Anterior Capsule Opacification Research Articles

Effect of primary posterior continuous curvilinear capsulorhexis on clinical performance of ACR6D SE single-piece hydrophilic acrylic intraocular lenses

To evaluate the effects of a primary posterior continuous curvilinear capsulorhexis (PCCC) on the clinical performance of a single-piece hydrophilic acrylic intraocular lens (IOL) with haptic angulation. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. A prospective study of 52 patients with bilateral age-related cataract was conducted. Patients had standard cataract surgery with implantation of the same IOL in both eyes. Randomly, a PCCC was created in 1 eye and the posterior capsule was left intact in the fellow eye. Assessed parameters were visual axis opacification (VAO) in eyes with a PCCC or regeneratory posterior capsule opacification (PCO) in eyes without PCCC (scale 0 to 10) in the central (3.0 mm eccentricity), intermediate (3.0 to 4.5 mm eccentricity), and peripheral (>4.5 mm eccentricity [capsulorhexis edge]) areas; neodymium:YAG (Nd:YAG) laser capsulotomy or laser polishing of ongrowing lens epithelium; anterior capsule opacification (ACO); best corrected visual acuity (BCVA); and contrast sensitivity. Thirty patients completed the 2(1/2)-year follow-up. Visual axis opacification was significantly lower in the central region in the PCCC group (mean 0.5 +/- 0.7 [SD]) than PCO in the central region of the non-PCCC group (mean 1.1 +/- 1.1) (P = .02). Forty percent in the non-PCCC group had an Nd:YAG laser capsulotomy during the follow-up period; none in the PCCC group had laser polishing. There were no significant differences in ACO, SE, BCVA, or contrast sensitivity. There was no additional gain in BCVA or contrast sensitivity in eyes with a PCCC compared with eyes without a PCCC when VAO and PCO were low. A PCCC significantly reduced PCO formation within the central 3.0 mm eccentricity as well as the need for Nd:YAG laser capsulotomy in eyes with a single-piece hydrophilic acrylic IOL with angulated haptics.

Clinical effects of primary posterior continuous curvilinear capsulorhexis in eyes with single-piece hydrophilic acrylic intraocular lenses with and without haptic angulation

To evaluate the clinical effects of a primary posterior continuous curvilinear capsulorhexis (PCCC) on the intraocular performance of hydrophilic acrylic single-piece intraocular lenses (IOLs) with and without haptic angulation. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. A prospective study comprised 52 patients with bilateral age-related cataract who had standard cataract surgery including a PCCC. One eye of each patient was randomized to receive a hydrophilic acrylic IOL with haptic angulation (ACR6D SE, Laboratoires Cornéal) and the contralateral eye, a hydrophilic acrylic IOL without haptic angulation (C-flex 570C, Rayner). The following parameters were assessed: regeneratory posterior opacification (RPO) in the central, intermediate, and peripheral areas (scale 0 to 10); anterior capsule opacification (ACO); best corrected visual acuity (BCVA); and contrast sensitivity (CSF). Thirty-one patients completed the 1(1/2)-year follow-up. In both IOL groups, RPO within the PCCC was slight in the central area, with a mean score of 0.33 +/- 0.84 (SD) in the angulated IOL group and 0.16 +/- 0.57 in the nonangulated IOL group (P = .29). The mean RPO score in the peripheral area was 2.07 +/- 1.37 and 2.35 +/- 1.45, respectively (P = .12). The difference between the central and peripheral areas was 1.74 in the angulated IOL group (P<.00001) and 2.19 in the nonangulated IOL group (P<.00001). Haptic deformation occurred in 9 eyes (29%) with an angulated IOL and no eye with a nonangulated IOL. There was significantly more ACO in the nonangulated IOL group (P = .012). There were no significant differences in BCVA or CSF between the 2 groups. Creating a PCCC led to significantly lower RPO intensity within the PCCC area than in the peripheral area in eyes with hydrophilic acrylic IOLs with and without haptic angulation. Haptic angulation had no apparent significant influence on the intensity of RPO or on BCVA and CSF. Haptic deformation may occur in hydrophilic IOLs with angulated haptics.

