Sharp-edged Intraocular Lenses Research Articles

Zwitterionic modified and freeze-thaw reinforced foldable hydrogel as intraocular lens for posterior capsule opacification prevention

Posterior capsule opacification (PCO) is a predominant postoperative complication, often leading to visual impairment due to the aberrant proliferation and adhesion of lens epithelial cells (LECs) and protein precipitates subsequent to intraocular lens (IOL) implantation. To address this clinical issue, a foldable and antifouling sharp-edged IOL implant based on naturally-derived cellulose hydrogel is synthesized. The mechanical strength and transparency of the hydrogel is enhanced via repeated freeze-thaw (FT) cycles. The incorporated zwitterionic modifications can remarkably prevent the incidence of PCO by exhibiting proteins repulsion and cell anti-adhesion properties. The graft of dopamine onto both the haptic and the periphery of the posterior surface ensures the adhesion of the hydrogel to the posterior capsule and impedes the migration of LECs without compromising transparency. In in vivo study, the zwitterionic modified foldable hydrogel exhibits uveal and capsular biocompatibility synchronously with no signs of inflammatory response and prevent PCO formation, better than that of commercialized and PEG-modified IOL. With foldability, endurability, antifouling effect, and adhesive to posterior capsule, the reported hydrogel featuring heterogeneous surface design displays great potential to eradicate PCO and attain post-operative efficacy after cataract surgery.

How does sharp-edged intraocular lens (IOL) design compare with round-edged IOL for preventing posterior capsule opacification after cataract surgery?

How does sharp-edged intraocular lens (IOL) design compare with round-edged IOL for preventing posterior capsule opacification after cataract surgery?

Технологические приемы изготовления интраокулярных линз и их влияние на качество зрения

Modern ophthalmic surgery places high demands on intraocular lenses (IOL). Among the most significant technical solutions the following should be noted: an aspheric design; an increase of moisture content to prevent glistening; square sharp edge all over the IOL back for hydrophobic IOLs; back sharp edge IOL`s back surface for hydrophilic IOLs; transition to preloaded systems. Key words: hydrophobic; hydrophilic; intraocular lens; glistening; aspheric; square sharp edge; back sharp edge; preloaded IOL.

Intraocular lens optic edge design for the prevention of posterior capsule opacification after cataract surgery.

Intraocular lens optic edge design for the prevention of posterior capsule opacification after cataract surgery.

Commentary: Anterior capsule polishing: The present perspective.

Commentary: Anterior capsule polishing: The present perspective.

Comparison of posterior capsule opacification development with 2 single-piece intraocular lens types

To evaluate the differences in the incidence of posterior capsule opacification (PCO) and visual and optical performance between2 hydrophobic acrylic single-piece sharp-edged intraocular lenses (IOLs) over 3years. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Prospective randomized case series. Patients with bilateral cataract were prospectively randomizedto receive an Eyecee One IOL (IOL A) or an Acrysof SN60WF IOL (IOL B) and were followed for 36months. The corrected distance visual acuity (CDVA) and IOL decentration and tilt were measured. The PCO was quantified by analysis of standardized retroillumination images. The study comprised 160 eyes of 80 patients. The PCO incidence was low for both IOLs at all follow-up visits. Three years postoperatively, the median objective PCO score was 1.4 (range 0 to 5.6) for IOL A and 1.5 (range 0 to 5.0) for IOL B (P=.67). The neodymium:YAG (Nd:YAG) capsulotomy rate 3years after surgery was 16.4% and 6.0% (P=.06), respectively. Visual acuity and contrast sensitivity outcomes were also comparable at all follow-up visits. Both IOLs showed good capsular bag performance and low PCO rates 3years after surgery. Both IOLs also showed comparable results for visual acuity, contrast sensitivity, decentration and tilt, PCO score, slitlamp examination, and Nd:YAG capsulotomy rates.

Epidemiological evaluation of YAG capsulotomy incidence for posterior capsule opacification in various intraocular lenses in Japanese eyes.

