Incidence Of Posterior Capsular Opacification Research Articles

IOL's material and PCO

Posterior capsular opacification (PCO) is the most common of late post‐surgery complications and can lead to reduced visual acuity, diplopia, or glare. The different types of material used in intraocular lenses (IOLs) plays a significant role in possible post‐surgery complications, such as anterior capsule opacification (ACO) and phimosis, posterior capsule opacification (PCO), and the formation of IOL opacification. PCO incidence increases with time and varies from 10% to 50%. The incidence of PCO will rise in the nearest future since IOLs will stay longer in the eye, as people's lifespans are increasing. It was shown that hydrophilic IOLs had significantly more and denser PCO than hydrophobic or silicone IOLs. The higher incidence of PCO formation in hydrophilic than in hydrophobic IOLs should be considered as an important medical and health economic issue when choosing the IOL for implantation.

Comparison of the Incidence of Nd:YAG Laser Capsulotomy Based on the Type of Intraocular Lens.

Background and Objectives: Posterior capsular opacification (PCO) is the most common long-term complication of successful cataract surgery and can cause visual impairment. We aimed to investigate the effects of intraocular lens (IOL) characteristics on PCO by comparing the incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy for different types of intraocular lenses. Materials and Methods: A retrospective analysis was performed on 2866 eyes that underwent cataract surgery between January 2010 and December 2017, with at least 5 years of follow-up. The IOLs used for surgery were the hydrophobic lenses SN60WF (Alcon, Fort Worth, TX, USA), ZCB00 (Johnson & Johnson Vision, Santa Ana, CA, USA), and MX60 (Bausch & Lomb, Rochester, NY, USA), and the hydrophilic lens MI60 (Bausch & Lomb, Rochester, NY, USA). We analyzed the incidence of Nd:YAG laser capsulotomy according to the type of IOL used. Results: The incidence of Nd:YAG laser capsulotomy was significantly higher with MI60 lenses (31.70%, 175/552 eyes) compared to SN60WF (7.90%, 113/1431 eyes), ZCB00 (10.06%, 64/636 eyes), and MX60 (10.57%, 13/123 eyes; p < 0.001) lenses. The incidence of Nd:YAG laser capsulotomy was significantly lower with the hydrophobic IOLs (8.68%, 190/2190 eyes) than with the hydrophilic IOL (31.70%, 175/552 eyes; p < 0.001). Over time, the rate of increase in the cumulative number of Nd:YAG laser capsulotomy cases was the highest with MI60. The cumulative rate of Nd:YAG laser capsulotomy during the first 3 years was 4.90% with SN60WF (70/1431 eyes), 6.76% with ZCB00 (43/636 eyes), 8.94% with MX60 (11/123 eyes), and 26.10% with MI60 (144/552 eyes) lenses. Conclusions: The incidence of PCO is influenced by the material of the IOLs. The hydrophilic IOL was associated with a higher rate of Nd:YAG laser capsulotomy than the hydrophobic IOLs, with a shorter time to Nd:YAG laser capsulotomy.

Comparison between Posterior Capsular Opacification Following Implantation of Hydrophilic &amp; Hydrophobic Acrylic IOLs

Background Nowadays, care of a cataractous patient greatly exceeds surgical removal of the opacified lens. In a step forward to the welfare of the elderly, special concern is given for posterior capsular opacification (PCO), which remains one of the most common complications after cataract surgery. Aim of the Work The aim of that work was to compare the incidence of posterior capsular opacification in patients who underwent hydrophilic IOLs versus hydrophobic IOLs implantation. Patients and Methods The present study was conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University, and assessed patients, who underwent uneventful phacoemulsification cataract surgery and hydrophilic or hydrophobic acrylic nonheparinized IOL implantation. Surgeries were done by equal caliber experienced surgeons. ―In-thebag‖ fixation of a square-edged IOL and continuous curvilinear capsulorhexis with cortical cleanup was performed. Patients’ data were collected from the electronic medical records. Results The study revealed that neither the IOL material nor the general medical condition significantly delayed the onset of PCO development. However, we need to collect more clinical records of cases and conduct multicenter logistic regression analyses on a larger sample using a prospective study design. Conclusion The present study found no significant difference between the incidence PCO development between hydrophobic and hydrophilic IOLs. Moreover, the patients’ general conditions did not show a significant association with PCO incidence.