Effect of lens epithelial cell aspiration on postoperative capsulorhexis contraction with the use of the AcrySof intraocular lens

To determine whether aspiration of lens epithelial cells (LECs) from under the anterior capsule reduces postoperative contraction of the capsulorhexis aperture. Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom. This prospective randomized observer-masked study comprised 100 patients who had routine phacoemulsification by the same surgeon at a district general hospital in the United Kingdom. The postoperative changes in capsulorhexis apertures and anterior capsule opacification (ACO) between Group A (aspiration of LECs) and Group B (control) were compared. Digital retroillumination images of the capsulorhexis aperture were taken 1 week and 3 months postoperatively. The area of capsulorhexis aperture was determined with computer software, and capsule opacification was graded subjectively. Three months postoperatively, the mean decrease in capsulorhexis aperture was 1.9% in Group A and 5.6% in Group B (P = .02). The ACO at 3 months was grade 2 in 44% of eyes in Group A and in 61% in Group B (P = .13). Aspiration of LECs from the anterior capsule was a safe procedure that reduced capsulorhexis aperture contraction 3 months after cataract surgery.

Effect of anterior capsule polishing on the posterior capsule opacification–inhibiting properties of a sharp-edged, 3-piece, silicone intraocular lens

To evaluate the long-term effects of anterior capsule polishing on regeneratory posterior capsule opacification (PCO), anterior capsule opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL) with sharp optic edges. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. This prospective bilateral randomized patient- and examiner-masked clinical trial comprised 130 eyes of 65 patients with bilateral age-related cataract. All eyes had implantation of a 3-piece silicone IOL with a truncated, sharp-edged optic (CeeOn Edge 911A, Advanced Medical Optics). In 1 eye, the anterior capsule was extensively polished using an aspiration curette after phacoemulsification and cortex aspiration. Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were graded subjectively 1, 2, 3, and 5 years postoperatively. The mean ACO score was significantly lower in the eyes in which the anterior capsule had been polished (1 year, P<.02; 2 years, P<.03; 3 years, P<.01; 5 years, P<.01). The mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups was not statistically significant. Three years after cataract surgery, eyes in which the anterior capsule had been polished had significantly less ACO. However, polishing did not lower PCO intensity when a sharp-edged CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior capsule polishing may enhance the development of regeneratory PCO, this trend did not reach statistical significance.

Poster 69: Anterior Capsular Contraction Syndrome Following Cataract Extraction

Purpose: To evaluate the long-term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO).Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.Methods: This randomized double-blind study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients received round-edged intraocular lenses (IOLs); 26 received an SI-40 IOL (Advanced Medical Optics Inc.) in both eyes, and 26 received a Silens6 IOL (Domilens) in both eyes. Both IOLs consist of different silicone material and have different haptic angulation. The SI-40 IOL has 13.0 mm open-loop poly(methyl methacrylate) (PMMA) haptics angulated by 10 degrees. The Silens6 IOL has 12.5 mm open-loop PMMA haptics with no angulation. In 1 eye, the anterior capsule was extensively polished. The anterior capsule was left unpolished in the contralateral eye, which acted as a control. Digital slitlamp photographs of the ACO and fibrotic PCO were taken with a standardized technique for 3 years postoperatively. The intensity of ACO was measured objectively (score 0% to 100%) using Adobe Photoshop software. Fibrotic PCO was graded subjectively (score 0 to 4).Results: The mean ACO was 17% in the polished eyes and 26% in the control eyes (P = .0001). The mean fibrotic PCO score was 0.5 and 1.0, respectively (P = .0007). The mean ACO was 15% in the polished SI-40 eyes and 26% in the control SI-40 eyes (P = .01). It was 19% in the polished Silens6 eyes and 26% in the control Silens6 eyes (P = .003). The mean fibrotic PCO score was 0.4 in the polished SI-40 eyes and 1.1 in the control SI-40 eyes (P = .0006). It was 0.6 in the polished Silens6 eyes and 0.9 in the control Silens6 eyes (P = .08).Conclusions: Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round-edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.