Background and objectiveWe investigated the yttrium aluminum garnet (YAG) capsulotomy rates in various intraocular lenses (IOLs).Study design/patients and methodsWe retrospectively analyzed 23,440 eyes implanted with either MA60BM, MA60AC, VA-60BB, CeeOnEdge, Clariflex, Technis Z9002, SI-40NB, or UV26T IOLs. We calculated the YAG capsulotomy rates at 1, 3, 5, and 10 years post lens implantation.ResultsYAG capsulotomy rates at 3 years postimplantation for the eight groups of IOLs were, respectively, 3.7%, 3.9%, 23.7%, 3.4%, 4.5%, 4.7%, 10.4%, and 21.0%. YAG capsulotomy rates at 10 years postimplantation for the MA60BM and SI-40NB IOLs were, respectively, 9.1% and 15% (P<0.05). The average YAG rates for all sharp-edged and round-edged IOLs at 5 years postimplantation were, respectively, 5.2%±0.7% and 25.6%±9.0% (P<0.05).ConclusionIn all studied IOLs, posterior capsule opacification prevention seemed to be associated with the posterior optic sharp-edge design. Round-edged silicone IOLs may also retard posterior capsule opacification formation, though not as much as sharp-edged IOLs. As the follow-up period progressed, round-edged silicone IOLs showed significantly higher YAG rates than sharp-edged IOLs.

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 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.

Prevention of Posterior Capsule Opacification With 3 Intraocular Lens Models: a Prospective, Randomized, Long-Term Clinical Trial

The aim of this prospective randomized study was to evaluate the impact of different sharp-edged intraocular lenses (IOLs) (hydrophobic acrylic or silicone) on posterior and anterior lens capsule opacification (PCO and ACO) at 3-year postoperative follow-up. A total of 96 eyes (89 patients) having a standard uncomplicated phacoemulsification procedure for age-related cataract were included in a prospective clinical study: 34 eyes with a 3-piece acrylic hydrophobic (AcrySof, MA3OBA), 32 eyes with a 1-piece acrylic hydrophobic (AcrySof, SA3OAL), and 30 eyes with a 3-piece silicone (CeeOn 911A) IOL. Visual acuity, capsulorrhexis/optic overlapping, ACO and PCO (using EPCO2000 system) were evaluated at 3-year follow-up. Capsulotomies performed by means of neodymium-yttrium-aluminum-garnet (Nd:YAG) laser were recorded. Three years after surgery, the grade of ACO of the capsulorrhexis rim area and the capsule/optic area was significantly greater in the silicone IOL group than in the acrylic IOL groups (P<0.05). During 3 postoperative years, there were no significant differences in the PCO values either in the entire IOL optic area or in the central 3-mm optic zone comparing the groups. Three years after surgery, 9% of eyes with a 3-piece acrylic IOL, 3.1% of eyes with a 1-piece acrylic IOL, and no case in the silicone IOL group had Nd:YAG capsulotomy (P>0.05). The 3-year follow-up after cataract surgery showed no difference in PCO development (EPCO2000) between acrylic hydrophobic and silicone sharp-edged IOLs. However, the need for Nd:YAG laser capsulotomy was higher in the acrylic IOL groups than the silicone IOL group, though the difference was not significant. ACO was greatest in the eyes with 3-piece silicone IOLs.

Alkylphosphocholine hemmen die Proliferation und Anhaftung von Linsenepithelzellen

Posterior capsule opacification (PCO) is one of the major concerns in modern cataract surgery. Ten years after successful surgery, Nd:YAG capsulotomy is required in up to 42% of patients with an acrylic sharp-edged intraocular lens (IOL). Some accommodative and multifocal IOLs display even higher capsulotomy rates. Pharmacologic prophylaxis with alkylphosphocholines (APCs) could be a novel option in PCO prevention. The human lens epithelial cell line HLE-B3 served as an in-vitro model. After incubation with APCs in different concentrations (0.01, 0.1, and 1 mM), the trypan blue exclusion assay and the live/dead test were performed at serum concentrations of only 5%. Cell proliferation was assessed with the MTT test. Evaluation of cell attachment was done with fibronectin- and laminin-coated wells. APCs can inhibit the proliferation of human lens epithelial cells in the presence of only 5% serum in a dose-dependent manner. Proliferation inhibition of 60% and attachment inhibition of about 50% were reached at concentrations of 0.1 µM. APCs inhibit proliferation and attachment of human lens epithelial cells in nontoxic concentrations in vitro. The substance can be applied topically, and an intraoperative application for pharmacologic PCO prophylaxis is feasible.