Influence of the CleaRing intraocular open capsule device on refractive predictability in cataract surgery.

The marked improvement in cataract surgery and intraocular lens (IOL) quality has led to a decline in posterior capsular opacification (PCO) incidence; however, PCO remains a common complication of cataract surgery. The CleaRing intraocular capsule open device (IOCD) decreases PCO incidence. We aimed to investigate the influence of the CleaRing IOCD on refractive predictability in cataract surgery. We conducted this prospective pilot study at the Wolfson Medical Center, Holon, Israel. Ten eyes of patients who underwent cataract surgery and insertion of an IOL after IOCD implantation into the capsular bag were included. All patients completed 12 months of follow-up, including refraction, measurement of uncorrected (UDVA) and best-corrected distance visual acuity (CDVA), slit-lamp biomicroscopy, and ultrasound biomicroscopy. All the surgeries were uneventful, with no postoperative complications. The IOL was centred in the device and bag in all cases. The mean prediction error at 1 and 12 months postoperatively was +0.28 ± 0.32 D and +0.50 ± 0.32 D, respectively. The mean UDVA was 0.17 ± 0.13 and 0.15 ± 0.11 logMAR, and the mean CDVA was 0.04 ± 0.10 and 0.04 ± 0.06 logMAR, respectively. The manifest refractive cylinders at 12 months postoperatively were compatible with corneal astigmatism. Implantation of the IOCD resulted in a slight, predicted, and stable hyperopic shift with a low standard deviation. The standard deviation of the prediction error demonstrated excellent refractive accuracy and predictability using the IOCD, which was as low as 0.32 D at the 12-month follow-up.

Comparison of the Rate of Posterior Capsule Opacification Following Combined Treatment With Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone: A Two-Year, Randomized Clinical Investigation.

Background and aim The use of non-steroidal anti-inflammatory drugs in animals decreases the incidence of posterior capsular opacification (PCO) following cataract surgery. We evaluated the rate of PCO in patients with cataract surgery and foldable "in the bag" posterior chamber intraocular lens (PC-IOL) implantation treated with combined dexamethasone 0.1% plus ketorolac tromethamine 0.5% versus dexamethasone 0.1% alone. Materials and methods A total of 114 eyes of 101 patients underwent uneventful corneal small-incision phacoemulsification with primary implantation of a foldable acrylic PC-IOL (AcrySof®, Alcon, Fort Worth, USA). Postoperatively for four weeks, group 1 eyes were treated with dexamethasone 0.1% plus ketorolac tromethamine 0.5% ophthalmic solutions four times daily for each whereas group 2 eyes were treated with dexamethasone 0.1% alone. Other regiments were the same for each group. Patients were evaluated between one- and four-yearfollowing surgery. The frequency and timing of severe PCO following surgery that needed Nd:YAG laser posterior capsulotomy were recorded and evaluated. Results The mean (SEM) age of group 1 (n = 54) and group 2 (n = 60) at operation was similar (62.8 ± 2.2 vs. 60.6 ± 1.7 years, respectively). Eighty-eight patients had unilateral cataract and 13 cases had bilateral disease. Overall, the mean follow-up duration was 24.7 months postoperatively (range, 15-48). Clinically significant PCO that finally needed Nd:YAG laser application developed in two eyes (3.7%) in group 1 and in four eyes (6.6%) in group 2, and the difference was not statistically significant (p>0.05). The mean month at capsulotomy was 26.5 in group 1 and 24.3 months in group 2 eyes (p>0.05). Conclusions Topical instillation of ketorolac ophthalmic solution in the immediate period after phacoemulsification and PC-IOL implantation did not seem to influence the incidence of PCO formation two years after cataract surgery.