Interlenticular opacification: Dual-optic versus piggyback intraocular lenses

To evaluate and compare the incidence of capsular bag opacification, particularly interlenticular opacification (ILO), in rabbit eyes implanted with a dual-optic silicone intraocular lens (IOL) or piggyback lenses. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Ten dual-optic study IOLs (Synchrony), 10 control pairs of piggyback silicone-plate lenses, and 10 control pairs of piggyback single-piece hydrophobic acrylic lenses were implanted in the capsular bag of 30 rabbit eyes following phacoemulsification. After a 6-week follow-up, the rabbits were killed and their eyes enucleated. Anterior capsule opacification and posterior capsule opacification were graded on a 0 to 4 scale from a posterior or Miyake-Apple view. Interlenticular opacification was noted in relation to the center of the interlenticular space (periphery, paracentral, and central area) and to the number of quadrants involved. The eyes were then evaluated histopathologically. Postoperative inflammatory reaction was similar in all groups. Interlenticular opacification formation was statistically different among the 3 groups of lenses (ILO extension, P = .0013, and ILO extension x ILO quadrants, P = .0023; Kruskal-Wallis test). Pairwise post comparisons of ILO formation showed that the differences between the study IOL group and the silicone-plate lens group were not significant. Interlenticular opacification post comparisons between the hydrophobic acrylic lenses and the study lens or the silicone-plate lenses were significant (P = .002 and P = .001, respectively). Histopathologic examination showed extension of the proliferating cortical material from the peripheral Soemmering's ring into the interlenticular space, causing ILO, especially with the pairs of hydrophobic acrylic lenses. In this rabbit model, ILO was significantly associated with pairs of hydrophobic acrylic lenses implanted in the bag. This study appears to confirm clinical observations that implantation of 2 silicone-plate lenses in the bag is not associated with ILO. There was also a relative lack of ILO with the dual-optic silicone lens.

Effect of Optic Material and Haptic Design on Anterior Capsule Opacification and Capsulorrhexis Contraction

To examine the influence of optic material (silicone and hydrophobic acrylic) and haptic design (one-piece and three-piece open loop) of sharp optic edge intraocular lenses (IOL) on anterior capsule opacification (ACO) and capsulorrhexis contraction. Randomized, controlled, double-blind clinical trial with intraindividual comparison. This study was performed at the Department of Ophthalmology, Medical University of Vienna, Austria, and comprised 210 eyes of 105 patients with bilateral age-related cataract. In group 1 (n = 53 patients), a three-piece acrylic IOL was compared with a three-piece silicone IOL. In group 2 (n = 52 patients), the three-piece acrylic IOL was compared with the one-piece acrylic IOL. One year after the operation, standardized digital slit-lamp images of ACO were taken; 1 week and 1 year after the operation, digital retroillumination images were taken to assess capsulorrhexis size. The intensity of ACO was graded objectively (score, 0% to 100%), and the capsulorrhexis area (square millimeters) was determined objectively. One year after surgery, the mean ACO score was 21% for the acrylic and 20% for the silicone IOL (P = .4) in group 1 and 18% for both the three-piece and one-piece acrylic IOLs (P = .87) in group 2. Concerning the amount of capsulorrhexis contraction, there was no significant difference between the IOL types that were evaluated in this study (after Bonferroni-Holm correction, P > .05). In the hydrophobic sharp optic edge IOLs that were examined, neither the optic material nor the haptic design had an influence on the amount of ACO or capsulorrhexis contraction.

Evaluation of posterior capsule opacification using a new posterior view method in rabbits

To introduce a new procedure for evaluating posterior capsule opacification (PCO) in rabbit eyes and to perform a comparative study of the single-piece and 3-piece acrylic intraocular lenses (IOLs) on PCO using the new evaluation method. Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. A single-piece or 3-piece acrylic IOL was implanted in 1 eye and the other in the contralateral eye of 5 rabbits. Three weeks after surgery, PCO was scored by Evaluation of Posterior Capsule Opacification (EPCO) in posterior view. Before the posterior view was photographed, the anterior capsule was removed from the whole optic area to eliminate disturbing anterior capsule opacification (ACO) for the PCO evaluation. Posterior capsule opacification could be well observed and viewed in the posterior view so that it could be scored by EPCO without confusion with ACO. The mean PCO score of the single-piece and 3-piece acrylic IOLs was 3.12 +/- 0.19 and 2.41 +/- 0.70, respectively (P < .05 and P = .03, respectively). The removal of ACO allowed scoring of PCO by EPCO in rabbit eyes. The single-piece acrylic IOL showed significantly more PCO than the 3-piece acrylic IOL at least 3 weeks after surgery in rabbits.

