Regeneratory Posterior Capsule Opacification Research Articles

Commentary: Anterior capsule polishing: The present perspective.

Commentary: Anterior capsule polishing: The present perspective.

Capsular bag performance of a hydrophobic acrylic 1-piece intraocular lens

To compare parameters after 1-piece and 3-piece intraocular lens (IOL) implantation. Moorfields West End Clinic, London, United Kingdom, and Hanusch Hospital, Vienna, Austria. Prospective randomized controlled trial. Each eye of patients having bilateral surgery for age-related cataract was randomized to have implantation of a 1-piece IOL (Tecnis ZCB00) or a 3-piece IOL (Tecnis ZA9003). Changes in visual acuity, refraction, and anterior chamber depth (ACD) were evaluated during a 2-year follow-up. Intraocular lens tilt and decentration were evaluated using a Purkinje meter. Regeneratory posterior capsule opacification (PCO) was analyzed using retroillumination photographs in Automated Quantification of After-Cataract image-analysis software. This study comprised 100 eyes of 50 patients. No statistically significant differences were found in IOL tilt or decentration between groups (P≥.06). Minimal but statistically significant changes were observed in the vertical tilt component 12 months postoperatively in the 3-piece IOL group (P<.01). The tilt and decentration components did not correlate with changes in sphere or the regeneratory PCO score (r = 0.38, P≥.06). The ACD decreased significantly between 1 day and 1 month postoperatively in both groups (P<.01), with no significant changes afterward (P≥.22). The anterior chamber was significantly deeper in the 1-piece group at all follow-up visits (P<.01). Both the 1-piece IOL and the 3-piece IOL showed excellent positional stability in the capsular bag, resulting in good clinical outcomes. Regeneratory PCO levels were low and comparable between the IOLs. No author has a financial or proprietary interest in any material or method mentioned.

Comparison of methods to quantify posterior capsule opacification using forward and backward light scattering

To compare forward and backward light scattering measurements to quantify posterior capsule opacification (PCO). Vienna Institute for Research in Ocular Surgery, Vienna, Austria. Prospective single-center study. This observational study comprised consecutive patients scheduled for neodymium:YAG (Nd:YAG) capsulotomy for regeneratory PCO. The corrected distance visual acuity (CDVA) using Early Treatment of Diabetic Retinopathy Study charts and the contrast sensitivity under mesopic and photopic conditions using Pelli-Robson charts were assessed before an Nd:YAG capsulotomy was performed. Retroillumination images, rotating Scheimpflug scans (Pentacam HR), and straylight meter (C-Quant) and point-spread function (PSF) meter (Optical Quality Analysis System) measurements were performed before and after Nd:YAG capsulotomy. The study enrolled 50 eyes of 50 patients. The mean uncorrected distance visual acuity and CDVA were 0.76 logMAR ± 0.18 (SD) and 0.68 ± 0.2 logMAR, respectively. The mean log contrast sensitivity (logCS) was 1.2 ± 0.15 logCS under photopic conditions and 1.05 ± 0.15 logCS under mesopic conditions. There was a moderate correlation between the Scheimpflug score and the Automated Quantification of After-Cataract score (r(2) = 0.37, P=.03). Furthermore, a moderate and close to significant correlation between the PSF meter and the straylight meter was observed (r(2) = 0.32; P=.07). Each of the 4 devices assesses different aspects of a patient's quality of vision. Further developments should focus on methods that measure forward scatter of light in a large visual angle and are not too patient or examiner dependent.