Bilateral Implantation of Multifocal Intraocular Lenses: 10-Year Follow-Up

To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs). This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patients' satisfaction, and spectacle independence. All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification. MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence.

YAG Capsulotomy Rates in Patients Following Cataract Surgery and Implantation of New Hydrophobic Preloaded Intraocular Lens in an Australian Cohort: 3-Year Results.

To assess the risk of posterior capsular opacification (PCO) following implantation of the Clareon lens. Retrospective analysis was performed for 484 consecutive eyes that had undergone phacoemulsification and implantation of a monofocal lens (CNA0T) between April 2018 and February 2020. Eyes with other ocular pathology that may affect outcomes, previous refractive surgery or eyes corrected for a near target were excluded. Incidence of PCO and YAG capsulotomy was recorded and regression analysis was performed to determine risk factors associated with PCO formation. Overall incidence of PCO following implantation of the CNA0T monofocal lens was 3.7% (18 eyes) at 1 year with 1.9% (9 eyes) undergoing YAG capsulotomy. At 3 years, 8.7% (42 eyes) had developed PCO and 4.1% (20 eyes) had undergone YAG capsulotomy cumulatively. Primary open angle glaucoma (POAG; OR = 6.53; 95% CI = 18.68, 2.28; P = 0.0005), age-related macular degeneration (AMD; OR = 2.35; 95% CI = 5.21, 1.06; P = 0.036), vitreomacular traction (VMT; OR = 7.32; 95% CI = 45.08, 1.19; P = 0.032), retinal vein occlusion (RVO; OR = 8.42; 95% CI = 38.99, 1.82; P = 0.006) and history of anti-VEGF therapy (OR = 3.22; 95% CI = 10.26, 1.01; P = 0.048) were positively associated with an increased risk of PCO. Incidence of PCO requiring YAG capsulotomy was relatively low. However, certain co-morbidities were found to increase the risk of PCO development, most significantly POAG and RVO.

Rapid and Economical Drug-Eluting IOL Preparation via Thermoresponsive Agarose Coating for Effective Posterior Capsular Opacification Prevention.

Posterior capsular opacification (PCO), the highest incidence complication after cataract surgery, is mainly due to the attachment, proliferation, and migration of the residual lens epithelial cells (LECs). Although the drug-eluting IOLs have been proved to be an effective way to prevent PCO incidence, its preparations are time consuming and require tedious preparation steps. Herein, the thermoreversible agarose is adopted to prepare drug-eluting IOL. Such functional coating can be obtained easily by simple immersion in the antiproliferative drug containing hot agarose and taken out for cooling, which not only does not affect the optical property but also can effectively decrease the PCO incidence after intraocular implantation. As a result, the proposed agarose coating provides a rapid and economical alternative of drug-eluting IOL fabrication for PCO prevention.

Nanoporous Gold Ring-Integrated Photothermal Intraocular Lens for Active Prevention of Posterior Capsular Opacification.

Posterior capsular opacification (PCO) is the leading complication after cataract surgery, and is mainly induced by the proliferation and migration of residual lens epithelial cells (LECs). Although numerous attempts have been made to reduce the incidence of PCO, this complication remains a critical challenge in postoperative visual recovery. This study aims to report a functionalized intraocular lens (R-IOL) with a region-confined photothermal effect for the active prevention of PCO after implantation. The outer rim of R-IOL (non-optical area) is decorated with a nanoporous gold (NPG) ring, which can effectively eliminate the LECs around R-IOL, ultimately inhibiting the migration of LECs from the periphery to the visual axis center in the initial stage, and preventing the subsequent PCO. Furthermore, the mechanism of LECs elimination can be attributed to apoptosis induced by mild photothermal therapy. After in vivo implantation for 30 days, PCO is rarely observed in the R-IOL group, whereas the considerably higher incidence of PCO (75%) is found in the pristine IOL (P-IOL) group. The region-confined photothermal effect based on NPG not only provides an active strategy to effectively prevent PCO, but also introduces new opportunities for the treatment of undesirable hyperplasia.

