Single-piece AcrySof Research Articles

Scleral Fixation of a Single-Piece AcrySof Toric Intraocular Lens: A Case Report

Purpose: To describe a simple and least invasive surgical method of transscleral fixation of a dislocated single-piece AcrySof® toric intraocular lens (IOL).Case summary: A 62-year-old male was referred with dislocated toric IOL (SN6AT4, AcrySof® IQ Toric; Alcon Laboratories, Fort Worth, TX, USA) in his right eye after an uneventful cataract surgery. Scleral fixation using the toric IOL was performed by placing the suture knot at the optic-haptic junction right beside the toric axis markings which easily achieved the desired positioning of the axis. The preoperative uncorrected distance visual acuity was 20/400 and it improved to 20/60 at 1 week after repositioning of the IOL and the IOL was well-centered with its toric alignment within 5 degrees of the intended axis.Conclusions: Transscleral fixation of single-piece AcrySof toric IOLs is easy to learn technique, which reduces surgical time with minimal manipulation and enables IOL stability with good postoperative toric axis alignment.

PMD24 - ASSOCIATION BETWEEN IOL DESIGN AND INCIDENCE OF PCO AND ND:YAG CAPSULOTOMY: A RETROSPECTIVE REAL WORLD EVIDENCE STUDY IN THE UK

Patients post-cataract surgery may experience abnormal proliferation of lens epithelial cells on the posterior capsule (posterior capsule opacification, PCO). Neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy is considered a safe surgical treatment for PCO, but could occasionally lead to further complications. Existing studies have reported numerous factors influencing PCO incidence including IOL material and design. In this study, real-world incidence of both PCO and Nd:YAG in the 5 years post-cataract surgery were assessed in a large UK population, including their association with IOL material. Patients (≥65 years) undergoing cataract surgery with ‘in-the-bag’ placement of acrylic monofocal single-piece IOLs between 2010-2013 were included. Data were collected from Electronic Medical records (EMR) from 7 UK NHS Ophthalmic clinics; only IOL models used in at least 500 procedures were included. The analysis focused on the association between the IOL model and the risk of PCO and Nd:YAG. Incidence proportion of PCO and Nd:YAG at 5 years from cataract surgery was calculated for each IOL model. Pairwise comparisons were conducted between AcrySof IOLs and other IOLs using Bonferroni adjustment for multiplicity. Multivariate analyses were also conducted adjusting for known confounders. Incidence proportion of Nd:YAG at 5 years post-cataract surgery was 5.8% for AcrySof (CI 5.2%-6.4%, n=5,342); this was significantly lower than Tecnis (8.5%, CI 7.8%-9.2%, n=5,609), B&L (15.2%, CI 14.3%-16.0%, n=6,847) and Lenstec (19.3%, CI 17.9%-20.8%, n=2,964) (all P values <0.001). AcrySof IOLs also had significantly lower incidence proportion of PCO compared with the other IOLs. This real world evidence study demonstrated that hydrophobic single-piece AcrySof IOLs are associated with a significantly lower incidence of Nd:YAG capsulotomy and PCO post cataract surgery, at a long-term follow-up of five years.

Comparative study of induced changes in effective lens position and refraction after Nd:YAG laser capsulotomy according to intraocular lens design.

PurposeTo evaluate and compare the changes in refraction and effective intraocular lens (IOL) position between a plate-haptic IOL and a c-loop single-piece IOL after neodymium-doped yttrium aluminium garnet (YAG) laser posterior capsulotomy.MethodsIn a prospective study, anterior chamber depth and subjective refraction were measured in 110 pseudophakic eyes from 110 patients, before and 1 month after YAG laser capsulotomy. Patients were divided into 2 groups according to the IOL design: group 1 (plate-haptic acrylic hydrophilic AT LISA tri 839MP®) and group 2 (c-loop acrylic hydrophobic single-piece AcrySof® SA60AT). Lens position was obtained through optical coherence biometry (Biograph WaveLight OB820®).ResultsYAG laser capsulotomy was performed 37.8±9.8 months after surgery in group 1 and 40.6±8.6 months in group 2 (p=0.125). Significant changes were found in the lens effective position after treatment in the 2 groups. The YAG posterior capsulotomy led to a change of anterior chamber depth in group 1 from 4.03±0.32 mm to 3.86±0.34 mm (p=0.02) and in group 2 from 4.03±0.37 mm to 4.14±0.45 mm (p=0.025). After YAG laser posterior capsulotomy, no significant changes were observed in mean spherical equivalent, sphere or cylinder for both groups (p>0.05).ConclusionYAG laser posterior capsulotomy can induce a significant change in the IOL position according to the IOL type; however, the refractive change after treatment is clinically insignificant.