Interventions for preventing posterior capsule opacification.

Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO. To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions. We searched CENTRAL, MEDLINE, EMBASE, LILACS in March 2009 and reference lists of identified trial reports. We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices and pharmacological therapy compared to each other, placebo or standard treatment. We extracted data and entered it into RevMan. We compared visual acuity data, PCO scores and YAG capsulotomy rates and performed a meta-analysis when possible. Sixty six studies were included in the review. The review was divided into three parts. 1. Influence of IOL optic material on the development of PCO. There was no significant difference in PCO development between the different IOL materials (PMMA, hydrogel, hydrophobic acrylic, silicone) although hydrogel IOLs tend to have higher PCO scores and silicone IOLs lower PCO scores than the other materials. 2. Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however not between 1-piece and 3-piece IOLs. 3. Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intraoperative/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) which led to a significantly lower PCO rate. Due to the highly significant difference between round and sharp edged IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.

Comparison of posterior capsule opacification development with 3 intraocular lens types: Five-year prospective study

To compare the effects of hydrophobic acrylic, silicone, and heparin-surface-modified poly(methyl methacrylate) (HSM PMMA) intraocular lenses (IOLs) on posterior capsule opacification (PCO). In this 5-year prospective study, the same surgeon performed standard phacoemulsification in patients who were randomized to implantation of a round-edged HSM PMMA IOL (809C), a round-edged silicone IOL (SI-40NB), or a sharp-edged hydrophobic acrylic IOL (AcrySof MA60BM). The neodymium:YAG capsulotomy rate was recorded. To evaluate PCO and the position of the anterior capsulorhexis, retroillumination digital photographs were taken 5 years postoperatively and analyzed using the POCOman computer-analysis system. After 5 years, there was no significant difference in the fraction or severity of PCO between the silicone IOLs and acrylic IOLs (both P =1.0). The silicone IOL group had a significantly higher capsulotomy rate (29%) than the acrylic IOL group (8%) (P=.0068). The HSM PMMA IOL group had a significantly higher PCO fraction, severity, and capsulotomy rate (54%) than the silicone and acrylic groups. In all eyes, the fraction (P=.0076) and severity (P=.0081) of PCO were statistically significantly higher when the anterior capsulorhexis was partly decentered than when it was completely on the optic; within each IOL group, there was no significant difference. After 5 years, there was no significant difference in the semiquantitative evaluation of PCO between the sharp-edged acrylic IOL and round-edged silicone IOL. Eyes with the HSM PMMA IOL had more PCO than eyes with the other IOLs.

Posterior capsule opacification and neodymium:YAG laser capsulotomy rates with a round-edged silicone and a sharp-edged hydrophobic acrylic intraocular lens 10 years after surgery

