Foldable Hydrophobic Acrylic Intraocular Lens Research Articles

Comparison of Clinical Outcomes of Implantation of Foldable Hydrophobic Acrylic Intraocular Lens With and Without Heparin Surface Modification in Indian Diabetic Patients.

Background This study aimed to compare the clinical outcomes of a heparin surface-modified (HSM) hydrophobic acrylic foldable intraocular lens (IOL) (CT LUCIA 601PY) and non-heparin-modified hydrophobic acrylic foldable IOL (AcrySof IQ SN60WF) in diabetic patients undergoingphacoemulsification. Methodology Thisrandomized, single-surgeon, double-masked controlled trial was conducted at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. In this randomized controlled trial, 100 eyes of 100 diabetic patients with or without mild-to-moderate diabetic retinopathy were enrolled (HSM IOL, n = 50; non-HSM IOL, n = 50). Outcome measures were aqueous flare, visual acuity, and anterior chamber depth (ACD). These were measured preoperatively as well as one day, one week, one month, three months, six months, and one year postoperatively. Results The HSM IOL group had significantly lower anterior chamber aqueous flare values (photon count/ms) than the non-HSM IOL group on postoperative day one (9.97 ± 5.2 vs. 17.56 ± 11.3, p < 0.001), postoperative week one (11.47 ± 7.78 vs. 17.06 ± 9.4, p = 0.02), and postoperative month three (7.7 ± 4.1 vs. 12.5 ± 5.6, p = 0.004) of phacoemulsification. The corrected distance visual acuity (CDVA) was significantly better in the HSM IOL group on postoperative day one (uncorrected distance visual acuity: p = 0.022; CDVA; p = 0.005), but there was no significant difference at any other follow-ups. ACD was significantly longer in the HSM IOL group at all follow-ups. Conclusions Theimplantation of HSM IOL resulted in significantly lower inflammatory reactions in the early postoperative period in diabetics.

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.

Improvement of Uveal and Capsular Biocompatibility of Hydrophobic Acrylic Intraocular Lens by Surface Grafting with 2-Methacryloyloxyethyl Phosphorylcholine-Methacrylic Acid Copolymer

Biocompatibility of intraocular lens (IOL) is critical to vision reconstruction after cataract surgery. Foldable hydrophobic acrylic IOL is vulnerable to the adhesion of extracellular matrix proteins and cells, leading to increased incidence of postoperative inflammation and capsule opacification. To increase IOL biocompatibility, we synthesized a hydrophilic copolymer P(MPC-MAA) and grafted the copolymer onto the surface of IOL through air plasma treatment. X-ray photoelectron spectroscopy, atomic force microscopy and static water contact angle were used to characterize chemical changes, topography and hydrophilicity of the IOL surface, respectively. Quartz crystal microbalance with dissipation (QCM-D) showed that P(MPC-MAA) modified IOLs were resistant to protein adsorption. Moreover, P(MPC-MAA) modification inhibited adhesion and proliferation of lens epithelial cells (LECs) in vitro. To analyze uveal and capsular biocompatibility in vivo, we implanted the P(MPC-MAA) modified IOLs into rabbits after phacoemulsification. P(MPC-MAA) modification significantly reduced postoperative inflammation and anterior capsule opacification (ACO), and did not affect posterior capsule opacification (PCO). Collectively, our study suggests that surface modification by P(MPC-MAA) can significantly improve uveal and capsular biocompatibility of hydrophobic acrylic IOL, which could potentially benefit patients with blood-aqueous barrier damage.

Cataract Surgery with Primary Lens Implantation in Children with Chronic Uveitis

ABSTRACTPurpose: To evaluate the evolution of chronic uveitis in children undergoing cataract surgery with primary intraocular lens (IOL) implantation.Methods: Twelve children with chronic uveitis underwent cataract surgery with primary posterior chamber intraocular lens (IOL) implantation.Results: Fourteen eyes were implanted with a foldable hydrophobic acrylic IOL. The mean follow-up was 35.39 months (8.72–69.57). The mean BCDVA before surgery and at the end of follow-up was 1.11 (0.40–2.30; SD: 0.57) and 0.48 (0–3; SD: 0.77; p=0.007) respectively. The mean oral corticosteroids dosage after surgery and at the end of follow-up was 0.80 mg/kg/day (SD: 0.37) and 0.17 mg/kg/day (SD: 0.24; p=0.001) respectively. All patients except one were treated with methotrexate. Four patients (5 eyes) were additionally treated with anti-tumor necrosis factor agent.Conclusions: Cataract surgery with primary posterior chamber hydrophobic IOL implantation is possible and leads to a good visual recovery in cases of pediatric chronic uveitis. This surgery requires aggressive anti-inflammatory management with immunosuppressive drugs to control inflammation and reduce the corticosteroids dosage.