Cionni Ring and In-the-Bag Intraocular Lens Implantation for Subluxated Lenses: A Prospective Case Series

To report the intraoperative performance and postoperative outcomes of the Cionni-modified capsule tension ring (CTR) implantation in eyes with subluxated lenses. Prospective, observational case series. This study was carried out at Iladevi Cataract & IOL Research Centre, Ahmedabad, India. The study population comprised 41 eyes with subluxated lenses that underwent lens extraction, capsular bag fixation with modified CTR, and in-the-bag single-piece AcrySof intraocular lens (IOL) implantation. Main outcome measures were intraoperative performance and postoperative best-corrected visual acuity (BCVA), IOL centration, and complications. The mean age was 29.46 ± 16.16 years (3-68 years). Mean extent of subluxation was 6.1 ± 1.0 clock hours. Preoperatively, vitreous was detected in the anterior chambers of 5 eyes (12.2%). Two-port anterior chamber vitrectomy was performed in 2 eyes. Mean follow-up was 45.8 ± 2.9 months. Mean preoperative BCVA was 0.66 ± 0.22 logMAR (35 eyes). Mean postoperative BCVA at final follow-up was 0.33 ± 0.21 logMAR (41 eyes) (P < .001). BCVA improved in 35 eyes (85.4%) at the last follow-up. In 3 eyes (7.3%) IOL decentration was noted and repositioning was required in 2 eyes. Posterior capsule opacification developed in 14 eyes (34.2%); 12 eyes (29.3%) required Nd:YAG capsulotomy. Other complications included cystoid macular edema in 1 eye (2.4%), posterior synechiae in 1 eye (2.4%), and retinal detachment in 1 eye (2.4%). In-the-bag implantation of a Cionni-modified CTR with IOL appears to be a safe option in eyes with subluxated cataract, ensuring a stable IOL with few complications.

Accelerated 20-year sunlight exposure simulation of a photochromic foldable intraocular lens in a rabbit model

To assess the long-term biocompatibility and photochromic stability of a new photochromic hydrophobic acrylic intraocular lens (IOL) under extended ultraviolet (UV) light exposure. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. A Matrix Aurium photochromic IOL was implanted in right eyes and a Matrix Acrylic IOL without photochromic properties (n = 6) or a single-piece AcrySof Natural SN60AT IOL (n = 5) in left eyes of 11 New Zealand rabbits. The rabbits were exposed to a UV light source of 5 mW/cm(2) for 3 hours during every 8-hour period, equivalent to 9 hours a day, and followed for up to 12 months. The photochromic changes were evaluated during slitlamp examination by shining a penlight UV source in the right eye. After the rabbits were humanely killed and the eyes enucleated, study and control IOLs were explanted and evaluated in vitro on UV exposure and studied histopathologically. The photochromic IOL was as biocompatible as the control IOLs after 12 months under conditions simulating at least 20 years of UV exposure. In vitro evaluation confirmed the retained optical properties, with photochromic changes observed within 7 seconds of UV exposure. The rabbit eyes had clinical and histopathological changes expected in this model with a 12-month follow-up. The new photochromic IOL turned yellow only on exposure to UV light. The photochromic changes were reversible, reproducible, and stable over time. The IOL was biocompatible with up to 12 months of accelerated UV exposure simulation.