Visual outcome of single piece yellow tinted hydrophobic acrylic intraocular lens: A hospital based prospective observational study

To evaluate the visual outcome of single piece yellow tinted hydrophobic acrylic intraocular lens (IOL) following phacoemulsification.A single center, hospital based, prospective, observational study. Eligible patients with significant cataract, underwent phacoemulsification with implantation of single piece yellow tinted hydrophobic acrylic IOL. Patients followed up for 6 months. Pre and post-operative assessment of UDVA, CDVA was done and documented in LogMAR values. Contrast sensitivity by Pelli-Robson chart, refraction by Auto refractometer was evaluated pre and post operatively. Post-operative evaluation of glistening and PCO done by slit lamp examination. Glare evaluated by pen-torch contrast sensitivity method. Adverse events documented on regular follow-up.132 patients were enrolled in the study. Majority of the subjects (97.7%) achieved expected visual outcome of LogMAR 0.0-0.2 on final follow-up day. Statistically significant improvement in contrast sensitivity noted in 99.2% of our patients. The mean refractive spherical equivalent at 180 days was 0.10±0.81. The incidence of glistening was 3.8% at 180 days follow up. Glare was present in 4.6% subjects on first operative day, 3% on 3rd and decreased to 0.8% on 7th postoperative day. None of our patients complained of glare after 1 month. The incidence of PCO and adverse events was 0.8% and 15.2% respectively, on last postoperative follow-up.Implantation of single piece yellow tinted hydrophobic acrylic IOL provides expected visual outcome, refractive stability, enhances contrast sensitivity with minimal glistening, glare and adverse events. The square edge design of the hydrophobic lens reduces incidence of posterior capsular opacification.

Foldable Bulk Anti-adhesive Polyacrylic Intraocular Lens Material Design and Fabrication for Posterior Capsule Opacification Prevention.

Posterior capsular opacification (PCO) is a primary complication after phacoemulsification combined with intraocular lens (IOL) implantation, which is attributed to adhesion, proliferation, and migration of residual lens epithelial cells on IOL. Although surface hydrophilic coating is considered to be a powerful way to inhibit PCO incidence after surgery, it requires complex post-production processes, thus limiting their applicability. In comparison, bulk modification is a stable, effective, and facile IOL synthesis method for PCO prevention. Herein, a new anti-adhesive IOL material was designed and successfully synthesized by radical copolymerization of ethylene glycol phenyl ether methacrylate (EGPEMA) and 2-(2-ethoxyethoxy) ethyl acrylate (EA). The physicochemical properties of P(EGPEMA-co-EA) copolymer materials, including chemical structure, mechanical, thermal, surface, and optical properties, were analyzed by using 1H NMR spectroscopy, FT-IR spectroscopy, tensile test, thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), water contact angle measurement, and UV-vis spectroscopy. The elongation at break and the modulus of elasticity of the copolymer were tunable through the change of the composition of monomers. Compared to other components, the tensile results showed that P(EGPEMA-co-EA) materials (70% EGPEMA in mass ratio, F7) are suitable for the preparation of foldable intraocular lens with lower elastic modulus and higher elongation at break. TGA and DSC showed that the material has high thermal stability, and the glass transition temperature of F7 material is 16.1 °C. The water contact angle measurement results showed that the introduction of EA improved the hydrophilicity of the material. The percentage of transmittance of all copolymers at 400-800 nm is above 85%. Then, the biocompatibility of the materials was evaluated by in vitro assay and subcutaneous implantation. Both in vitro results and subcutaneous implantation experiments showed that the designed IOL materials exhibited a good anti-adhesion effect and no cytotoxicity. Finally, phacoemulsification and IOL intraocular implantation were performed, and the in vivo results confirmed the good PCO prevention ability as well as the biocompatibility of the new IOL materials.

Prediction Error Stabilization and Long-Term Standard Results with a Monofocal Intraocular Lens.

