Glistenings in the Artiflex phakic intraocular lens

PURPOSE: To report the appearance of glistenings in the Artiflex iris-claw phakic intraocular lens (pIOL) (Ophtec B.V.); evaluate their prevalence, severity, and visual significance; and determine whether a large in-depth study of the IOL is warranted. SETTING: La Fe University Hospital, Valencia, Spain. METHODS: Twenty eyes of 13 patients who had the Artiflex pIOL implantation at the same institution over a 2-year period were randomly selected and evaluated by slitlamp examination; visual acuity was also measured. Glistenings in the Artiflex pIOL were graded from trace to 4+ at the slitlamp. RESULTS: Four Artiflex pIOLs had lenticular glistenings ranging from grade 1+ to grade 4+. Analysis of visual acuity and patient satisfaction showed that the glistenings had no clinical significance. CONCLUSIONS: Glistenings appeared some Artiflex pIOLs to varying degrees, although they were not visually significant in any case. A larger study of this IOL is needed to determine whether severe cases of glistenings affect visual function and assess their cause and evolution over time.     

Glistenings in the AcrySof intraocular lens: pilot study

PURPOSE: To evaluate the prevalence, severity, and visual significance of glistenings seen in the AcrySof intraocular lens (IOL) and determine whether a large in-depth study of this lens is warranted. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Patients who had the AcrySof IOL implanted at 1 institution over the past 4 years were serially selected. Forty-two eyes that had phacoemulsification with implantation of the AcrySof IOL were evaluated. The examination consisted of visual acuity, glare, contrast sensitivity, and dilated fundus and dilated slitlamp evaluations. Glistenings in the IOL were graded at the slitlamp from trace to 4+. RESULTS: All 42 IOLs had some degree of lenticular glistenings. The glistenings were graded as trace in 27 IOLs (64%), 1+ in 5 (12%), 2+ in 5 (12%), 3+ in 3 (7%), and 4+ in 2 (5%). The Snellen acuity in eyes with severe glistenings (> or = 2+) was one-half line lower than in eyes with mild glistenings (+) (P =.01). In all eyes, the Brightness Acuity Tester score was a little more than one-half line lower than the Snellen acuity, and the difference was 1 full line in eyes with glistenings graded above 2+. Fourteen of 15 IOLs (93%) with glistenings graded greater than trace had been in the eye for more than 1 year. There was no evidence that contrast sensitivity was affected by the glistenings. CONCLUSIONS: Glistenings occurred frequently in AcrySof IOLs, with most cases mild. A larger study of this lens is needed to determine whether severe presentations affect visual function and to understand how glistenings change over time.     

A long-term follow-up of cataract extraction with and without intraocular lens implantation

In 176 consecutive intracapsular cataract extracted eyes with an iris clip lens (IOL) and 159 eyes with consecutively performed intracapsular extractions (ICCE), the visual outcome and complications were examined in a follow-up study. The average observation time was 48 months in the IOL group and 53 months in the ICCE group. In both groups the main cause of a visual acuity less than 0.5 was pre-operatively recognized maculopathy. Eighty-six per cent of the remaining IOL eyes and 93% of the remaining ICCE eyes achieved a visual acuity greater than or equal to 0.5. Post-operative complications were the cause of a visual acuity less than 0.5 in 11.9% of the IOL and 6.9% of the ICCE group. The most frequent complications were corneal oedema and retinal detachment. Pre-operative and early post-operative complications were important factors in the development of late complications in the IOL group. With proper pre-operative evaluation and good surgical technique intraocular lens implantation is a safe procedure.     

Black diaphragm aniridia intraocular lens for congenital aniridia: long-term follow-up