Technological Advances in Pediatric Cataract Surgery

Purpose: Managing pediatric cataracts is often challenging. It is technically difficult to perform surgery in these small complaint eyes and there is higher prevalence of postoperative complications. The outcomes of surgery depend on technique and technology. The purpose of this study is to review the current literature on technological advances in pediatric cataract surgery. Methods: Review of literature on management of pediatric cataract surgery. Results: The advent of vitrectomy machines and intraocular lenses (IOLs) has revolutionized pediatric cataract surgery. “Vitrectorhexis” has become a good alternative to manual capsulorhexis. Primary management of posterior capsule and limited anterior vitrectomy has reduced the incidence of visual axis opacification. Primary IOL implantation is becoming a standard of care in the youngest children. Single piece Acrysof® is preferred for in-the-bag implantation and 3-piece Acrysof® for sulcus implantation. Newer IOLs are being evaluated in pediatric eyes. Precise measurement of intraocular lens power and predicting refractive change are major challenges in long term care of children after surgery. Conclusion: New technology and surgical techniques have refined pediatric cataract surgery. It is critical to focus our efforts on precise biometry measurements, IOL power calculation, and designing IOLs that may address refractive changes in the growing pediatric eye.

Intraoperative performance and postoperative outcomes of endocapsular ring implantation in pediatric eyes

To study the intraoperative performance and postoperative outcomes of Cionni modified capsule tension ring (CTR) and intraocular lens (IOL) implantation in the capsular bag in pediatric eyes with ectopia lentis. John A. Moran Eye Center, Salt Lake City, Utah, USA. Thirty-five eyes (22 children) with ectopia lentis and visually significant cataract that had lens aspiration and in-the-bag implantation of single-piece AcrySof IOL and Cionni CTR were included. Single- and double-eyelet CTRs were used. The rings were sutured to the sclera using 9-0 or 10-0 polypropylene (Prolene) sutures. Preoperative and postoperative best corrected visual acuity (BCVA), intraoperative performance, IOL centration, and complications were studied. The mean patient age was 8.2 years +/- 5.1 (SD) and the median follow-up, 28 months. A double-eyelet CTR was implanted in 12 eyes and a single-eyelet CTR, in 23 eyes. The mean BCVA at the final follow-up (0.37 +/- 0.25 logMAR, 33 eyes) was significantly better than preoperatively (0.78 +/- 0.42 logMAR, 28 eyes) (P = .003). At the last examination, the BCVA was 20/40 or better in 16 eyes (45.7%). Three eyes (8.5%) required resuturing for IOL decentration. Nineteen eyes (54.3%) had a secondary procedure for posterior capsule opacification. Other complications included anterior capsule opacification (2.85%), cystoid macular edema (5.71%), chronic uveitis (5.71%), and vitreous prolapse (2.85%). Implantation of the Cionni CTR and single-piece AcrySof IOL in the capsular bag in pediatric eyes with subluxated lenses was safe and effective and led to a stable IOL with few significant complications.

Glistenings in the Single-Piece, Hydrophobic, Acrylic Intraocular Lenses

To study glistenings in single-piece AcrySof (models SA60 and SN60; Alcon, Fort Worth, Texas, USA) intraocular lenses (IOLs). Observational, longitudinal study. Consecutive patients with the SA60 were examined at 12, 24, and 36 months after surgery; those with the SN60 were examined 12 months after surgery. Best-corrected logarithm of the minimum angle of resolution visual acuity, glare testing, contrast sensitivity, and wavefront analysis were performed. Any patient with pathologic features likely to impact visual quality was eliminated. All IOLs were photographed, and glistenings were analyzed for size and density by a computer program. All IOLs had glistenings, and neither size, density, nor severity index (size x density) correlated with acuity, glare testing, or wavefront analysis results. High spatial resolution contrast acuity (patch D) had a borderline correlation (P = .06) with severity index, as did progress over time (P = .04). All IOLs studied had glistenings. High spatial resolution contrast sensitivity impact and severity progression over time deserve further study.