The aim of this study was to assess the stability and differences between objective (O-Rx) and subjective (S-Rx) refraction for the assessment of the prediction error (PE). A secondary aim was to report the results of a monofocal intraocular lens (IOL). 100 subjects were included for whom S-Rx and O-Rx were obtained for all visits, and for visual performance, posterior capsular opacification incidence and Nd:YAG rates at 12 months. Either S-Rx and O-Rx showed a hyperopic shift from 1 to 6 months (p < 0.05) and stabilization after 6 months. S-Rx was related with the axial length (rho = −0.29, p = 0.007), obtaining a major tendency towards hyperopia in short eyes implanted with high-power IOLs. O-Rx showed a myopic shift in comparison to S-Rx (p < 0.05). This resulted in a decrease of the number of eyes in ±0.50 D and ±1.00 D from 79 to 67% and from 94 to 90%, respectively. The median (interquartile range) uncorrected and corrected visual acuities were 0.1 (0.29) and 0 (0.12) logMAR, respectively, and seven eyes required Nd:YAG capsulotomy at 12 months. Some caution should be taken in PE studies in which O-Rx is used or S-Rx is measured in a 1-month follow-up. Constant optimization should be conducted for this IOL after S-Rx stabilization.

Photo-responsive intraocular lens with on demand drug release for posterior capsule opacification prevention and improved biosafety

Posterior capsular opacification (PCO) is the most common complication after cataract surgery, which is caused by the adhesion, proliferation, migration and epithelial-mesenchymal transformation of the residual lens epithelial cells (LECs) in lens capsule. The drug eluting coating modification provides a powerful way to inhibit PCO incidence after IOL implantation. However, the uncontrolled proliferative drug brings intraocular biosafety issues when application. Therefore, developing new strategies with controlled drug release for PCO prevention is of great significance. In this investigation, a hydrophilic photo-responsive drug release coating was successfully constructed on IOL surface, which was verified through 1H•NMR, UV–Vis, FTIR and XPS. In vitro assay indicated that the IOL coating exhibited excellent anti-adhesion and anti-proliferation effects on LECs under irradiation. The photo-controlled drug release in vitro can be achieved by simply adjusting the intensity and time of irradiation. Finally, the surface-modified IOL was implanted in rabbit eyes and in vivo evaluation was carried out. In vivo assay demonstrated that the implantation of the modified IOL into eyes can significantly reduce the occurrence of PCO. Moreover, the modified IOL exhibited good biocompatibility and biosafety. We believe that this work will provide a synergistic strategy for effective prevention of PCO through a photo-controllable drug release coating on IOL surface.

Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal

Aim: This study aimed to compare the performance of two monofocal Intraocular Lenses (IOL) platforms. Background: The Clareon® Intraocular Lens (IOL) is a relatively new monofocal lens platform designed to improve postoperative results compared to other monofocal platforms. Objective: This study aimed to assess and compare the visual and refractive outcomes, and incidence of YAG capsulotomy of the Clareon® IOL and a standard non-preloaded AcrySof® monofocal IOL following contralateral implantation in patients undergoing cataract surgery. Methods: A total of 20 patients (40 eyes; 12 female, average age 72.8±6.4 years) who had undergone contralateral implantation of an AcrySof® IQ monofocal lens (SN60WF or SN6AT; Alcon; Texas, USA) and a Clareon®monofocal lens (CNAOT0; Alcon; Texas, USA) were selected. Uncorrected Distance Visual Acuity (UDVA), Contrast Sensitivity (CS), kinetic perimetry, and refraction were measured 1 month following the second surgery and subjective vision was measured 6 months following the second surgery using a quality-of-life questionnaire. Results: There was no difference in postoperative UDVA (P=0.94), CS (P&gt;0.05), or refraction (P=0.64) between eyes that received the Clareon® and AcrySof® IQ lenses. Clareon® eyes had a higher incidence of glare/haloes and positive dysphotopsia while AcrySof® IQ eyes had a higher incidence of negative dysphotopsia. Patient satisfaction was similar between the groups (P=0.86), although 25% of patients reported more clarity in the eye that received the Clareon® lens. The incidence of posterior capsular opacification was low for both groups. Conclusion: Clareon® and AcrySof® IQ lenses perform similarly, providing good refractive, visual, and subjective outcomes. Clareon® is available as a preloaded lens option and may reduce PCO and the need for Nd: YAG capsulotomy.