Relationship between anterior capsule contraction and posterior capsule opacification after cataract surgery in patients with diabetes mellitus

Relationship between anterior capsule contraction and posterior capsule opacification after cataract surgery in patients with diabetes mellitus

Influence of optic edge design, optic material, and haptic design on capsular bend configuration

To assess and classify capsular bend configuration at the optic rim and its association with posterior capsule (PCO) and anterior capsule opacification (ACO) and capsulorhexis contraction with various intraocular lenses (IOLs). Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. A total of 659 post-cataract surgery eyes of 370 patients from different prospective randomized studies were evaluated. All eyes had standardized phacoemulsification surgery with implantation of an IOL in the capsular bag. The IOLs had a sharp or round optic edge design and were made of silicone, acrylic, or poly(methyl methacrylate) optic materials. One year postoperatively, the configuration of the capsular bend at the optic rim was assessed at the slitlamp, and standardized slitlamp images of ACO and fibrotic PCO were taken. One week, 1 year, and 3 years postoperatively, digital retroillumination images were taken for objective quantification of regeneratory PCO and the capsulorhexis area. The outcome measures were the type of capsular bend configuration, ACO score (0% to 100%), regeneratory PCO score (0 to 10), fibrotic PCO score (0 to 3), and amount of capsulorhexis contraction (mm(2)). Four main types of capsular bend configuration were classified: parallel, "Y," right angle, and wrapping. The right-angle type was observed in the most cases (52%). Eyes with a wrapping capsular bend configuration had significantly less PCO, more capsulorhexis contraction, and more ACO than eyes with the other configurations. Wrapping capsule configuration was seen most often (55%) in round-edged silicone IOLs that had a thin optic rim. The design and material of IOLs influenced the long-term capsular bend configuration at the optic rim. The right-angle type was the most common capsular bend configuration. Intraocular lenses with silicone optic material and a thin optic rim caused a wrapping capsule configuration and resulted in more capsulorhexis contraction and ACO, but less PCO.

Late calcific deposition on the hydrophilic acrylic MemoryLens

Tehrani et al.1 presented a series of cases of late postoperative opacification of the MemoryLens intraocular lens (IOL) (Ciba Vision). We too have noted late optic opacification of the MemoryLens in a case that required IOL explantation. A 75-year-old man with insulin-dependent diabetes mellitus had uneventful cataract extraction with implantation of a 21.5 diopter Mentor MemoryLens in the left eye in August 1999. Over the next several years, the patient noted a steady decline in his visual acuity, attributed to progressive diabetic retinopathy. In April 2003, an examination revealed a best corrected visual acuity of counting fingers at 1 meter in the left eye and a well-positioned posterior chamber IOL in the capsular bag with fine deposits scattered over the anterior optic surface and moderate anterior capsule opacification, producing a diffuse haze that made visualization of the posterior capsule and retina difficult. In June 2003, 46 months after implantation, the IOL was explanted, although adherence of the posterior optic surface to the capsule made IOL removal from the capsular bag impossible, necessitating removal of the capsule and the IOL. After an anterior chamber IOL was implanted, the patient's postoperative visual acuity was 20/400 secondary to diabetic retinopathy. Histopathologic examination of the IOL optic showed calcium deposition on the anterior and posterior optic surfaces (Figure 1).Figure 1.: Photomicrograph of a sagittal section through the optic of a MemoryLens. The optic edge is outlined by granules that cover the entire surface of the optic and stained positively for calcium (von Kossa stain, original magnification ×125).The cause of the late postoperative IOL opacification, calcium deposition on the anterior and posterior optic surfaces, was the same as in the cases reported by Tehrani et al.1 However, each of the 6 opacified IOLs that they report was implanted between December 1999 and February 2000, during which time Ciba Vision reported a change in the manufacturing process of the MemoryLens. The case we report involved IOL implantation several months before this period, although the IOL may have been manufactured at the same time as those implanted in the Tehrani et al. cases, which became opacified approximately 2 years after implantation. We acknowledge that patient-related factors such as uveitis (1 of 6) and diabetes (1 of 6) may contribute to IOL opacification, and our patient had a history of diabetes as well as diabetic retinopathy. While delayed-onset inflammation has been reported with the MemoryLens,2 no anterior segment inflammation was observed in our patient during the postoperative course. Our case adds to an increasing number of reports of calcium precipitation on the optic of several hydrophilic acrylic IOLs, most commonly involving the SC60B-OUV (Medical Developmental Research, Inc.)3 and the Hydroview (Bausch & Lomb Surgical)4 IOLs. Such reports have led to investigations of the biocompatibility, manufacturing, and packaging of these IOLs, with the development of theories of pathogenesis and subsequent changes in polymer design and packaging. We commend Tehrani et al.1 for their detailed investigation into the nature and cause of late MemoryLens opacification. We report our case to add to the growing literature and encourage similar reports so the incidence of the opacification can be determined and appropriate investigations into the IOL optic composition as well as the manufacturing and packaging processes can be performed, if warranted. Anthony J. Aldave MD David A. Hollander MD, MBA Ben J. Glasgow MD Los Angeles, California, USA