Early opacification of a single-piece hydrophobic acrylic intraocular lens after a triple procedure

We report a case in which the optic of a single-piece AcrySof acrylic (SA60AT, Alcon) intraocular lens (IOL) became opacified. A 64-year-old man had a triple procedure of vitrectomy, phacoemulsification, and IOL implantation for cataract and a dense vitreous hemorrhage in the left eye. The IOL was clear on the day after surgery, but by the third day, a dusty haze was observed on the surface due to the presence of numerous, small brown corpuscles. The IOL was removed and replaced with another SA60AT. No optic opacification occurred on the replacement IOL. Analysis of the explanted IOL indicated the presence of proteinaceous material but no calcium on the surface. Early postoperative opacification of a single-piece acrylic SA60AT IOL might occur in combined cataract and vitreous surgery, even in eyes in which the posterior capsule is intact and there are no operative complications.

Magnetic resonance imaging of aging, accommodating, phakic, and pseudophakic ciliary muscle diameters

To quantify in vivo accommodative changes in the aging human ciliary muscle diameter in phakic and pseudophakic eyes. Department of Surgery/Bioengineering, UMDNJ-Robert Wood Johnson Medical School, Piscataway, and the Institute of Ophthalmology and Visual Science UMDNJ-New Jersey Medical School, Newark, New Jersey, USA. Images were acquired from 48 eyes of 40 people between the ages of 22 and 91 years, 1 eye of 32 phakic volunteers and both eyes of 8 patients who had monocular implantation of a single-piece AcrySof intraocular lens (IOL) (Alcon Laboratories). Images were acquired during physiological accommodation and with accommodation at rest, and the diameter of the ciliary muscle ring was measured. Results show the ciliary muscle remains active throughout life. The accommodative change in its diameter (mean 0.64 mm) (P<.00001) was undiminished by age or IOL implantation. Preliminary data showed that the accommodative decrease in muscle diameter in phakic and pseudophakic eyes was statistically identical. The phakic eyes had a marked decrease in ciliary muscle diameter with advancing age for both accommodative states (P<.000001 and P<.000001), which did not appear to be altered by IOL implantation. The lens equator was constant with age in the unaccommodated human eye, resulting in decreased circumlental space with advancing age in the phakic eyes. Although the undiminished ability of the ciliary muscle to decrease its diameter with accommodation can be relied on in strategies for presbyopia correction, even in advanced presbyopia, the decreasing circumlental space and its potential effects on zonular tension must also be considered.

Single-piece AcrySof intraocular lens implantation in children with congenital and developmental cataract

To evaluate surgical outcomes of 1-piece AcrySof SA30AL intraocular lens (IOL) (Alcon Laboratories) implantation in children having surgery for congenital and developmental cataracts. Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India. This prospective observational study comprised 134 consecutive eyes of 84 children from 2 to 15 years old who had surgery for congenital and developmental cataract. Two groups were formed depending on the age of the child at surgery. Primary posterior continuous curvilinear capsulorhexis (PCCC) was performed in children younger than 6 years (Group 1, 66 eyes), and no PCCC was performed in children older than 6 years (Group 2, 68 eyes). Vitrectomy was not performed. An AcrySof IOL was implanted in the bag in all eyes except 1 in Group 1, which received a sulcus-fixated IOL. The study's primary outcome measures were the incidence of visual axis obscuration and the need for a secondary procedure to clear the axis. Secondary observations included the incidence of posterior synechias, cell deposits, and haptic compression. A test of proportion was applied to determine whether age was a risk factor for the development of visual axis obscuration. The mean age at surgery was 6.0 years +/- 3.2 (SD). The mean follow-up was 2.6 +/- 0.6 years. In Group 1, 20 eyes (30.3%) developed visual axis obscuration but only 6 (9.1%) required a secondary procedure. In Group 2, 20 eyes (29.4%) developed visual axis obscuration and 10 (14.7%) required secondary procedures. Posterior synechias were observed in 2 eyes (3.0%) in Group 1 and none in Group 2. Cell deposits were seen in 8 eyes (12.1%) in Group 1 and 8 eyes (11.8%) in Group 2. Haptic compression was noted in 1 eye in Group 2. Mild IOL decentration was observed in the 1 eye with a sulcus-fixated IOL. The 1-piece AcrySof IOL provided satisfactory visual axis clarity, produced an acceptable inflammatory response, and maintained centration in pediatric eyes.