English

BACKGROUND Retinitis pigmentosa is a group of hereditary disorders characterised by difficulty of seeing at night, bony spicule pigmentation in mid retinal periphery, progressive visual field loss and abnormal electroretinogram (ERG) responses. Cataract surgery in patients with retinitis pigmentosa is associated with poor visual outcome with higher incidence of intraoperative and postoperative complications. This study was done to find the visual and surgical outcome of phacoemulsification and intraocular lens (IOL) implantation in patients with retinitis pigmentosa. METHODS This was a retrospective, non-comparative, observational study done at Regional Institute of Ophthalmology, RIMS Ranchi, India. Consecutive patients of retinitis pigmentosa who underwent phacoemulsification and IOL implantation between July 2015 to December 2019 were retrospectively analysed. Intraoperative and postoperative complications, visual and refractive outcomes were analysed. RESULTS Fifty six eyes of 48 patients (29 male, 19 female) with mean age 46.62 ± 8.45 years were included in study. Mean follow up was 17.92 ± 10.62 months. The types of cataract were posterior subcapsular in 30.35 %, cortical in 14.2 %, mixed in 51.8 % and nuclear sclerosis in 3.5 % of eyes. Intraoperative posterior capsular rent (PCR) was noted in 2 eyes (3.57 %) and zonular dehiscence in 3 eyes (35.35 %). Preoperative mean log minimum angle of resolution best corrected visual acuity (MARBCVA) was 1.45 ± 0.49 which improved to 1.24 ± 0.28 postoperatively at 4 weeks (P-value &lt; 0.05). Postoperatively, vision improved in 46 (82.14 %) eyes, unchanged in 7 (12.5 %) eyes and worsened in 3 (5.35 %) eyes. Postoperative cystoid macular oedema (CME) was noted in 5 eyes (9.07 %). Significant posterior capsular opacification (PCO) was noted in 15 eyes (26.78 %) and anterior capsular phimosis was noted in 3 eyes (5.35 %). CONCLUSIONS Cataract surgery improves vision in most of the patients with retinitis pigmentosa. The incidence of PCR, zonular dehiscence, CME, PCO and anterior capsular phimosis is higher in these patients. KEYWORDS Retinitis Pigmentosa, Cataract, Capsular Phimosis

IOL decentration post Nd-YAG laser capsulotomy

One of the most common cause of decrease of vision in a pseudophakic patient is the formation of posterior capsular opacification (PCO) which is affected by several factors like the design of the implanted intraocular lens (IOL) and material of the IOL. PCO incidence has been reported to be 20.7% at 2 years &amp; 28.5% at 5 years. Decrease of vision because of PCO necessitates a posterior capsulotomy with neodymium yttrium aluminum garnet (Nd-YAG) laser to create a small opening in the developed opacification. It is a commonly performed relatively safe procedure associated with rare complications like increased intraocular pressure, iritis, IOL Pitting, macular edema, retinal haemorrhage, retinal detachment and endophthalmitis. Herein documenting a case of IOL decentration occurring as an acute complication post Yag Cap leading to decrease of the visual acuity of the patient which has been rarely documented in any of the many articles on Yag complications.

Surface Modification of Intraocular Lens with Hydrophilic Poly(Sulfobetaine Methacrylate) Brush for Posterior Capsular Opacification Prevention.

