystoid edema (5.3%) which resolved within 4 weeks.ConclusionsWe presented a novel adjustable technique for IOL fixation, which stabilize IOLs by using an intrascleral double-knots structure. This technique minimized surgical manipulations by using a single sclerotomy looping technique without large conjunctival dissection and scleral flap creation. The technique offers a reliable and optimal IOL positioning and improved visual outcomes in patients undergoing scleral fixed IOL implantation.

Light adjustable intraocular lenses in cataract surgery: considerations.

Light adjustable intraocular lens (LAL) is a promising concept in cataract surgery. This review explores considerations for the use of LALs. Through updates, the safety of LALs and light delivery devices have been enhanced, enabling more efficient treatment with lower ultraviolet (UV) energy. Preoperative topography and aberration are essential for understanding indications for LALs. Furthermore, when determining intraocular lens power, it is crucial to factor in potential postoperative myopia or hyperopic adjustments. This is achieved by establishing a proper postimplantation refractive target and considering potential wavefront changes. Postoperative adjustments for defocus and astigmatism have demonstrated excellent outcomes. Monovision strategy by adjustable blended vision of LALs revealed distance vision of 20/20 along with near vision of J2 in 96% of patients. However, the results of clinical studies on postrefractive cataract surgery showed contrasting outcomes at distance, indicating the need for further research results regarding its effectiveness. A new postoperative workflow needs to be designed to enable a systematic follow-up process. LALs are safe and demonstrate promising refractive outcomes. To achieve appropriate results, understanding the changes in optical characteristics associated with adjustment and constructing a new postoperative workflow are necessary.

New Nitinol-based Thermomechanically Adjustable IOL Technology.

To evaluate the feasibility of new adjustable intraocular lens (IOL) technology. The foldable adjustable IOL consists of a nitinol mechanism placed in a haptic-optic cradle. Heating actuators on the nitinol mechanism with a continuous green laser achieve controlled movement of the mechanism and optic. Activation occurs in controlled steps: rotation in 1-degree steps over 360 degrees, and anterior posterior movement in 0.25-diopter (D) steps with a range of +1.50 D. The IOL was tested in vitro and in vivo in a rabbit eye. Foldability and unfolding were demonstrated through a 2.6-mm cartridge. The adjustable lens mechanism was successfully tested in vitro and in vivo. Activation resulted in a change in optic position relative to the haptics and the capsular bag. Activation of the lever and ratchet mechanism showed radial advancement of the IOL clockwise and counterclockwise. In vivo rotatory movement was achieved after activation by the argon laser at 1 week after implantation. Anterior to posterior movement was accomplished by activating the circular spring actuator mechanism in the laboratory model. Uneventful folding and unfolding were performed. A new adjustable IOL with a mechanism that responds in measured steps had been shown to move as planned after activation by argon laser. This was successful in the laboratory in both radial and anterior posterior movement. The radial movement was also proven in vivo in an animal model. Further refinement of the prototype is currently being undertaken. [J Refract Surg. 2023;39(10):662-667.].

Comparing Visual Outcomes of Light Adjustable Intraocular Lenses in Patients With and Without Prior History of Corneal Refractive Surgery

To assess visual outcomes of light adjustable intraocular lens (LAL; Calhoun Vision, Inc) implantation after cataract extraction in patients with a history of corneal refractive surgery. The records of patients who received LALs with and without a history of corneal refractive surgery were retrospectively reviewed. Data for 51 eyes (30 patients) with a history of corneal refractive surgery and 52 eyes (44 patients) without refractive surgery were analyzed. A total of 36 eyes of patients with and 43 eyes of patients without a history of corneal refractive surgery had 12-month follow-up data available. The primary outcomes evaluated were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). At 12 months, 31% of eyes with a history of corneal refractive surgery had a UDVA of 20/20 or better and 97% of eyes were 20/40 or better. In contrast, 63% of patients with no history of corneal refractive surgery had 20/20 UDVA or better at 12 months and 100% were 20/40 or better. Of patients with a history of corneal refractive surgery, 55% and 83% of eyes at 12 months were within ±0.50 and ±1.00 diopters, respectively, of the target refraction compared to 89% and 96% of eyes without a history of corneal refractive surgery. LALs are a promising platform for achieving excellent visual outcomes following cataract surgery. Patients with a prior history of corneal refractive surgery can achieve excellent visual outcomes with the LAL. However, this study found that patients with a history of corneal refractive surgery demonstrated less predictable visual acuity outcomes when compared to patients without a history of corneal refractive surgery. [J Refract Surg. 2023;39(5):311-318.].