Refractive Results: Safety and Efficacy of Secondary Piggyback Sensar™ AR40 Intraocular Lens Implantation to Correct Pseudophakic Refractive Error.

In this study we evaluate the visual outcomes, safety, efficacy, and stability of implanting of second sulcus intraocular lens (IOL) to correct unsatisfied ametropic patients after phacoemulsification. Methods. Retrospective study of 15 eyes (15 patients) underwent secondary intraocular lens implanted into the ciliary sulcus. The IOL used was a Sensar IOL three-piece foldable hydrophobic acrylic IOL. The first IOL in all patients was acrylic intrabagal IOL implanted in uncomplicated phacoemulsification surgery. Results. Fifteen eyes (15 patients) were involved in this study. Preoperatively, mean log⁡MAR UDVA and CDVA were 0.88 ± 0.22 and 0.19 ± 0.13, respectively, with a mean follow-up of 28 months (range: 24 to 36 months). At the end of the follow-up, all eyes achieved log⁡MAR UDVA of 0.20 ± 0.12 with postoperative refraction ranging from 0.00 to −0.50 D of attempted emmetropia. Conclusions. Implantation of the second sulcus SensarAR40 IOL was found to be safe, easy, and simple technique for management of ametropia following uncomplicated phacoemulsification.

A simple method to shorten the unfolding time of prehydrated hydrophobic intraocular lens

ObjectiveTo evaluate the effect of warm ophthalmic viscosurgical devices (OVDs) on the unfolding time of prehydrated hydrophobic acrylic intraocular lenses (IOLs). DesignExperimental study and human trial. ParticipantsThree foldable hydrophobic acrylic IOLs (enVista MX60, AcrySof SN60AT, and Tecnis 1 ZCB00). MethodsThe unfolding times of 3 kinds of IOLs were measured according to temperature from 26°C to 32°C in a transparent container filled with a mixture of OVDs and balanced salt solution. The unfolding time of each IOL was measured 4 times for each temperature. Unfolding time was defined as the time required for the folded IOL to recover ≥90% of its overall optic diameter before folding. In human trials, the unfolding time of the MX60 in a capsular bag filled with 30°C OVDs was compared with that filled with room temperature OVDs for 4 cases in each group. ResultsThe unfolding time of the MX60 (215 ± 25 seconds) was significantly longer than that of the SN60AT (28 ± 7 seconds) and the ZCB00 (29 ± 7 seconds) at 26°C (p = 0.013). However, there were no differences in the unfolding time of 3 IOLs at 32°C. In human trials, the unfolding time of the MX60 was shorter in a capsular bag filled with 30°C OVDs (32 ± 13 seconds) than if filled with OVDs kept at room temperature (127 ± 27 seconds; p = 0.029). ConclusionsWhen fast and complete unfolding characteristics are needed, filling the anterior chamber and capsular bag with OVDs warmed to 30°C before IOL implantation is recommended.

Posterior capsule opacification and neodymium:YAG rates with 2 single-piece hydrophobic acrylic intraocular lenses: Three-year results

To compare the incidence and intensity of posterior capsule opacification (PCO) between 2 similar 1-piece foldable hydrophobic acrylic intraocular lenses (IOLs) over 3 years. Department of Ophthalmology, Medical University Vienna, Vienna, Austria. Randomized prospective patient- and examiner-masked clinical trial with intraindividual comparison. Patients with bilateral age-related cataract had cataract surgery and implantation of a Tecnis ZCB00 continuous-optic-edge IOL in 1 eye and an Acrysof SA60AT interrupted-optic-edge IOL in the other eye. Postoperative examinations were performed at 6 months and 3 years. Digital retroillumination images were taken of each eye. The amount of PCO (score 0 to 10) was assessed subjectively at the slitlamp and objectively using automated image-analysis software. The study comprised 54 patients (108 eyes). The mean objective PCO score was 1.3 ± 1.7 (SD) for the continuous-optic-edge IOLs and 0.9 ± 1.3 for the interrupted-optic-edge IOLs (P=.10). Three years postoperatively, a neodymium:YAG (Nd:YAG) capsulotomy was performed in 26.1% of eyes with the continuous-optic-edge IOL and 21.7% with the interrupted-optic-edge IOL (P=.56). There was no significant difference in corrected distance visual acuity, capsulorhexis–IOL overlap, capsule folds, or anterior capsule opacification 3 years after surgery. Both IOLs had comparable PCO and Nd:YAG rates 3 years postoperatively. The optimized barrier function of the continuous-optic-edge IOL and the material properties of the interrupted-optic-edge IOL seemingly outbalanced the effect on lens epithelial cell migration and proliferation beneath the optic.