Long-term efficacy of adding a sharp posterior optic edge to a three-piece silicone intraocular lens on capsule opacification: Five-year results of a randomized study

To compare the intensity of capsule opacification with the sharp and the round optic edge variant of an open-loop hydrophobic silicone intraocular lens (IOL). Randomized, controlled, double-blind clinical trial with intraindividual comparison. Fifty-one patients with bilateral age-related cataract were included (102 eyes). Each patient had had cataract surgery in both eyes and received a Microsil IOL with a sharp optic edge design (model S) in one eye and a Microsil IOL with a round optic edge design (model R) in the fellow eye. Both IOLs had an identical haptic design (nonangulated polymethylmethacrylate) and silicone optic material. The patients were examined at the slit lamp, best-corrected visual acuity was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken 5 years after surgery. The intensity of regeneratory posterior capsule opacification (rPCO), fibrotic PCO (fPCO), and anterior capsule opacification (ACO) was assessed subjectively at the slit lamp, and of rPCO, objectively using automated image analysis software (AQUA). The need for an Nd:YAG laser capsulotomy (Nd:YAG-LCT) was noted. The mean AQUA PCO score was 1.2 for the model S and 2.4 for the model R lens (P = .001). The model S lens also led to less peripheral fPCO (P = .003). Concerning ACO, there was no significant difference between both IOL groups (P = .72). Whereas no capsulotomy was required with the model S, four cases (16%) had been performed in the model R group. Five years postoperatively, the sharp-edged silicone IOL showed less rPCO and fPCO than the round-edged IOL. However, regarding ACO, there was no significant difference between both IOL styles.

The Flexiring??: A Ring for the Prevention of Capsulophimosis

ABSTRACTThe topic is about the Flexiring®, a capsular ring that showed a higher rate of capsule shrinkage prevention than standard tension rings. In fact, anterior capsule opacification is more likely to occur in modern surgery; with small incision bimanual surgery, rhexis are often smaller than in

Effect of optic material on posterior capsule opacification in intraocular lenses with sharp-edge optics: Randomized clinical trial

Comparison of the intensity of posterior capsule opacification (PCO) between a silicone intraocular lens (IOL) and a hydrophobic acrylic IOL, both of them 3-piece and open-loop and having truncated optics with sharp edges. Randomized, controlled, patient- and examiner-masked trial with intrapatient comparison. One hundred six eyes of 53 patients with age-related bilateral cataract. Each patient had cataract surgery in both eyes and received a silicone IOL in one eye and a hydrophobic acrylic IOL in the fellow eye. Follow-up examinations were at 1 and 3 years after surgery. The patients were examined at the slit lamp, visual acuity (VA) was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken. The amount of PCO was assessed subjectively at the slit lamp and objectively using automated image analysis software. Data of 56 eyes of 28 patients, who were examined at each follow-up, were analyzed. Posterior capsule opacification intensity at 3 years as measured with automated image analysis. At 1 and 3 years after surgery, PCO did not differ between the silicone (1.6 and 1.9 [image analysis scores, 0-10 scale], respectively) and acrylic IOLs (1.7 and 2.2) (P > 0.24). Furthermore, there was no significant difference in best-corrected VA, rhexis/IOL overlap, capsular folds, and amount of anterior capsule opacification during the follow-up period. In each group, one neodymium:yttrium-aluminum-garnet (YAG) laser capsulotomy was performed during the entire study duration. Silicone and hydrophobic acrylic are similarly effective in inducing the PCO-inhibiting effect of a rectangular, sharp optic edge. Three years after surgery, the PCO intensity and the YAG rate were low with both IOL models.