Implantation of single‐piece foldable acrylic IOLs in small children in the Ukraine

To evaluate the efficacy and outcome of implantation of a single-piece foldable acrylic intraocular lens (IOL) in children younger than 2 years in the Ukraine. A total of 31 children from all over the Ukraine with a median age of 11 months (range 2-28 months) underwent cataract surgery with anterior and posterior capsulorhexis, implantation of a single-piece AcrySof SA30AL IOL and anterior dry vitrectomy. Of these, 22 patients attended the last follow-up. Ten patients had follow-up periods of 12 months; 12 had follow-up periods of 18 months. At the postoperative visits, we investigated visual acuity (VA), whether or not the subject had strabismus, lens epithelial cell migration and signs of secondary glaucoma. The single-piece IOL remained clinically centred in all eyes. No secondary glaucoma was detected. Eleven patients needed surgery for after-cataract. All but two patients achieved better VA after surgery. Many patients suffered from deprivation amblyopia as quite a few cataracts were probably congenital; however, the improvement in VA shows that cataract surgery was worth performing despite the late intervention. The foldable single-piece acrylic IOL seems to be well tolerated by children aged 0-2 years. No serious complications were seen and no patient developed secondary glaucoma within the follow-up time. However, lens epithelial cells are very lively in this age group.

Irregularities on the surface of single-piece AcrySof SA60AT intraocular lenses

To report a case series of what initially appeared to be macroscopic biomaterial deposits and irregularities on the surface of AcrySof SA60AT intraocular lenses (IOLs) (Alcon Inc.) Department of Ophthalmology and Somerset Hospital, Taunton, United Kingdom; Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA; and Intraocular Implant Unit, Sydney Eye Hospital, University of Sydney, Sydney, Australia. Twelve AcrySof SA60AT IOLs were initially thought to have irregularities on their surfaces when examined under the operating microscope before implantation in the capsular bag during cataract surgery. The IOLs were sent for further analysis, including gross examination and light and scanning electron microscopy, to John A. Moran Eye Center, Salt Lake City, Utah, USA, and to Alcon Laboratories, Hemel Hempstead, United Kingdom. Light microscopy revealed the presence of irregular fine lesions on the IOLs' optics and haptics. The lesions consisted of elevations and depressions of the IOL surface that were present on both the anterior and the posterior surfaces of the IOLs. Scanning electron microscopy confirmed the presence of physical/mechanical damage to the IOLs, which was thought to originate from the packaging. The manufacturer believed this to have resulted from compression of the IOL between the container and its cover. Implantation of an imperfect IOL remains a potentially serious occurrence. Faults still occur in modern IOLs, and some defects can be detected by examining the IOL under the operating microscope before implantation into the eye.

Update on bimanual microincisional cataract surgery

The purpose of this article is to highlight the major issues associated with bimanual microincisional cataract surgery and to review the recent literature addressing this subject. Bimanual microincisional cataract surgery has been performed successfully using all of the major phacoemulsification platforms. Technological advances in ultrasound power management and fluidics have improved the safety profile and efficiency of this technique. New intraocular-lens designs and surgical maneuvers permit intraocular-lens insertion through corneal incisions measuring 2 mm or less. Clinical results achieved with bimanual microincisional cataract surgery and new microincision lenses are comparable to those obtained with conventional coaxial phacoemulsification and established intraocular lenses. Bimanual microincisional cataract surgery is a promising surgical technique that continues to grow as phacoemulsification technology and intraocular-lens designs evolve.