Effect of a Single-Piece and a Three-Piece Acrylic Sharp-Edged IOL on Posterior Capsule Opacification

Background: To compare the intensity of posterior capsule opacification (PCO) between two intraocular lenses (IOLs) of the same optic material, but with different haptic design (1-piece vs. 3-piece).Methods: This prospective intraindividual controlled cohort study comprised eighty eyes of 40 patients with bilateral age-related cataract. Each patient received a Polylens Y10 (Polytech, Germany) 1-piece IOL in 1 eye and a Polylens Y30 (Polytech, Germany) 3-piece IOL in the contralateral eye. The IOL type in the first operated eye was randomly assigned before patient recruitment. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for regeneratory PCO. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.Results: The Polylens Y10 (1-piece) group showed significantly higher regeneratory and fibrotic PCO scores 1 year after surgery in subjective slitlamp evaluation, however not with objective evaluation using automated image-analysis software. Subjective PCO assessment resulted in a mean PCO score (scale = 0–10) of 1.6 in the Polylens Y10 group and 0.6 in the Polylens Y30 group at 1 year (p < 0.05). The mean automated image-analysis software PCO score was 1.5 in the Polylens Y10 group and 0.9 in the Polylens Y30 group (p = 0.6).Conclusion: Both investigated IOLs showed good clinical performance regarding PCO, BCVA and IOL-centration. The Polylens Y10 IOL showed slightly more regeneratory PCO than the 3-piece acrylic IOL 1 year after surgery.

Influence of a Modified Nd:YAG Laser Treatment Outside the Visual Axis on the Morphology of Elschnig Pearls

Purpose: To observe changes in posterior capsule opacification (PCO) after Nd:YAG treatment with and without opening the posterior lens capsule. Method: This prospective randomized study included patients with regeneratory PCO. In substudy 1, a small low-energy Nd:YAG capsulotomy was performed (MiniYAG). In substudy 2, a low-energy Nd:YAG laser treatment without opening the lens capsule was performed (GentleYAG). Concerning analysis, in both substudies, the posterior capsule was divided into 4 quadrants and the quadrant where the Nd:YAG laser treatment was performed was randomly allocated. Change in PCO was analyzed using retroillumination images objectively (AQUA score: 0–10). Results: In total, 27 eyes of 25 patients were used for this study. In substudy 1, the mean amount of PCO (AQUA score) for the entire posterior capsule decreased significantly (p < 0.05, ANOVA) from 5.2 (SD: 1.6) before to 4.0 (SD: 1.9) immediately after the MiniYAG. In substudy 2, the mean amount of PCO (AQUA score) for the entire posterior capsule analyzed before and immediately after the GentleYAG was 5.1 (SD: 2.4) and 5.2 (SD: 2.3), respectively. Conclusion: Performing a MiniYAG led to a significant PCO reduction. Gentle polishing of the posterior capsule resulted in a relevant reduction of PCO in one third of the patients.

In-vitro recording of forward light-scatter by human lens capsules and different types of posterior capsule opacification

The purpose of the present study was to elucidate the effect of posterior capsule opacification (PCO) on the straylight domain of visual function. PCO is heterogeneous with regard to morphology and severity; both aspects contribute to its functional effect. The isolated impact of capsule areas with specific morphology and severity on straylight was studied in-vitro by recording forward light-scatter. Forward light-scatter by four different capsule types, i.c. anterior capsule (AC), clear posterior capsule (PC), fibrotic and regeneratory PCO, was recorded at several visual angles with a goniometer, using different wavelengths. Angular (θa) and wavelength dependencies (λb) were studied by determining exponents a and b. Recorded straylight values of isolated capsule areas varied between 10× below to 10× above the value normal for the human eye, depending on the capsule's condition (clear to opacified). The angular dependence of light scattered by clear PCs was weaker, whereas in the other capsule types it was stronger than in the normal eye. On average, the wavelength dependence of light scattered by different capsule types was similar, but the variation was considerable. At the smallest visual angles, increased angular and decreased wavelength dependence was found, especially in fibrotic and regeneratory PCO. It was concluded that the range of straylight values found in-vitro in lens capsules properly corresponded to that found previously in in-vivo pseudophakics. Surprisingly, the wavelength dependence of PCO indicated that small-particle light-scattering is important in PCO. Refractile effects were more important at small visual angles, as indicated by the combined stronger angular and weaker wavelength dependence.