PURPOSE: To present long-term results of implantation of a black diaphragm aniridia intraocular lens (IOL) in eyes with congenital aniridia. SETTING: Eye Hospital, Heinrich-Heine-University, Düsseldorf, Germany. METHODS: Cataract surgery was performed in 19 eyes of 14 patients with congenital aniridia. The black diaphragm aniridia IOL was implanted in front of the capsular bag in the ciliary sulcus. Mean patient age was 30 years (range 10 to 59 years) and mean follow-up, 46 months (range 12 to 84 months). Before surgery, corneal epithelial disorders; corneal pannus; cataract; hypoplasia of the macula, optic nerve, or both; and nystagmus were present in all 19 eyes. Clinically detectable glaucoma was present in 5 eyes. RESULTS: Despite the presence of amblyopia and nystagmus, visual acuity improved in 14 of the 19 eyes. The main postoperative problems were glaucoma deterioration (4 of 19 eyes) or development (4 of 19 eyes), cystoid macular edema (2 of 11 eyes), chronic endothelial cell loss (3 of 11 eyes), and progression of corneal epithelial disorders (4 of 19 eyes). Glaucoma was controlled by medical or surgical therapy in all patients. Intraocular lens explantation was performed in 2 eyes with glaucoma. CONCLUSION: Implantation of the black diaphragm aniridia IOL improved visual acuity in the majority of patients with a variety of endogenous problems in addition to aniridia.     

Additional long-term follow-up on the IOLAB Azar 91Z anterior chamber intraocular lens

A retrospective study of 98 91Z anterior chamber intraocular lenses used with intracapsular cataract extraction was performed. Minimum follow-up was 12 months and average follow-up was two years seven months. These patients were part of a group of 113 91Z patients previously reported with minimum six-months follow-up and an average of one year follow-up. Comparing the two groups showed the number of patients with 20/40 visual acuity declined from 84.1% to 67.4% and those with visual acuity less than 20/400 increased from 0.9% to 5.1%. The number of 91Zs explanted more than doubled from five (4.4%) to 11 (11.2%). Pseudophakic bullous keratopathy not present in the one-year follow-up group is occurring with longer follow-up. This study demonstrates an increasing incidence of inflammatory - hemorrhagic and corneal complications in 91Z patients.     

In vivo fracture of an extruded polymethylmethacrylate intraocular lens loop

The inferior loop of a semiflexible, closed-loop anterior chamber intraocular lens in the eye of a 72-year-old female fractured at two sites. The loop was composed of extruded polymethylmethacrylate. The inferotemporal portion of the loop was first noted to be broken 25 months postoperatively, and the fractured nasal portion of the same loop was first observed 55 months after implantation. The patient denied any excessive rubbing of the eye or major trauma to the eye or head. Both fractures occurred near the loop-optic junction. The intermittent touch of the cornea by the broken loop caused endothelial damage and edema in the lower one third of the cornea. The two portions of the lens were removed and exchanged with another style of anterior chamber lens. The visual acuity at six weeks postexchange was 20/30.     

Verisyse虹膜固定型人工晶状体植入治疗高度近视的中长期疗效观察

目的:研究Verisyse虹膜固定型人工晶状体植入治疗高度近视中长期的有效性和安全性。方法:高度近视患者37例56眼植入Verisyse虹膜固定型人工晶状体,术后随访4～7a,对手术前后的裸眼和最佳矫正视力、屈光状态、眼压变化、角膜透明度及角膜内皮计数、前房、瞳孔和虹膜、自然晶状体改变及患者满意度进行观察分析。结果:所有眼术中均顺利植入Verisyse虹膜固定型人工晶状体,术后各时间点裸眼视力及最佳矫正视力均明显提高且保持稳定,各时间点角膜内皮细胞计数变化无统计学意义,随访期间无角膜内皮失代偿、顽固的色素膜炎、白内障、青光眼及视网膜脱离等严重并发症发生。结论:Verisyse虹膜固定型人工晶状体治疗高度近视是安全和有效的,能够显著提高裸眼视力及最佳矫正视力而并发症较少,对于不适合角膜手术的高度或超高度近视患者是一种比较理想的选择。     

Clinical Characteristics of recurrent intraocular lens dislocation after scleral-fixated sutured intraocular lens and long-term outcomes of intraocular lens re-fixation

Graefe's Archive for Clinical and Experimental Ophthalmology - This study aimed to investigate the clinical characteristics of patients with recurrent intraocular lens (IOL) dislocation after...     

Fibrinous uveitis and intraocular lens implantation. Surface modification of polymethylmethacrylate during extracapsular cataract surgery.