Purpose: The intraocular lens (IOL) is a common, yet important, implantable device used in treatment of cataract in clinics. However, the unexpected adhesion of postoperative residual lens epithelial cells (LECs) often causes serious complications, such as posterior capsular opacification (PCO), which lead to vision loss again. In this investigation, a poly(sulfobetaine methacrylate) (PSBMA) brush coating was fabricated on an IOL to generate a hydrophilic surface coating on the IOL for enhanced cell adhesion resistance so as to decrease PCO incidence. Methods: The PSBMA brush coating on the IOL surface was fabricated using surface-initiated reversible addition-fragmentation chain transfer polymerization. X-ray photoelectron spectroscopy (XPS) was used to demonstrate the surface coating preparation. The water contact angle (WCA) measurement was used to test surface hydrophilicity. In vitro LEC culture was use to evaluate the cell behavior on the IOL material surfaces, with or without PSBMA coating modification. Finally, animal cataract surgeries were carried out to evaluate in vivo biocompatibilities and anti-PCO effects. Results: The XPS and WCA measurements illustrate successful surface modification and good surface hydrophilicity. The in vitro cell culture results show that the hydrophilic PSBMA polymer brush coating evidently decreases adhesion and proliferation of LECs. Results of the in vivo cataract surgery with intraocular implantation show that PSBMA modification on the IOL surface does not induce side effects in nearby tissues, whereas posterior capsular hyperplasia can be evidently reduced. Conclusion: The PSBMA brush surface-modified IOL has good in vivo biocompatibility and it can effectively reduce the incidence of postoperative PCO.

A Comparative study of post-operative results with different grades of diabetic retinopathy after phacoemulsification and small incision cataract surgery (SICS) [with various types of IOLs

The objective of this study is to look for post-operative complications after cataract surgery in patients with Diabetic Retinopathy.Out of sixty patients, we took fifteen patients each from BDR, Pre-PDR, PDR and DR with maculopathy respectively and patients underwent SICS and phacoemulsification with implantation of IOLs. We looked for post-operative inflammation (aqueous flare, cells, pigment deposition on optic of IOL), incidence of posterior capsular opacification, progression of underlying diabetic retinopathy, incidence of cystoid macular edema and visual outcome.We observed that visual acuity after cataract surgery improves to &amp;#62;6/12 in 22%. No patient with BDR grade developed post-0perative uveitis. Maximum inflammation post-operatively was with PDR and pre-PDR was 26%. Cystoid macular edema developed in 26 (55%) patients. Visual outcome improvesin majority of eyes and was not dependent upon the surgical technique employed or the type of IOL implanted. Post- operative uveitis was maximum with PDR. Majority of patients with PDR developed cystoid macular edema. Progression of retinopathy and maculopathy represented the natural history of disease not upon the surgical technique employed.

Safety and efficacy of A1-UV aspheric intraocular lens implantation over the postoperative 5 years