Use of Adjustable Intraocular Lens After Cataract Surgery in a Patient With Post-LASIK Ectasia Stabilized With CXL

PURPOSE: To describe a case of a patient who developed corneal ectasia after laser in situ keratomileusis and first underwent corneal cross-linking, followed by sequential cataract surgery with implantation of the Light Adjustable Lens (RxSight). METHODS: Case report. RESULTS: The patient had a good postoperative outcome with an uncorrected visual acuity of 20/20 at distance and 20/30 at near. The patient reported overall satisfaction with the outcome. CONCLUSIONS: Despite careful planning and proper lens selection, refractive surprises are not uncommon when performing cataract surgery in eyes that have had refractive surgery or eyes with corneal ectasia after refractive surgery. In these cases, the Light Adjustable Lens may be a good option to achieve the desired postoperative refractive outcome. [ Journal of Refractive Surgery Case Reports. 2021;1(1):e2–e5.]

Light Adjustable Intraocular Lens for Cataract Surgery After Radial Keratotomy

To describe a case of light adjustable lens implantation after radial keratotomy. A patient with a 30-year history of radial keratotomy subsequently underwent phacoemulsification with implantation of intraocular light adjustable lenses. Serial refractions were performed at varying hours of the day postoperatively and were repeated for 3 months. The light adjustable lenses were adjusted twice, and the refractive power of the implant was eventually locked. The patient was able to achieve uncorrected distance visual acuity of 20/25 in both eyes, improving from 20/125 in the right eye and 20/80 in the left eye, with no surgical complications. The authors report the first case of light adjustable lens implantation after radial keratotomy, which has yielded promising results for mitigating intraocular lens miscalculations after radial keratotomy. [J Refract Surg. 2020;36(12):852-854.].

Photoreversibility and Biocompatibility of Polydimethylsiloxane-Coumarin as Adjustable Intraocular Lens Material.

Polydimethylsiloxane (PDMS) constitutes an interesting material for a variety of biomedical applications, especially as intraocular lenses (IOLs), for its excellent transparency. In this work, a photoreversible PDMS-coumarin network, whose shape and properties can be adjusted postoperatively in a noninvasive manner, is developed. The synthesis of PDMS-coumarin is achieved by amidation of a coumarin acid chloride derivative with amine-functionalized PDMSs. Under exposure of λ > 300 nm, these polymers can be cured by dimerization of coumarin. The cured polymers can be uncrosslinked via photocleavage of cyclobutane dimers upon illumination at λ < 290 nm. The diffusion of linear PDMSs in a crosslinked network and the controlled shape modification are studied, which demonstrate that these polymers are good candidates for adjustable IOL application. IOL disks prepared from these materials show high hydrophobicity and good transparency. In vitro cytotoxicity, lens epithelial cell adhesion assays, and rabbit host reaction against implanted disks demonstrate the biocompatibility of the polymer.

Latest research progress of adjustable intraocular lens

Latest research progress of adjustable intraocular lens

Evaluation of stability and capsular bag opacification of a new foldable adjustable intraocular lens.

Incorrect lens power remains one of the most common reasons for intraocular lens explantation/exchange. We evaluated stability and effect on capsular bag opacification of a new foldable modular lens system, with a base component and an optic component in rabbit eyes. Bilateral phacoemulsification was performed on six rabbits; one eye received the test lens (Harmoni Modular Lens, ClarVista Medical), whereas the other received a single-piece hydrophobic acrylic control lens (SA60AT, Alcon). Slit-lamp examinations were performed at postoperative weeks 1, 2, 3, 4 and 6. All rabbits were sacrificed at week 6. After enucleation, the eyes were examined grossly from the Miyake-Apple view. Following, all globes were sectioned and processed for histopathological examination. The modular lens was stable in all six rabbits. Uveal biocompatibility was similar to or better in the test eyes when compared with control eyes up to 6 weeks postoperatively. Overall, capsular bag opacification was found to be significantly lower in the test eyes when compared with control eyes. At the 6-week gross examination, central posterior capsule opacification was scored as 0.58 ± 0.73 in the test group, and as 3.00 ± 1.26 in the control group (paired two samples for means t-test; two-tail P = 0.005). The Harmoni Modular system remains stable within the capsular bag after implantation. Due to the design of the base component featuring long loops, along with peripheral anterior and posterior square edges, the lens appeared to prevent overall capsular bag opacification in the rabbit model.

Light-adjustable intraocular lens in post-LASIK and post-traumatic cataract patient

The case illustrates the use of a light-adjustable intraocular lens (IOL) in a patient who had had refractive surgery and developed blunt trauma with resultant flap damage and traumatic cataract. Consistent with early reports of the light adjustable IOL, which show positive results in non-LASIK eyes, this case suggests that the light-adjustable IOL may have similar benefits in the post-LASIK eye and other complex situations.