Posterior capsule opacification and capsular bag performance of a microincision intraocular lens

To assess the axial stability and posterior capsule opacification (PCO)-inhibiting efficacy of a microincision hydrophilic intraocular lens (IOL) (Idea 613 XC) and a standard hydrophobic open-loop acrylic IOL (Acrysof SA60AT). Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Clinical trial. Patients with bilateral cataract received a microincision cataract surgery (MICS) IOL in 1 eye and a small-incision cataract surgery (SICS) IOL in the contralateral eye. Follow-up examinations were performed immediately after surgery and postoperatively at 1 week and 3 and 24 months. Posterior capsule opacification was assessed using retroillumination photography. Anterior chamber depth (ACD) was measured using partial coherence laser interferometry, and IOL tilt and decentration were measured using a Purkinje meter. Seventy eyes (35 patients) were enrolled. The mean ACD at 3 months was 4.91 mm ± 0.26 (SD) in the MICS group and 4.60 ± 0.23 mm in the SICS group. The anterior IOL shift over the first 3 months was slightly smaller with the MICS IOL (81 μm) than with the SICS IOL (254 μm). The mean ACD was 0.377 ± 178 μm deeper with the MICS IOL (P<.01, paired t test). Two years postoperatively, the amount of regeneratory PCO was higher with the MICS IOL than with the SICS IOL (image analysis software score 2.6 versus 1.9; P=.005). Two years after surgery, the PCO rate was slightly higher with the MICS IOL. The 2 IOLs had similar performance in terms of axial stability, decentration, and tilt. No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Elschnig pearl formation and disappearance

Abstract Purpose To observe and analyze morphological changes of Elschnig pearls in eyes with after‐cataract. Methods Pseudophakic eyes with pronounced regeneratory posterior capsule opacification were included in the prospective studies. In the first study the natural course of Elschnig pearls was observed during days and weeks. In the second study morphological changes immediately after a Nd:YAG‐capsulotomy were observed. And in two further studies the Nd:YAG laser capsulotomy was modified and the effect on Elschnig pearls was observed. Results In the first study, in total 6309 Elschnig pearls (85 eyes) were analyzed. On average, four pearls were found per square millimeter (range, 0.2‐9.7/mm2) with a mean cumulative area of 0.66 mm2) (range, 0.03‐2.18 mm2) of all marked pearls per eye and follow‐up. The mean pearl size was 9630 microm2 (range, 2390‐33,745 microm2) at baseline. The mean change of a pearl per day was 583 microm2 (range, 175‐1631 microm2) or a 6% change in area. In the second study in total, 2431 Elschnig pearls (20eyes) were observed. Of these, 535 pearls (30.6%) disappeared, and 503 pearls (27.6%) survived on the remaining capsule peripheral to the capsulotomy opening. Conclusion Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly between eyes. Capsulotomy had an immediate impact on the morphology of PCO outside the capsulotomy opening. Knowledge about Elschnig pearl turnover may be of importance for attempts to modulate lens epithelial regeneration or lens regrowth and for lens‐refilling procedures.

Reproducibility of an Analysis Software for Qualitative Observation of Elschnig Pearls

To determine the reproducibility of a semi-objective analysis software for the morphological analysis of single Elschnig pearls from retroillumination images of posterior capsule opacification. In this prospective study, images of eyes with varying degrees of regeneratory posterior capsule opacification and the presence of Elschnig pearls were taken. The size and morphology of single Elschnig pearls was evaluated from consecutive images using an analysis method called PearlTracer using three different modes: snake selection, where a few points detected the pearl border automatically; diameter circle selection, a circle function; and polygon selection, where several points were connected by straight lines. The interobserver and intraobserver reproducibility and the limits of the different modes concerning contrast were assessed. One hundred fifty-eight retroillumination images of 55 eyes of 50 patients were included with a total of 857 pearls being analyzed. A high interobserver reproducibility was found, as well as a high intraobserver reproducibility. Furthermore, a significant difference in the pearl size and the pearl morphology between the three analysis features of the software was found. For the observation of single Elschnig pearls and their morphological changes, the semi-objective PearlTracer analysis software was found to be a highly reproducible and useful method.