AcrySof Natural SN60AT versus AcrySof SA60AT intraocular lens in patients with color vision defects

To determine whether implantation of the AcrySof Natural intraocular lens (IOL) worsened the severity of existing color deficit in congenital partial red-green color deficient individuals (CPRG). A prospective controlled randomized double-masked analysis of 30 consecutive patients with CPRG defect and bilateral cataracts received a Natural IOL (test group) in 1 eye and a single-piece AcrySof IOL (control group) in the other eye. Patients were tested unilaterally to detect CPRG defect using Ishihara pseudoisochromatic plates and the Farnsworth D-15 test. Plates 1 to 21 measured the Ishihara error score; plates 22 to 25 indicated severity of defect based on clarity of both numerals as partial mild/moderate (both visible), partial severe defect (only 1 visible). The D-15 test is based on number of diametrical crossings on the circular diagram; severity is graded as mild (1 crossing), moderate (2 crossings), or severe (>2 crossings). Tests were performed before and after IOL implantation at 1, 3, and 6 months. At mean follow-up of 6.13 months +/- 1.2 (SD), analysis of variance test judged the difference in error scores and cross tabulation represented change in number of diametrical crossings. The mean age was 62.3 +/- 8.5 years. All patients were men. Before IOL implantation, all patients had moderate CPRG defect on both tests. The Ishihara error score in the test and control groups did not reveal statistically significant differences (P = .505 and P = .119, respectively). With D-15, none of the patients in the test or control group showed >2 crossings. The implantation of AcrySof Natural IOL did not worsen the preexisting severity of color defect in CPRG individuals.

Acute haptic-induced ciliary sulcus irritation associated with single-piece AcrySof intraocular lenses

We report an analysis of 3 single-piece hydrophobic acrylic intraocular lenses (IOLs) that were explanted because of complications related to the presence of their haptics in the ciliary sulcus. In 2 cases, the IOL was primarily implanted in the ciliary sulcus because of inadequate posterior capsule support. In the third case, postoperative displacement of 1 haptic in the sulcus was associated with hyphema and vitreous hemorrhage. Ultrasound biomicroscopy confirmed the contact between the haptic and iris. Areas of iris atrophy were observed in all cases. Light microscopy and scanning electron microscopy of the explanted lenses revealed the presence of pigmentary dispersion on the anterior surfaces. In Case 3, the pigments were concentrated on the surface of the haptic that was displaced from the capsular bag and on the corresponding optic-haptic junction. Scanning electron microscopy also showed the IOL's squared edges and unpolished side walls. The flexibility and thickness of the single-piece hydrophobic acrylic haptics, as well as the square optic and haptic edges, may increase the risk for iris chafing when the haptics are in the sulcus. Therefore, sulcus fixation of this IOL design is not recommended.

After-cataract in children having cataract surgery with or without anterior vitrectomy implanted with a single-piece AcrySof IOL

To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. Filatov Institute, Odessa, Ukraine. Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. Children in the younger age group (</=62 months at surgery) had surgery for after-cataract more often than children in the older age group (P<.01). Patients who did not receive an anterior vitrectomy had surgery for after-cataract more often (P<.01). Age at surgery and whether an anterior vitrectomy was performed did not significantly affect the EPCO score. The patients who had surgery for after-cataract had a significantly higher EPCO score (P<.001). The IOL remained centered in all eyes; no eye developed posterior synechias. This prospective study shows that cataract surgery with anterior vitrectomy is advantageous in younger patients concerning after-cataract formation. The AcrySof SA30AL maintains good centration, produces minimal inflammation, and is well tolerated in the pediatric eye.

Pathological evaluation of postmortem human eyes implanted with a new single-piece hydrophobic acrylic lens

Purpose: To report the pathological findings in 14 human cadaver eyes implanted with a single-piece AcrySof® (Alcon Laboratories) posterior chamber intraocular lens (IOL). Setting: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Methods: Fourteen human autopsy eyes implanted with a single-piece AcrySof (SA30AL) IOL were evaluated. The eyes were sectioned at the equatorial plane, and the anterior segment containing the IOL in the capsular bag was evaluated from a posterior perspective (Miyake-Apple view) and from an anterior perspective (surgeon's view) after removal of cornea and iris. They were then processed through paraffin, sectioned, and stained with hematoxylin–eosin, periodic acid-Schiff, and Masson's trichrome and examined under light microscopy. Results: All IOLs had symmetric in-the-bag fixation. Slight decentration was measured in 1 eye, which also had an anterior capsule tear. Grade 1 anterior capsule opacification was present in 9 eyes. No central posterior capsule opacification or posterior capsule folds were observed in any eye. Soemmering's ring formation was observed in 5 eyes. Zonular stretch caused by different degrees of capsular bag contraction was present in 4 eyes without decentration of the IOL. Conclusions: Analyses of pseudophakic cadaver eyes from the posterior (Miyake-Apple) view, complemented by microscopic analyses, proved useful in the evaluation of IOL–capsular bag interaction. These studies are more important in cases of newly introduced lens designs.