Posterior Capsule Opacification with the iMics1 NY-60 and AcrySof SN60WF 1-Piece Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial

To compare the intensity of posterior capsule opacification (PCO) 3 years after implantation of 2 different 1-piece foldable hydrophobic acrylic intraocular lenses (IOLs). Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. One hundred patients with bilateral age-related cataract (200 eyes) had standard cataract surgery with implantation of an iMics1 NY-60 IOL (Hoya Corp) in one eye and an AcrySof SN60WF IOL (Alcon Laboratories) in the other eye. Follow-up examinations were performed at 1 week and 3 years. Digital retroillumination images were obtained of each eye. The main outcome measure was PCO score (scale, 0 to 10) assessed subjectively at the slit lamp and objectively using automated image analysis software (Automated Quantification of After-Cataract) 3 years after surgery. The objective PCO score (mean ± standard deviation) was 3.0 ± 2.0 for the iMics1 NY-60 IOL and 1.9 ± 1.4 for the AcrySof SN60WF IOL (P < .001). Three years after surgery, 35.6% of patients underwent a neodymium:yttrium-aluminum-garnet capsulotomy in the iMics1 NY-60 eye and 13.7% underwent a capsulotomy in the AcrySof SN60WF eye (P = .001). There was no statistically significant difference in best-corrected visual acuity, rhexis-IOL overlap, capsular folds, or anterior capsule opacification. Glistening formations were found in no iMics1 NY-60 IOLs, but in 97% of the AcrySof SN60WF IOLs. Comparison of 2 sharp-edged single-piece IOLs of similar design and hydrophobic acrylic material indicated a statistically significant difference in PCO and neodymium:yttrium-aluminum-garnet capsulotomy rate 3 years after surgery.

Effect on visual acuity of increased surface light scattering in intraocular lenses

To assess the long-term increase in surface light scattering of foldable hydrophobic acrylic intraocular lenses (IOLs) and to evaluate its effect on visual acuity. Miyata Eye Hospital, Miyazaki, Japan. Cross-sectional study. The clinical records of patients who received an Acrysof IOL (study group) or a Sensar AR40 or AR40e IOL (control group) were reviewed retrospectively. Surface light scattering of IOLs was measured 1 year postoperatively or later. The corrected distance visual acuity (CDVA) at the surface-light-scattering examination was compared with the CDVA 1 month after IOL implantation. The changes in CDVA over time were compared with the increase in surface light scattering. The study evaluated 466 eyes of 337 patients. Surface light scattering in the study group continued to increase up to 15 years postoperatively. The light scattering was higher on the anterior IOL surface after 4.5 years. Increased surface light scattering had no significant impact on CDVA; however, there were more cases with decreased CDVA when the surface light scattering exceeded 50 computer-compatible tape steps. Surface light scattering with the implanted foldable hydrophobic acrylic IOL continuously increased during the postoperative years and was a risk for decreased visual acuity.

Incision sizes before and after implantation of SN60WF intraocular lenses using the Monarch injector system with C and D cartridges

To evaluate incision sizes for 6.0 mm optic hydrophobic acrylic intraocular lenses (IOLs) implanted with different injector systems and surgical techniques. Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt, Germany. In this prospective randomized trial of 100 cataract patients, hydrophobic acrylic IOLs (SN60WF) were implanted using 2 injector systems with 2 cartridges (Monarch II and Monarch III with C and D cartridges, respectively; Alcon) and 2 surgical techniques (direct implantation and wound-assisted docking implantation). Incision sizes were measured before and after phacoemulsification as well as before and after IOL implantation using a Tsuneoka microincision gauge. The Saphiro-Wilks test was performed to detect nonparametric distribution and the Kruskal-Wallis test, to test for significant differences between groups. The mean incision sizes (mm) at the 4 points of treatment with the Monarch III with the D cartridge were 1.98+/-0.07, 2.01+/-0.05, 2.42+/-0.07, and 2.51+/-0.05, respectively, with direct implantation and 1.92+/-0.06, 1.98+/-0.04, 2.02+/-0.11, and 2.09+/-0.11, respectively, with wound-assisted implantation. With the Monarch II with the C cartridge, the mean incision sizes were 2.17+/-0.06, 2.2+/-0.16, 2.77+/-0.11, and 2.86+/-0.11, respectively, with direct implantation and 2.12+/-0.10, 2.17+/-0.19, 2.19+/-0.09, and 2.28+/-0.08, respectively, with wound-assisted implantation. Postoperative incision sizes differed significantly from preoperative incision sizes and from each other (P<.05). With new injector systems and an appropriate docking implantation technique, foldable hydrophobic acrylic IOLs can be implanted through 2.0 mm tunnel incisions.