To compare posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) laser capsulotomy rates 10 years after surgery between two 3-piece intraocular lenses (IOLs): a silicone IOL with round optic edges and a hydrophobic acrylic IOL with sharp optic edges. Department of Ophthalmology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. Patients having had cataract surgery and implantation of at least 1 study IOL by the same surgeon between 1994 and 1999 were retrospectively examined. The number of Nd:YAG laser capsulotomies performed was noted. The PCO intensity was assessed using digital retroilluminated photographs and Automated Quantification of After-Cataract (AQUA) software. The AQUA scores in eyes with Nd:YAG capsulotomy were estimated with a multiple-imputation procedure. Anterior capsule opacification (ACO) and fibrotic PCO were graded subjectively at the slitlamp. The study evaluated 143 eyes (98 patients). Eight (18%) of 44 eyes with a silicone IOL and 41 (42%) of 99 eyes with an acrylic IOL had Nd:YAG capsulotomy after 10 years (P = .007). The AQUA scores were lower with the silicone IOLs. The median difference in AQUA scores was significantly different after missing values of the Nd:YAG capsulotomies were imputed. There was no difference in ACO. There was more fibrotic PCO with round-edged silicone IOLs than with sharp-edged acrylic IOLs. Ten years after surgery, acrylic IOLs seemed to lose their PCO preventive effect, despite their sharp optic edges. The increasingly longer life expectancy and earlier cataract surgery mandate reconsideration of preferences regarding optic materials and design elements of IOLs.

Effect of intraocular lens design on posterior capsule opacification

Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. Many studies have attempted to identify factors that influence the development of PCO. The aim of this systematic review based on Cochrane methodology was to summarize the effects of intraocular lens (IOL) geometry, including modifications of the IOL optic (especially optic edge design) and haptics, on the development of PCO. Twenty-six prospective randomized controlled trials with a follow-up of at least 12 months were included. In 5 of 7 studies, visual acuity was better in sharp-edged IOLs than in round-edged IOL. The PCO score was significantly lower with sharp-edged IOLs but did not differ significantly between 1-piece and 3-piece open-loop IOLs. Because of the significant difference in the PCO score, sharp-edged IOL optics should be preferred to round-edged IOL optics.

Uveal and capsular biocompatibility of two foldable acrylic intraocular lenses in patients with endogenous uveitis — a prospective randomized study

To compare a hydrophobic and a hydrophilic acrylic single-piece intraocular lens (IOL) in uveitis patients with respect to biocompatibility and visual outcome. Prospective, randomized study in patients with noninfectious uveitis after phacoemulsification and implantation of either a hydrophobic AcrySof (group 1, n = 30) or a hydrophilic Akreos adapt (group 2, n = 30), sharp-edged acrylic IOL. The primary outcome was uveal biocompatibility, detected by giant-cell deposition, anterior chamber cell count and laserflare photometry over a 6-month follow-up period. Secondary outcome measures were capsular biocompatibility, as detected by posterior capsule opacification (PCO), lens epithelial cell outgrowth and Nd:YAG capsulotomies, and visual outcome. The groups did not differ with respect to anatomic type of uveitis, immunosuppressive treatment, associated systemic disease, and intraoperative manipulation. The number of giant cells on the anterior IOL surface was higher in group 1 than in group 2 (p = 0.03). The number of anterior chamber cells, laser flare photometry levels, and uveitis reactivations after surgery did not differ between the groups. After 6 months, the number of patients with PCO development (p = 1.0) and Nd:YAG capsulotomies (p = 0.21), lens epithelial cell outgrowth, visual outcome and uveitis complications were comparable in both groups. Both of the acrylic IOLs used had good uveal and capsular biocompatibility, leading to significant improvement in BCVA in patients with noninfectious uveitis. No obvious differences were detected at 6 months with respect to uveal and capsular biocompatibility and visual outcome.

Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases

BackgroundCurrent after-cataract prevention relies on optimizing the natural barrier effect of the optic rim against lens epithelial cell (LEC) migration. However, deficiencies in circumferential capsular bag closure caused by the intraocular lens (IOL) haptic or delayed secondary re-division of the fused capsules by Soemmering´s ring formation lead to primary or secondary barrier failure. Consequently, surprisingly high posterior laser capsulotomy rates have been reported long-term, even with optimal capsular surgery and the most widespread hydrophobic acrylic IOLs, considered to be the most advanced. Intraoperative removal of the central posterior capsule has been shown to be effective in further reducing LEC immigration. However, efficacy has turned out to be limited because of the propensity of LECs to use the posterior optic surface as an alternative scaffold.Material and methodsTechnique: in pediatric cataract surgery, buttoning-in of the optic into an adequately-centered posterior capsulorhexis opening has been described previously. This technique was further elaborated and applied as the standard technique in a large series of adult eyes. In general, the diameter aimed at was 5–6 mm for the anterior, and 4–5 mm for the posterior capsulorhexis. Between September 2004 and June 2007, 1000 consecutive cases have thus been performed and systematically evaluated. One hundred and fifty eyes additionally underwent extensive anterior LEC abrasion. Another sub-series investigated the option of further reducing capsular fibrosis by creating an anterior capsulorhexis larger than the optic.Evaluation: special scrutiny was applied to detect postoperative vitreous entrapment. Regeneratory and fibrotic after-cataract formation were both meticulously followed-up. Postoperative pressure course, anterior segment inflammation, macular thickness and morphology, as well as axial optic stability and optic centration, were evaluated in intraindividual comparison studies.ResultsA low rate of vitreous complications was found, which can be avoided by appropriate surgery. Vitreous entanglement occurred in six eyes, and vitreous herniation after PPCCC over-sizing in two. In three, anterior vitrectomy was performed. There was only one single case of retinal detachment—supposedly unrelated to the technique itself—and no case of cystoid macular edema. Retro-optical regenerate formation was completely abolished, while fibrosis was drastically reduced by the posterior capsule sandwiched in between the anterior LEC layer on the backside of the anterior capsule and the anterior optic surface, thereby blocking contact-mediated myofibroblastic LEC transdifferentiation. Additional capsular polishing further reduced residual fibrosis emerging from the anterior capsule contacting the optic adjacent to the haptic junction, as well as regeneratory LEC re-proliferation on the posterior capsule overlying the optic. Postoperative pressure course was almost identical to that found after standard in-the-bag implantation of the IOL, as was flare, and macular thickness and morphology. As opposed to bag-fixated IOLs, no axial movement of the optic was detected. IOL optics always perfectly centered even when the capsular opening was not optimally centered. Due to the exquisite stretchability and elasticity of the posterior capsule, the 6-mm IOL optic could safely be buttoned-in in a posterior capsulorhexis of 4 mm and smaller.ConclusionsPosterior optic buttonholing (POBH) is a safe and effective technique which not only excludes retro-optical opacification, but also withholds capsular fibrosis by obviating direct contact between the anterior capsular leaf and the optic surface. Anterior LEC abrasion significantly reduced both the residual fibrosis and regeneratory LEC proliferation. Apart from pediatric cataract, POBH is currently recommended for eyes with pseudoexfoliation syndrome, high axial myopia, peripheral retinal disease, and multifocal IOL implantation. Toric IOLs and magnet-driven accommodative IOL systems are other potential applications. Generally, POBH holds promise for becoming a routine alternative to standard in-the-bag IOL implantation in the future.

Statistical problems caused by missing data resulting from neodymium:YAG laser capsulotomies in long-term posterior capsule opacification studies: Problem identification and possible solutions

To describe a way to eliminate the problem caused by missing data due to neodymium:YAG (Nd:YAG) laser capsulotomies before statistical analysis, which leads to incomplete data in long-term studies of posterior capsule opacification (PCO). Medical University of Vienna, Vienna, Austria. To demonstrate the problem, an existing long-term study comparing PCO development in eyes with round-edged and sharp-edged intraocular lenses (IOLs) was analyzed. In the study, several Nd:YAG capsulotomies led to dropouts in the round-edged IOL group. To solve the resulting missing value problem, the missing values were replaced by estimated PCO values in various scenarios; that is, different assumptions were made of how PCO would have developed without a capsulotomy. Standard statistical analyses that included the estimated PCO values rather than excluding the incomplete cases were then performed. The analysis of all cases (including the estimated PCO scores) showed a highly significant difference between the round-edged group and the sharp-edged group. Sensitivity analyses confirmed that the difference between the 2 groups remained significant up to highly implausible values chosen for the missing PCO scores, thus proving the correctness of the analysis. This study showed it is possible to perform statistical analyses without excluding incomplete cases. This approach is recommended for all studies with Nd:YAG dropouts as it increases the statistical power. Excluding incomplete cases may lead to biased or wrong study conclusions.