Effect of Nd:YAG capsulotomy on the morphology of surviving Elschnig pearls

Aim:To observe the short-term changes in morphology of Elschnig pearls induced by Nd:YAG capsulotomy.Setting:Department of Ophthalmology, Medical University of Vienna, AustriaMethod:Twenty eyes of 19 pseudophakic patients with regeneratory posterior capsule...

Natural Course of Elschnig Pearl Formation and Disappearance

To observe and analyze the daily and weekly changes in morphology and size of Elschnig pearls in eyes with after-cataract. Pseudophakic eyes with pronounced regeneratory posterior capsule opacification (PCO) were included in this prospective study. High-resolution retroillumination images were taken, and the changes in size and shape of Elschnig pearls were analyzed at baseline and at 2, 7, and 14 days later using dedicated imaging software. In total, 6309 Elschnig pearls in 85 eyes of 77 patients were analyzed. On average, four pearls were found per square millimeter (range, 0.2-9.7/mm(2); CV, 49.5%) with a mean cumulative area of 0.66 mm(2) (range, 0.03-2.18 mm(2); CV, 66.7%) of all marked pearls per eye and follow-up, which was 3.8% of the analyzed area. The mean pearl size was 9630 microm(2) (range, 2390-33,745 microm(2); CV, 61.0%) at baseline, which corresponded to a diameter of 174 microm. The mean change of a pearl per day was 583 microm(2) (range, 175-1631 microm(2); CV, 55.4%) or a 6% change in area. In total, 36% (CV, 5.5%) of all pearls increased in size, 7% (CV, 8.6%) did not change, and 35% (CV, 6.7%) decreased in size during 1 week. Furthermore, 11% (CV, 6,3%) of all pearls newly appeared, and the same number disappeared (CV, 5.7%) within 1 week. Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly between eyes. Knowledge about Elschnig pearl turnover may be of importance for attempts to modulate lens epithelial regeneration or lens regrowth and for lens-refilling procedures.

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.

Effect of Topical Prednisolone and Diclofenac on the Short-Term Change in Morphology of Posterior Capsular Opacification

To observe and document the effect of steroidal and nonsteroidal antiinflammatory treatment on the formation of Elschnig pearls. A prospective, randomized, double blinded, placebo controlled, two-way-cross-over study. Thirty-nine eyes of 32 patients with pronounced, regeneratory posterior capsule opacification (PCO) were included. The patients were treated topically with prednisolone and diclofenac (verum) or with lubricating eye drops (placebo) four times daily for one week. After a wash-out period of two weeks the patients received the contrary treatment also four times daily for one week. Digital retroillumination images were taken at day one, three, five, eight, and 15 of each medication period. The changes in the size of 4,675 Elschnig pearls were analyzed. The mean cumulative area of all marked pearls/eye and follow-up was 1.2 mm(2) (range: 0.1 mm(2) to 3.2 mm(2)). The mean pearl size was 12,809 microm(2) (range: 60 microm(2) to 1.08 x 10(6) microm(2)). Between the follow-up examinations, 1,274 pearls disappeared (mean: 33 pearls/eye, range: five to 69 pearls; 27%) and 777 newly formed pearls appeared (mean: 20 pearls/eye, range: three to 53 pearls; 20%). There was no statistically significant difference in pearl size change and in number of disappeared and newly appeared pearls between the verum and the placebo treatments. Topical prednisolone and diclofenac do not influence the short-term change of Elschnig pearls. Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly among eyes.

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.