Clinical Evaluation of an Ultraviolet Light Adjustable Intraocular Lens Implanted after Cataract Removal: Eighteen Months Follow-up

To determine the effectiveness of a light-adjustable intraocular lens (LAL) that can be adjusted postoperatively using ultraviolet (UV) irradiation. A prospective, nonrandomized clinical trial was conducted at Center for Vision Science, Ruhr University Eye Clinic, in Bochum, Germany. We included 122 eyes of 91 patients with significant cataract. All patients had a visually significant cataract and were willing to volunteer for the trial. Participants underwent small-incision phacoemulsification followed by implantation of a LAL and were treated with a spatially profiled UV light delivered by a digital light delivery device to induce a targeted spherical and cylindrical refractive change postoperatively. Once the desired correction was achieved, the LAL was treated again to lock in the lens power. Distance visual acuity and manifest refraction was determined with follow-up time to determine the achieved refractive corrections and their stability. We measured uncorrected visual acuity and best corrected visual acuity achieved versus targeted refractive outcome and refractive stability with a follow-up time of 18 months. Residual postoperative refractive errors of 0.96 ± 0.85 diopters (D) in sphere and -0.98 ± 0.50 D in cylinder were corrected and stable over a follow-up time of 18 months. Final refraction achieved was 0.03 ± 0.17 D in spherical equivalent refraction. Residual spherocylindrical errors up to 2.25 D in sphere and -2.75D in cylinder were successfully corrected with precision. The LAL technology has the potential individually to correct postoperative refractive errors precisely. The achieved refractive corrections are stable for up to 18 months. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Combined Correction of Axial Hyperopia and Astigmatism Using the Light Adjustable Intraocular Lens

To determine whether residual spherical and cylindrical errors could be corrected postoperatively using spatially profiled UV light irradiation in patients with axial hyperopia undergoing cataract surgery and implantation of a light adjustable, silicone intraocular lens (LAL). We conducted a prospective, nonrandomized clinical trial. The LALs were implanted in eyes with axial lengths <22.20 mm and were treated with a spatial intensity profile delivered by a digital light delivery device to induce a targeted spherical and cylindrical refractive change postoperatively. Once the desired correction was achieved, the LAL was treated again to lock-in the lens power. We studied 15 eyes of 15 patients with axial hyperopia. The manifest refraction, uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BCVA) were determined with follow-up time of 12 months to determine the achieved refractive corrections and their stability. We measured UCVA, BCVA, achieved versus targeted refractive outcome, and refractive stability with a follow-up time of 12 months. Of 15 eyes, 14 (93%) achieved ± 0.5 diopters (D), and 10 (67%) were within ± 0.25 D of the targeted refractive adjustment up to 12 months postoperative follow-up. Only 1 treated eye showed a change of 0.38 D in manifest spherical equivalent refraction, the remaining 14 eyes showed <0.25 D change between 1 month post lock-in, and at the 3-, 6-, and 12-month postoperative visits. The light-adjustable lens is a promising technology with the potential to reduce the rate of postoperative refractive surprises up to 2 D of spherical and cylindrical errors after cataract surgery. Postoperative refractive errors were successfully corrected with precision and significant improvement in UCVA and without compromising BCVA using the light-adjustable intraocular lens technology. The data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures.

Adjustierung von sphärozylindrischen Refraktionsfehlern bei hyperopen Augen: 6 Monatsergebnisse nach Kataraktchirurgie und Implantation einer lichtadjustierbaren Intraokularlinse

The aim of this study was to determine whether residual spherical and cylindrical errors could be corrected postoperatively in a non-invasive manner using ultraviolet irradiation in patients with axial hyperopia undergoing cataract surgery and implantation of a light-adjustable lens, silicone intraocular lens (LAL) (Calhoun Vision, Pasadena, CA). In a prospective, non-randomised clinical trial at Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany, 15 eyes of 15 patients with axial hyperopia (less than 22.2 mm) were studied. The manifest refraction, uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) were determined with a follow-up time of six months to determine the achieved refractive corrections and their stability. The adjustment and lock-in procedures were well tolerated by patients. Preoperative refraction was in mean + 2.56 D as spherical equivalent, postoperative before adjustment + 1.01 D, one month after lock-in procedure + 0.03 D, after 3 months + 0.12 D and after 6 months 0.0 D (± 0.21 D). 6 months after lock-in all patients reached an uncorrected visual acuity of 20/30 or better, 10 of 15 patients reached 20/25 and 1 patient 20/20. The data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures. Postoperative refractive errors were successfully corrected with precision and significant improvement in UCVA and without compromising BSCVA using the light adjustable intraocular lens technology. Our data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures. The light-adjustable lens is a promising technology with the potential to eliminate postoperative refractive surprises of up to 2 diopters of refractive and cylindrical error following cataract surgery.