Objective: To evaluate the clinical safety and efficacy of A1-UV aspheric intraocular lens (IOL) implantation over the postoperative 5 years. Methods: Prospective cohort study. The subjects came from a finished multicenter, randomized and controlled clinical trial with a follow-up period of 1 year from April to November 2012. The clinical research centers were Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Peking University Third Hospital, Tianjin Medical University Eye Hospital, and Daping Hospital of Army Medical University. Cataract patients in the experimental group were implanted with A1-UV type IOL, while cataract patients in the control group were implanted with SN60WF type IOL, and monocular patients were enrolled. From April to May 2018, patients enrolled in the previous study were recalled for follow-up and continued observation. The visual acuity, spherical equivalent, postoperative complications, non-contact intraocular pressure and subjective evaluation results were statistically analyzed preoperatively, at 1 to 2 days, 1 week, 1 month, 3 months, 6 months, 1 year and 5 years after operation. The main statistical methods included Mann Whitney U test, Wilcoxon signed rank test, independent sample t test, chi square test and Fisher exact test. Results: A total of 42 subjects (22 in the experimental group and 20 in the control group) completed 5-year continuous observation. Among the 42 subjects, 28 were female and 14 were male. The age was (70±9) years, and the time from surgery to recall was (5.77±0.19) years. The age, gender distribution, left/right eye distribution, axial length, IOL power and nucleus hardness classification data of the experimental group and the control group were balanced and comparable (all P>0.05). At different visiting time points, there was no significant difference in the best corrected distance visual acuity (BCDVA), best corrected near visual acuity (BCNVA), uncorrected distance visual acuity (UCDVA) and uncorrected near visual acuity (UCNVA) between the groups (all P>0.05). At 5 years after operation, the UCDVA, BCDVA and BCNVA of the two groups were significantly improved compared with the baseline [all P<0.01; UCDVA was improved from 0.75 (0.30 to 1.30) to 0.10 (-0.10 to 0.70) in the experimental group and from 0.75 (0.30 to 1.60) to 0.20 (-0.10 to 0.80) in the control group; BCDVA was from 0.60 (0.10 to 1.00) to 0.00 (-0.10 to 0.54) in the experimental group and from 0.60 (0.10 to 1.60) to 0.10 (-0.10 to 0.50) in the control group; BCNVA was from 0.55 (0.00 to 1.10) to 0.10 (-0.10 to 0.60) in the experimental group and from 0.55 (0.10 to 1.60) to 0.10 (-0.20 to 0.60) in the control group], but there was no significant change in the UCNVA (both P>0.05). There were no significant differences in the spherical equivalent, intraocular pressure, subjective evaluation of visual adverse symptoms, distance vision spectacle independence and comprehensive evaluation of satisfaction between the groups (all P>0.05). In the experimental group, one eye (4.5%) had an abnormal pupil, one eye (4.5%) had an abnormal IOL with a few particles on the surface of the IOL but no glistening, and 3 eyes (13.6%) had posterior capsular opacification (PCO); in the control group, one eye (5.0%) had an abnormal cornea, five eyes (25.0%) had abnormal IOLs [one eye (5.0%) had IOL calcification, and four eyes (20.0%) had IOL glistening], and one eye (5.0%) had PCO with posterior capsular folds and IOL tilt. There was no significant difference in PCO and IOL abnormality between the two groups (both P>0.05), but there was significant difference in the occurrence of IOL glistening (P=0.04). Conclusion: The long-term effect of A1-UV aspheric IOL on improving the UCDVA is stable and good, with high subjective satisfaction of patients, a low incidence of PCO, no glistening and good biocompatibility, over the postoperative 5 years. (Chin J Ophthalmol, 2021, 57: 41-47).

Surface modification of intraocular lenses via photodynamic coating for safe and effective PCO prevention.

Posterior capsular opacification (PCO) is an emerging complication in cataract phacoemulsification and intraocular lens (IOL) implantation surgery, mainly stemming from the adhesion, proliferation, and trans-differentiation of the post-surgery residual lens epithelial cells (LECs). Previous investigations have shown that an anti-proliferative drug eluting coating on the IOL surface provides an effective way to inhibit PCO. However, due to the undesirable elution of the anti-proliferative drug, the safety of such modification is one of the important issues to be solved. In this investigation, photodynamic coating was introduced into IOL surface modification. The photosensitizer chlorin e6 grafted α-cyclodextrin (α-CD-Ce6) was synthesized and self-assembled onto the poly(poly(ethylene glycol) methacrylate) (PPEGMA) brush established IOL surface via the supramolecular interaction between α-CD and poly(ethylene glycol) chains. The results of investigation into its optical properties, including transmittance, refractive index, and surface morphology, showed no obvious alterations after photodynamic coating modification on the IOL surface. The in vitro LEC behaviour investigation optimized the photodynamic therapy parameters when light illumination was used for the cell elimination on the photodynamic coating modified IOL. The results have also shown that this functional coating modification effectively eliminates the cells on the surface of the IOL material when treated with light illumination, whereas it keeps excellent cytocompatibility in the absence of light illumination. The investigation of the cell elimination mechanism shows that this kind of functional coating eliminates the adherent cells by ROS induced apoptosis. The in vivo implantation result confirms the excellent PCO inhibition effect, as well as their safety and biocompatibility to the surrounding tissues. As a result, the proposed photodynamic coating provides a safer and effective alternative of IOL modification for preventing PCO.