Effect of anterior capsule polishing on fibrotic capsule opacification: Three-year results

Purpose: To evaluate the long-term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO). Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods: This randomized double-blind study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients received round-edged intraocular lenses (IOLs); 26 received an SI-40 IOL (Advanced Medical Optics Inc.) in both eyes, and 26 received a Silens6 IOL (Domilens) in both eyes. Both IOLs consist of different silicone material and have different haptic angulation. The SI-40 IOL has 13.0 mm open-loop poly(methyl methacrylate) (PMMA) haptics angulated by 10 degrees. The Silens6 IOL has 12.5 mm open-loop PMMA haptics with no angulation. In 1 eye, the anterior capsule was extensively polished. The anterior capsule was left unpolished in the contralateral eye, which acted as a control. Digital slitlamp photographs of the ACO and fibrotic PCO were taken with a standardized technique for 3 years postoperatively. The intensity of ACO was measured objectively (score 0% to 100%) using Adobe Photoshop software. Fibrotic PCO was graded subjectively (score 0 to 4). Results: The mean ACO was 17% in the polished eyes and 26% in the control eyes ( P = .0001). The mean fibrotic PCO score was 0.5 and 1.0, respectively ( P = .0007). The mean ACO was 15% in the polished SI-40 eyes and 26% in the control SI-40 eyes ( P = .01). It was 19% in the polished Silens6 eyes and 26% in the control Silens6 eyes ( P = .003). The mean fibrotic PCO score was 0.4 in the polished SI-40 eyes and 1.1 in the control SI-40 eyes ( P = .0006). It was 0.6 in the polished Silens6 eyes and 0.9 in the control Silens6 eyes ( P = .08). Conclusions: Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round-edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.

Phakic posterior chamber intraocular lens for high myopia

Purpose: To evaluate the efficacy, predictability, stability, and safety of the surgical correction of high myopia using a phakic posterior chamber intraocular lens (PPC IOL). Setting: Centro Oftalmológico de Valencia-CEOVAL, Valencia, Venezuela. Methods: A retrospective study was performed to analyze 18 eyes of 12 patients who had implantation of a modified PPC IOL, the implantable contact lens (ICL), for the treatment of high myopia. The target postoperative spherical equivalent (SE) refraction was emmetropia. Results: The mean follow-up was 26.6 months ± 11.3 (SD) (range 12 to 36 months). The mean preoperative SE was −15.27 ± 3.47 diopters (D) (range −10.0 to −21.25 D) and the mean postoperative SE, −0.62 ± 0.81 D (range −2.75 to +0.75 D). Eleven eyes (61.1%) had an SE within ±1.00 D of emmetropia. The best spectacle-corrected visual acuity was maintained or improved in all except 1 eye, which lost more than 2 lines of Snellen visual acuity. Two eyes (11.1%) developed pupillary block the first day after surgery. Four eyes (22.2%) had moderate pigmentary dispersion. Two eyes (11.1%) had lens opacification, 1 with mild peripheral anterior capsule opacification and the other eye with central anterior subcapsular opacification. One eye (5.5%) had a significant decrease in anterior chamber depth after surgery. Conclusions: Implantation of an ICL was effective for the correction of high myopia. Predictability must be improved and the long-term safety of the ICL determined. The main concerns over potential cataract formation, pigmentary dispersion, and angle-closure glaucoma remain.

Anterior capsule opacification spanning the anterior surface of an AcrySof intraocular lens

We present a case of linear anterior capsule opacification bridging the anterior surface of an AcrySof® intraocular lens (IOL) (Alcon Laboratories). A 75-year-old woman had uneventful cataract extraction and in-the-bag IOL insertion. Before implantation, the IOL was folded with a holding and an implantation forceps. The formation of a capsule bridge was observed on routine examination 20 days postoperatively. The bridge spanned the IOL parallel to the fold along the central axis, where the forceps had grasped the IOL. The bridge did not grow or regress for 24 months after surgery. The formation of the bridge along the fold might have been facilitated by a minute, undetected structural change in the AcrySof IOL created during folding.