Effect of AcrySof versus Silicone or Polymethyl Methacrylate Intraocular Lens on Posterior Capsule Opacification

To investigate the effect of AcrySof intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) compared with silicone or polymethyl methacrylate (PMMA) IOLs for patients with senile cataracts. Meta-analysis of randomized controlled trials (RCTs). Patient data from previously reported RCTs. A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify RCTs comparing AcrySof with silicone or PMMA IOLs in patients with senile cataract. A meta-analysis was performed on the results of RCTs. Posterior capsule opacification score, neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy rate, and best-corrected visual acuity (BCVA) of 0.5 or better after cataract surgery. In total, 10 RCTs involving 1202 eyes with senile cataract were included in this meta-analysis. The results suggested that AcrySof had lower PCO scores than round-edged silicone IOLs (standard mean difference [SMD], -0.25; 95% confidence interval [CI], -0.42 to -0.08; P = 0.003) and a somewhat higher PCO score than sharp-edged silicone IOLs (SMD, 0.48; 95% CI, 0.29-0.68; P<0.00001). AcrySof had a lower Nd:YAG capsulotomy rate than round-edged silicone IOLs (odds ratio [OR], 0.29; 95% CI, 0.14-0.62; P = 0.001) and did not differ from sharp-edged IOLs (OR, 1.72; 95% CI, 0.23-13.13; P = 0.60). AcrySof had a lower PCO score (SMD, -1.07; 95% CI, -1.29 to -0.85; P<0.00001) and a lower Nd:YAG capsulotomy rate (OR, 0.09; 95% CI, 0.04-0.20; P<0.00001) than round-edged PMMA IOLs. Furthermore, there was no significant difference in BCVA between AcrySof and round-edged silicone IOLs (OR, 2.28; 95% CI, 0.66-7.82; P = 0.19) or PMMA IOLs (OR, 3.20; 95% CI, 0.78-13.16; P = 0.11). AcrySof and sharp-edged silicone IOLs are similarly effective in inhibition of PCO after cataract surgery. In patients implanted with the AcrySof lens, significantly less PCO developed than in those who had round-edged silicone or PMMA IOLs. The results of this meta-analysis support the theory that a major factor in preventing PCO development is a sharp-edged IOL design.

Uveal and capsular biocompatibility after implantation of sharp-edged hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in eyes with pseudoexfoliation syndrome

To evaluate the uveal and capsular biocompatibility of 3 types of sharp-edged foldable intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome (PEX). Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Eighty-five eyes with PEX had implantation of 1 of the following sharp-edged 3-piece IOLs: hydrophilic acrylic (Injectacryl F3000, OphthalMed), hydrophobic acrylic (AcrySof MA60MB, Alcon), or silicone (CeeOn 911, AMO). Postoperative evaluation (flare, cellular reaction, and capsular reaction) was performed at 1, 3, and 7 days as well as 1, 3, 6, and 12 to 18 months. One year after surgery, flare was comparable between the IOLs. In terms of uveal biocompatibility, whereas the Injectacryl had the highest deposition of debris on the IOL surface (P = .04), the CeeOn 911 had significantly more small round cells in the first 6 months (P<.03). The AcrySof had the highest number of foreign-body giant cells (P = .01). In terms of capsular biocompatibility, lens epithelial cell outgrowth was highest in the AcrySof group (P<.02). Anterior capsule opacification was comparable between the 3 groups. Posterior capsule opacification was mild in all groups but was significantly greater in the Injectacryl group (P<.05). There were no cases of clinically significant IOL decentration or capsule contraction. In general, inflammatory cells accumulated more easily on hydrophobic IOLs than on hydrophilic IOLs; the AcrySof IOL had the highest prevalence of foreign-body giant cells. All 3 IOLs had good biocompatibility, although the AcrySof group had increased inflammatory signs.