BACKGROUND: The causes of fibrinous uveitis after cataract surgery are unclear, but surface modification of polymethylmethacrylate (PMMA) is known to influence post-operative inflammation. One hundred twenty-five patients were entered into a prospective investigation designed to assess the effect of intraoperative surface modification of PMMA, by coating with a 2% hydroxypropyl methylcellulose solution, on the incidence of fibrinous uveitis after extracapsular cataract surgery and lens implantation. METHODS: Of the 125 patients entered into this prospective study, 90 received pretreatment with a 1% indomethacin solution. RESULTS: Fibrinous uveitis developed in 18(33%) of 54 eyes with dry lens implantation and in 1 (3%) of 36 eyes with coated lens implantation (P less than 0.005). Thirty-five eyes were not pretreated with indomethacin, and fibrin formation occurred in 6 (30%) of 20 dry implanted eyes and in 0 of 15 eyes with coated lens implantation (S = 0.02). CONCLUSIONS: Intraoperative modification of the PMMA surface of an intraocular lens during implantation significantly reduces the severity of postoperative inflammation, as manifest by the incidence of fibrinous uveitis.     

Hydrophobic acrylic versus heparin surface-modified polymethylmethacrylate intraocular lens: a biocompatibility study

Background The implant of intraocular lenses (IOLs) following cataract surgery induces a foreign-body reaction to the IOL and a response on the part of the lens epithelial cells (LECs). The purpose of this study was to compare these aspects after the implantation of two different IOL materials.Methods Thirty-six cataract patients were randomised to receive two different foldable lens: an acrylic hydrophobic IOL (Acrysof MA30BA) and a heparin surface-modified (HSM) polymethylmethacrylate IOL (Pharmacia & Upjohn 809C) after phacoemulsification. Slit-lamp biomicroscopy with specular technique was used to assess the inflammatory cell adhesion on the anterior IOL surface, anterior capsule opacification (ACO) and membrane growth from the rhexis edge at 7, 30, 90, 180 and 360 days after surgery.Results The 809C group showed a higher percentage of patients with slight inflammatory cell adhesion on the anterior cell surface and a higher small cellular density during the whole follow-up period. The epithelioid cell response was greater in the 809C group than the Acrysof group but the difference between the two groups was not statistically significant. The ACO increased during the follow-up in both groups but was significantly higher in the 809C group.Conclusion Acrysof lenses are more biocompatible than HSM IOLs, showing a lower grade of inflammatory cell adhesion and ACO. The implantation of these lenses may be particularly indicated in patients with pathologies predisposing to blood–aqueous barrier damage.The authors have no proprietary or financial interest in any products or devices discussed in this paper and have not received any payment as reviewers or evaluators     

Foldable acrylic versus rigid polymethylmethacrylate intraocular lens in combined phacoemulsification and trabeculectomy

BACKGROUND: Combined trabeculectomy and phacoemulsification is a widely accepted option in treating patients with glaucoma who also have cataracts. Implantation of a foldable intraocular lens (IOL) in cataract surgery has several theoretical advantages.We performed a study to determine the results of combined phacoemulsification and trabeculectomy with mitomycin C and implantation of either a foldable acrylic or rigid polymethylmethacrylate (PMMA) IOL. METHODS: Review of the charts of 58 consecutive patients (60 eyes) who underwent combined phacotrabeculectomy for concomitant cataract and glaucoma at a university-affiliated hospital in Montreal between September 2001 and December 2002. Forty-one eyes received a foldable acrylic lens (3.2-mm-wide incision), and 19 eyes received a rigid PMMA lens (5.2-mm-wide incision). Outcome measures included visual acuity, intraocular pressure (IOP) and postoperative complications. The results in the two groups were compared. RESULTS: There were no differences in baseline characteristics between the two groups. Earlier recovery of visual acuity was noted in the foldable IOL group than in the rigid IOL group (p = 0.013 for the difference at day 7). IOP control was similar in the two groups, as was the incidence of IOP spikes in the early postoperative period. INTERPRETATION: The results suggest that combined phacotrabeculectomy with mitomycin C using a foldable acrylic IOL allows for good postoperative IOP control and earlier visual recovery than the same procedure with insertion of a rigid PMMA lens.     