Daily Changes in the Morphology of Elschnig Pearls

To observe and document the daily changes in the morphology of Elschnig pearls. A prospective cohort study. Twenty-nine pseudophakic eyes with pronounced, regeneratory posterior capsule opacification (PCO) were included in this prospective study. Retroillumination images were taken at days 0, 1, 2, and 14. A square grid was laid over the images. Increase, decrease, appearance, and disappearance of pearls between the follow-up images were quantified. A total of 1371 areas (mean: 53/eye) of 26 eyes were analyzed between days 0 and 1 and 1 and 2, and 896 areas (50/eye) of 18 eyes between days 0 and 14. Between days 0 and 1, days 1 and 2, and days 0 and 14, we observed "no change" in pearl size in 72%, 77%, and 32%, a "minor increase" in 16%, 14%, and 10%, a "major increase" in 4%, 3%, and 42%, a "minor decrease" in 14%, 11%, and 11%, and a "major decrease" in 4%, 3%, and 37%, respectively. Appearance of newly formed pearls was found in 1%, 1%, and 9% and disappearance of pearls in 1%, 1%, and 5%, respectively. Significant changes in the morphology of Elschnig pearls were observed within time intervals of only 24 hours. Appearance and disappearance of pearls, as well as progression and regression of pearls within these short intervals illustrate the dynamic behavior of regeneratory PCO. These findings may contribute to a better understanding of PCO and have implications on pharmaceutical interventions for PCO.

Effect of anterior capsule polishing on posterior capsule opacification and neodymium:YAG capsulotomy rates: Three-year randomized trial

To compare the long-term effect of extensive polishing and nonpolishing of the anterior lens capsule on posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. This prospective randomized bilateral double-masked study included 108 eyes of 54 consecutive patients with age-related cataract. Following phacoemulsification, 3-piece intraocular lenses (IOLs) with round-edged silicone optics were implanted. Patients received an Allergan SI-40 IOL with a truncated, round optic edge or a Domilens Silens6 IOL with a fully round optic edge. Patients were randomly assigned to have extensive anterior capsule polishing with the Menapace aspiration curette or no treatment in the first eye; the second eye received the opposite treatment. Digital retroillumination images were taken at 1 week, 1 year, and 3 years, and Nd:YAG capsulotomy rates were evaluated. Posterior capsule opacification was objectively scored using automated image analysis software (AQUA) or estimated based on clearly defined assumptions if a capsulotomy had been performed. Thirty-nine patients (78 eyes) concluded the study. Three-year PCO scores after polishing did not differ significantly (P>.05). However, 21 polished eyes (53.8%) required Nd:YAG laser capsulotomy compared with 14 nonpolished eyes (35.9%). The mismatch between PCO scores and Nd:YAG rates resulted from a change in PCO morphology that is not detected by scoring methods based on retroillumination photography but is visually disturbing to patients. Polishing the anterior capsule was effective in reducing fibrotic opacification but ineffective in reducing regeneratory opacification. Changes in regeneratory PCO morphology not picked up by retroillumination photography increased the need for Nd:YAG laser capsulotomy.

Long-term Effect of Sharp Optic Edges of a Polymethyl Methacrylate Intraocular Lens on Posterior Capsule Opacification: A Randomized Trial

To compare the posterior capsule opacification (PCO) inhibiting effect of a 3-piece polymethyl methacrylate (PMMA) intraocular lens (IOL) with a sharp optic edge design with that of the round-edged version of the same IOL during a 5-year period.Randomized patient- and examiner-masked clinical trial with intraindividual comparison.Thirty-two patients with bilateral age-related cataract (64 eyes).Each study patient had phacoemulsification cataract surgery in both eyes and received a sharp optic edge PMMA IOL in one eye and a round optic edge PMMA IOL in the fellow eye (both by Dr Schmidt in Germany). Follow-up examinations were at 1 week, 1 month, 1 year, 3 years, and 5 years. Digital retroillumination images were taken from each eye. The amount of posterior capsule opacification was assessed objectively by means of automated image analysis software (Automated Quantification of After-Cataract) at 1 year, 3 years, and 5 years after surgery.Posterior capsule opacification score: 0-10.The sharp optic edge IOL showed significantly less regeneratory and fibrotic PCO at 1 year, 3 years, and 5 years after surgery. The mean AQUA PCO score was 5.12 for the round-edge and 2.49 for the sharp-edge IOL (scale, 0-10; P<0.001) at 5 years. The mean difference among patients for the PCO score in the eye implanted with the sharp optic edge versus the score in the eye with the round optic edge was 2.83 at 5 years (95% confidence interval, 1.66-4.00). Due to the large number of neodymium:yttrium-aluminum-garnet laser capsulotomies that were performed (12 in the round-edge group and 4 in the sharp-edge group), there was no significant difference in visual acuity between both groups at any time point.Compared with the round-edge version, the sharp optic edge design of a 3-piece PMMA IOL led to significantly less PCO at 1 year, 3 years, and 5 years after surgery. However, the sharp optic edge did not lead to complete PCO prevention during this follow-up period. This finding has implications for the design of PMMA IOLs used for cataract surgery, especially in the developing world.