Comparison of posterior capsule opacification between the 1-piece and 3-piece Acrysof intraocular lenses: Two-year results of a randomized trial

Purpose To compare intensity of posterior capsule opacification (PCO) between the 1-piece and 3-piece haptic designs of an open-loop hydrophobic acrylic intraocular lens (IOL). Design A randomized, patient- and examiner-masked clinical trial with intraindividual comparison. Participants Fifty-two patients with bilateral age-related cataract (104 eyes). Methods Each patient had cataract surgery in both eyes and received a 1-piece Acrysof IOL in one eye and a 3-piece Acrysof IOL in the fellow eye. Follow-up examinations were at 1 week, 1 month, 6 months, 1 year, and 2 years. Patients were examined at the slit lamp, visual acuity (VA) was determined, and standardized high-resolution digital retroillumination images of the posterior capsule were taken. The intensity of PCO was assessed subjectively at the slit lamp and objectively using automated image analysis software. Main outcome measure Posterior capsule opacification score (scale, 0–10). Results There was no significant difference between IOL styles in best-corrected VA, rhexis/IOL overlap, capsular folds, and amount of anterior capsule opacification during the follow-up period. One year postoperatively, the amount of regeneratory PCO was higher for the 1-piece Acrysof eyes (image analysis software score: 1.3) than for the 3-piece Acrysof eyes (score: 0.9; P = 0.002). However, 2 years postoperatively, there was no significant difference between the 2 IOL styles (1-piece: 1.5; 3-piece: 1.3; P = 0.3). Neodymium:yttrium–aluminum–garnet capsulotomy was not performed in the study. Conclusion One year postoperatively, the 1-piece Acrysof showed slightly more regeneratory PCO than the 3-piece Acrysof. However, 2 years postoperatively, the barrier effect of the 1-piece design was comparable to that of the 3-piece haptic design, with low PCO intensity.

Effect of intraocular lens optic edge design and material on fibrotic capsule opacification and capsulorhexis contraction

To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. This randomized controlled patient- and examiner-masked study comprised 210 eyes of 105 patients with bilateral age-related cataract. In Group 1 (n = 53), the Sensar OptiEdge AR40e hydrophobic acrylic IOL with a sharp posterior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex OptiEdge silicone IOL with a sharp posterior optic edge was compared with the PhacoFlex SI-40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digital slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillumination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm(2)) was determined objectively. One year after surgery, the mean ACO score was 32% in eyes with the sharp-edged acrylic IOL and 29% in eyes with the round-edged acrylic IOL (P<.05). In the silicone group, the mean was 31% and 26%, respectively (P<.05). The mean fibrotic PCO score was lower in eyes with a sharp-edged acrylic IOL than in eyes with a round-edged acrylic IOL (0.26 and 0.93, respectively; P<.05) and in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (0.24 and 0.82, respectively; P<.001). At 1 year, the mean capsulorhexis area was statistically significantly smaller in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (P<.05). Acrylic and silicone IOLs with the sharp OptiEdge design led to significantly less fibrotic PCO but more ACO than round-edged acrylic and silicone IOLs. The sharp-edged silicone IOL caused significantly more capsulorhexis contraction than the round-edged silicone IOL and both acrylic IOLs.

Relationship between anterior capsule contraction and posterior capsule opacification after cataract surgery in patients with diabetes mellitus

Purpose: To prospectively assess the relationship between contraction of the anterior capsule opening and posterior capsule opacification (PCO) after cataract surgery in patients with diabetes mellitus. Setting: Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Kaiya Eye Clinic, Hamamatsu, and Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaragi, Japan. Methods: This study comprised 45 patients (45 eyes) with diabetes mellitus who had cataract surgery. In all eyes, the anterior capsule opening area and degree of PCO were determined by diaphanoscopy using an anterior eye segment analysis system (EAS-100, Nidek, Inc.) 1 day and 1 year postoperatively. Results: There was no correlation between the size of the anterior capsule opening area 1 day after surgery and the degree of PCO 1 year after surgery (Pearson correlation coefficient [ r] = 0.041; P = .79). The percentage reduction in the anterior capsule opening area from 1 day to 1 year after surgery did not correlate with the degree of PCO 1 year after surgery ( r = −0.08; P = .60). Conclusion: Contraction of the anterior capsule opening and PCO after cataract surgery cannot be explained by a common mechanism.