Interaction with intraocular lens materials: Does heavy silicone oil act like silicone oil?

To determine the interaction of heavy silicone oil with various intraocular lens (IOL) materials and whether heavy silicone oil covers the silicone IOL optic as silicone oil does. Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey. The study group comprised 5 poly(methyl methacrylate) (PMMA) IOLs, 4 foldable silicone IOLs, 5 foldable hydrophilic acrylic IOLs, and 5 foldable hydrophobic acrylic IOLs. Each IOL was bathed in balanced salt solution (BSS) for 10 minutes and then placed in heavy silicone oil dyed with Sudan Black for another 10 minutes. Afterward, each IOL was reimmersed in BSS for 5 minutes and examined under the light microscope. Digital images were analyzed to determine the optic area covered with heavy silicone oil. The mean heavy silicone oil coverage was 7.05% +/- 7.88% (SD) (range 1.13% to 20.54%) on PMMA IOLs, 100% on silicone IOLs, 12.17% +/- 11.43% (range 1.25% to 31.52%) on hydrophobic acrylic IOLs, and 34.64% +/- 13.28% (range 12.57% to 44.42%) on hydrophilic acrylic IOLs. Heavy silicone oil coverage of silicone IOLs was statistically significantly greater than the coverage of other IOL materials. Heavy silicone oil acted the same as silicone oil and covered the entire surface of silicone IOLs.

Effect of temporal and nasal unsutured limbal tunnel incisions on induced astigmatism after phacoemulsification

Purpose: To compare the surgically induced corneal astigmatism after unsutured temporal and nasal unsutured limbal tunnel incisions.Setting: Departments of Ophthalmology, Marienhospital, Aachen, and Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.Methods: In a prospective clinical study, 42 eyes of 21 patients with a mean age of 75.1 years had phacoemulsification and implantation of a foldable hydrophobic acrylic intraocular lens using a 3.6 to 3.8 mm unsutured limbal tunnel incision. The right eye always received a temporal incision and the left eye, a nasal incision. Computerized videokeratography was performed preoperatively and 2 weeks and 6 months postoperatively. Surgically induced astigmatism was calculated by vector analysis using the Holladay-Cravy-Koch formula. The 2 groups were compared using a paired Wilcoxon test.Results: The mean surgically induced corneal astigmatism in the temporal incision group was 0.62 diopters (D) ± 0.48 (SD) 2 weeks postoperatively and 0.47 ± 0.32 D at 6 months and in the nasal incision group, 1.55 ± 0.84 D and 1.05 ± 0.57 D, respectively. The difference between the groups was statistically significant (P < .05).Conclusions: There was a highly statistically significant difference in surgically induced corneal astigmatism after temporal and nasal unsutured limbal tunnel incisions. The degree of induced astigmatism and the difference between the temporal and the nasal incisions decreased over time. A nasal tunnel incision is not appropriate for astigmatism-neutral surgery.

Inflammation after phacoemulsification in diabetic retinopathy: Foldable acrylic versus heparin-surface-modified poly(methyl methacrylate) intraocular lenses

Purpose To evaluate inflammation after cataract surgery in patients with nonproliferative diabetic retinopathy (NPDR) and compare results with 2 intraocular lenses (IOLs): a foldable hydrophobic acrylic and a heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA). Setting Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods Patients with NPDR were randomized for implantation of an HSM PMMA IOL (811C®, Pharmacia) through a 6.0 mm sclerocorneal incision (30 patients) or a foldable hydrophobic acrylic IOL (AcrySof®, Alcon) through a 4.0 mm sclerocorneal incision (32 patients). Both IOLs had 6.0 mm optics. All patients were treated according to a standardized protocol. The degree of flare in the anterior chamber was measured with the Kowa 1000 laser flare–cell meter 1 day preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. Results In both IOL groups, flare was highest on the first postoperative day and decreased to preoperative levels by 3 months after surgery. There was no statistically significant difference in relative flare values between the 2 groups. Conclusion There was no difference in postoperative inflammation in eyes with a foldable hydrophobic acrylic IOL implanted through a small incision and those with a rigid HSM PMMA IOL. Postoperative inflammation results indicate that the lenses are equally suitable for the use in patients with diabetic retinopathy.