Short-term changes in the morphology of posterior capsule opacification

To observe and document posterior capsule opacification (PCO) growth in vivo over a short period of time (4 weeks). Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Fifteen eyes of pseudophakic patients with PCO of varying degrees were included in this prospective study. Digital retroillumination images were taken in a standardized fashion at 3 time points: 1 baseline image, a second image after 2 weeks, and a third image after 4 weeks. Thus, a 3-image series could be created for each eye. Additionally, sections of the posterior capsule with interesting structures were photographed with higher magnification and compared in supplementary image series. Morphologic changes in the PCO structure (eg, number and size of Elschnig pearls, total PCO area) were analyzed in the image series. In all cases, significant changes could be observed between the 3 time points. In 71% of cases, some Elschnig pearls increased in size during the first 2 weeks and during weeks 3 and 4. In 73% of cases, however, there was a reduction a pearl size or even disappearance of some Elschnig pearls. The total PCO area did not change significantly during the 4-week period. Development of (regeneratory) PCO is a very dynamic process that includes not only growth of preexisting structures and occurrence of new Elschnig pearls, but also reorganization and even disappearance of pearls within a short time period (2-4 weeks). The latter in particular is not well known but could be observed in the majority of cases in this study.

Long-term effect of optic edge design in an acrylic intraocular lens on posterior capsule opacification

To compare the posterior capsule opacification (PCO) inhibiting effect of the sharp posterior optic edge design of the Sensar OptiEdge AR40e intraocular lens (IOL) with that of the double-round edge design of the Sensar AR40 IOL over a period of 3 years. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Fifty-three patients with bilateral age-related cataract (106 eyes) were included in this randomized prospective bilateral patient- and examiner-masked clinical trial with intraindividual comparison. Each study patient had cataract surgery in both eyes and received a Sensar AR40 IOL (anterior and posterior round optic edges) in 1 eye and a Sensar OptiEdge AR40e IOL (round anterior and sharp posterior optic edge) in the other eye. Follow-up examinations were at 1 week, 1 and 6 months, and 1, 2, and 3 years. Digital retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software (AQUA) 1, 2, and 3 years after surgery. The sharp-edged AR40e lens showed significantly less regeneratory and fibrotic PCO 1, 2, and 3 years after surgery. The mean AQUA PCO score was 2.18 for the AR40 and 1.00 for the AR40e lens after 1 year; 2.94 and 1.56 after 2 years, and estimated at 3.13 and 1.77, respectively, after 3 years (scale 0 to 10; P<.001). The neodymium:YAG laser capsulotomy rate was significantly higher in the AR40 group. The AR40e lens also led to less peripheral fibrotic PCO. There was no significant difference in complaints concerning edge glare between the groups. Compared with the AR40 IOL, the sharp posterior optic edge design of the Sensar OptiEdge AR40e IOL led to significantly less PCO 1, 2, and 3 years postoperatively. In contrast with most past studies on PCO-preventative factors, this study varied only 1 parameter, namely the optic edge design, and the main outcome measure (PCO) was assessed with an objective image-analysis system.

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.