Clinical Results With the Light Adjustable Intraocular Lens After Cataract Surgery

The accuracy of intraocular lens (IOL) calculation is limited by the variation of the measurement of corneal power, axial length, anterior chamber depth, and effective postoperative lens position. Therefore, IOL predictability is limited. The aim of this study was to evaluate the performance of the novel light adjustable lens (LAL, Calhoun Vision). Ten eyes with cataracts (seven patients) were included. After standard phacoemulsification, the LAL was implanted. Two to 3 weeks after surgery, all IOL adjustments had been completed. Preoperatively, pre-adjustment, pre-lock-in, and 1 month post-lock-in, a full ophthalmic examination including objective (autorefraction) and subjective refraction (ie, manifest uncorrected visual acuity [UCVA] and manifest best spectacle-corrected visual acuity [BSCVA]) and topography were performed. All cataract surgeries were performed with no complications. Two weeks after surgery, the mean refraction was +0.78+/-0.79 diopters (D). After adjustment and lock-in, the refraction was -0.07+/-0.21 D. In 4 of 10 eyes, second adjustments were necessary. One month after surgery, all patients were within +/-0.50 D of the intended refraction. Preoperatively, the cylinder was 0.88+/-0.77 D, but was reduced after adjustments to 0.15+/-0.20 D. Mean UCVA was 1.02, and all eyes gained at least two lines on the Snellen visual acuity test (ie, BSCVA) after surgery. The LAL is a new IOL with the ability to correct up to 2.00 D of sphere and cylinder after implantation. Our first clinical results are promising and indicate effective safety and stability.

Correction of Residual Hyperopia After Cataract Surgery Using the Light Adjustable Intraocular Lens Technology

Correction of Residual Hyperopia After Cataract Surgery Using the Light Adjustable Intraocular Lens Technology

Correction of Residual Hyperopia After Cataract Surgery Using the Light Adjustable Intraocular Lens Technology

To determine whether residual hyperopia could be corrected postoperatively using the light adjustable lens technology in patients undergoing cataract surgery and light adjustable lens implantation. Prospective, nonrandomized clinical trial. Fourteen eyes of 14 patients were studied. The manifest refraction, uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were determined with follow-up time to determine the achieved refractive corrections and their stability. Of 14 eyes, 13 eyes (92.9%) achieved +/- 0.25 diopters (D) of the target refraction at one day post lock-in, with 100% of the eyes achieving the targeted refractive adjustment within 0.5 D or better up to six months postoperative follow-up. All eyes treated show no change in manifest spherical refraction >0.25 D between one day post lock-in, and three and six months postoperative visits. The data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures. The mean rate of change was 0.006 D per month, which is six times more stable than that of refractive procedures. Residual hyperopia errors in the range of +0.25 to +2.0 D were successfully corrected with precision and significant improvement in UCVA and without compromising BCVA using the light adjustable intraocular lens technology.

Long‐term results of cataract surgery with implantation of a mechanically, reversibly adjustable intraocular lens: *Acri.Tec AR‐1 PC/IOL

Abstract Purpose To investigate long‐term safety and function of a mechanically, reversibly adjustable intraocular lens in human eyes Methods Clinical long‐term monitoring of the initial 38 eyes of 38 patients with senile cataract after implantation of the *Acri.Tec AR‐1 PC/IOL including a control group. Results Median follow‐up was 25 (range 6 to 52 months). Throughout the entire period of observation all eyes were behaving clinically in the same way as if implanted with a conventionel PC/IOL. 2 eyes were adjusted surgically 2 weeks after implantation. 19/38 eyes underwent Nd:YAG laser capsulotomy after a median period of 12 (range 6 to 43) months after implantation. Median change of spherical equivalent between 1 month and the last visit was 0 (range – 0.5 to + 0.5) diopters. At the last visit median best visual acuity was 0.7 (range 0.2 to 1.0) for eyes with the *Acri.Tec AR‐1 PC/IOL and 0.8( range 0.3 to 1.0) for the control group. Both eyes having undergone adjustment surgery had visual acuity of 0.8 rsp 1.0 with stable refractions 45 rsp. 42 months after adjustment surgery. Conclusion The *Acri.Tec AR‐1 PC/IOL implanted into the capsular bag of adult human eyes is a safe PC/IOL. Refraction is predictably adjustable after implantation. It remains stable before and after Nd:YAG laser capsulotomy or after surgical adjustment of the refraction. This type of IOL may prove helpful especially in pediatric cataract surgery to avoid the development of amblyopia and in adults when precise refractive outcome is important either because of individual preference of the patient for a preferred refraction or because of intendend monovision to reduce spectacle dependence to a minimum. Commercial interest

Intraocular lenses in children

Intraocular lenses in children