Single-piece AcrySof in the newborn rabbit eye

Purpose: To evaluate the behavior of the single-piece AcrySof® SA30AT intraocular lens (IOL) (Alcon) in the eyes of newborn rabbits and to compare the postoperative complications in aphakic and pseudophakic eyes. Setting: St. Erik's Eye Hospital, Stockholm, Sweden. Methods: Clear lens extraction was performed in both eyes of 20 3-week-old rabbits. In 1 randomly selected eye in each rabbit, a single-piece acrylic IOL was implanted. Preoperatively and 1 and 2 months postoperatively, axial length and corneal diameter were measured. Corneal thickness was measured at the endpoint. The rabbits were also examined clinically; the position of the IOL and signs of secondary glaucoma were noted. At 2 months, the 19 surviving animals were killed. In 10 rabbits, the wet mass of the after-cataract was measured, and the eyes of 9 rabbits were fixed in formalin for histologic evaluation. Results: One animal died soon after surgery. Three rabbits developed secondary glaucoma in the aphakic eye. No rabbit developed glaucoma in the pseudophakic eye. In the 16 animals without secondary glaucoma, there were no significant differences in corneal diameter at 1 and 2 months or in corneal thickness at the endpoint; the axial length was significantly longer in aphakic eyes at 1 month, but not at 2 months. The aphakic eyes developed more posterior synechias and the pupil size at 1 and 2 months was significantly smaller in aphakic eyes than in pseudophakic eyes. Significantly more after-cataract developed in aphakic eyes than pseudophakic eyes (eyes with secondary glaucoma included). No difference in inflammation was seen between eyes in the histologic evaluation. In 11 of 19 pseudophakic eyes, the anterior capsulorhexis was not completely on the optic. In these eyes, the optic moved partly forward into the anterior chamber. Conclusion: The single-piece AcrySof SA30AT IOL seems to induce less inflammation and probably inhibits secondary glaucoma. It does not retard eye growth as much as previously tested IOLs. However, it is important to keep the entire capsulorhexis margin on the optic, especially in these small eyes.

Effect of haptic design on change in axial lens position after cataract surgery

Purpose: To compare the postoperative changes in anterior chamber depth (ACD) between single-piece and multipiece AcrySof ® intraocular lenses (IOLs) (Alcon Laboratories, Inc.) and their effect on the postoperative refractive shift. Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: This prospective randomized bilateral study with intraindividual comparison comprised 104 eyes of 52 consecutive patients with age-related cataract. All patients had standardized cataract surgery with a temporal self-sealing incision, phacoemulsification, and IOL implantation in the capsular bag. The first 30 patients received a single-piece, 5.5 mm optic IOL (AcrySof SA30) in 1 eye and a multipiece IOL (AcrySof MA30) in the other eye. Another 22 patients received the corresponding 6.0 mm optic models (AcrySof SA60 and AcrySof MA60, respectively). Anterior chamber depth measurements and evaluation of the change in ACD during the first 6 postoperative months were performed using partial coherence laser interferometry. The amount of change in capsulorhexis size during the first 6 postoperative months was assessed using standardized retroillumination photographs. Results: Single-piece IOLs shifted significantly less postoperatively than multipiece IOLs. The multipiece IOLs shifted forward, especially from 1 day to 1 month. The change in the capsulorhexis area was similar between IOL types. Conclusions: Single-piece AcrySof IOLs shifted minimally after the first postoperative day; therefore, the prescription for spectacles in eyes with this IOL can be obtained soon after surgery.