Bendazac lysine inhibition of human lens epithelial cell adhesion to polymethylmethacrylate intraocular lenses

The aim of the present work was to evaluate the effect of bendazac lysine on the human lens epithelial cell line HLE-B3 adhesion to polymethylmethacrylate (PMMA) intraocular lenses (IOLs). After adherence to IOLs, cells were incubated in the presence of the drug for 24 h. The number of cells contained in a 6-mm(2) area was then counted with an inverted phase microscope and adherent cells were distinguished from detached floating cells by focusing through the medium. Results obtained show that bendazac is able to induce a linear dose-dependent inhibition of HLE-B3 adhesiveness to PMMA IOLs. In particular, treatment with bendazac 33, 100 and 300 microM resulted in a 15, 32 and 54% inhibition, respectively. Statistical analysis shows that this effect is significant at 100 microM (p < 0.05) and 300 microM (p < 0.01). The analysis of the effects of bendazac on the viability and on the proliferative capacity of HLE-B3 cells did not show any drug-related toxicity up to the concentration of 400 microM. The present study demonstrates that bendazac lysine is able to inhibit adhesion of lens epithelial cells to PMMA IOLs and suggests the potential beneficial use of this drug in preventing secondary cataract development.     

Late opacification of a polymethylmethacrylate (PMMA) intraocular lens: case report

The use of intraocular lenses was a great advance in visual recovery after cataract surgery. Although usually with good biocompatibility, some alterations in the intraocular lens material may occur after implantation. Polymethylmethacrylate was the first intraocular lens material to be used on a large scale and assumed to be inert and well-tolerated. We present a rare case of late opacification of a polymethylmethacrylate lens, discussing important aspects of its management such as the indication for intraocular lens exchange.     

Three-year follow-up of the Artisan phakic intraocular lens for hypermetropia

PURPOSE: We report the postoperative results of the Artisan Hyperopia phakic intraocular lens (IOL; model 203W; Ophtec, Groningen, The Netherlands). DESIGN: Prospective, nonrandomized trial. PARTICIPANTS: Twenty-six eyes of 13 self-selected patients with refractive error ranging from +3.00 to +11.00 diopters (D). INTERVENTION: Patients with hypermetropia were implanted with the Artisan Hyperopia phakic IOL. Mean follow-up was 22.4 months (range, 3-36 months). MAIN OUTCOME MEASURES: Predictability, stability, efficacy, loss of best spectacle-corrected visual acuity, and complications. RESULTS: At six months, 90.9% (20 of 22 eyes) were +/-1.00 D of intended correction and 81.8% (18 eyes) were +/-1.00 D of emmetropia. The mean spherical equivalent was stable within 0.25 D during the entire 3-year follow-up period. Twenty-four eyes (92.3%) had a postoperative best spectacle-corrected visual acuity of 0.50 or better at all of their individual follow-up examinations. No patient lost 2 or more lines after the procedure. There was a significant negative correlation between anterior chamber depth and endothelial cell loss. Two patients experienced posterior synechiae with pigment deposits in both eyes. One of these patients had convex irides and underwent implant removal within 2 years with a consequent clear lens extraction and posterior chamber lens implantation. CONCLUSIONS: Implantation of the Artisan Hyperopic lens leads to accurate and stable refractive results with no significant loss of vision. More attention should be paid to convex irides and shallow anterior chambers during the preoperative screening to avoid unnecessary complications.     

Iris-fixated toric phakic intraocular lens: Three-year follow-up

PURPOSE: To evaluate the 3-year safety, efficacy, predictability, and stability of iris-fixated toric phakic intraocular lens (pIOL) implantation for the correction of myopia or hyperopia with astigmatism. SETTING: Department of Ophthalmology, Johannes Gutenberg University, Mainz, and Department of Ophthalmology, University Clinic, Bochum, Germany. METHODS: A prospective clinical trial of 40 eyes of 23 patients with high ametropia and astigmatism was conducted. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, refraction, astigmatism, intraocular pressure, slitlamp biomicroscopy, and indirect ophthalmoscopy were measured preoperatively and postoperatively. RESULTS: Of the 40 eyes, 28 were myopic and 12 were hyperopic. Three years postoperatively, 70% of eyes were within +/-1.00 diopter (D) of the targeted refraction. In the myopic group, mean preoperative BSCVA was 20/40 and improved postoperatively to 20/25. Sixty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.58 D +/- 1.26 (SD) preoperatively to -1.15 +/- 1.01 D postoperatively. In the hyperopic group, preoperative BSCVA was 20/25 and improved to 20/20 postoperatively. Thirty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.37 +/- 0.88 D to -1.53 +/- 0.69 D postoperatively. The correction was stable in all eyes 3 years after surgery. No potentially sight-threatening complications occurred. CONCLUSION: The 3-year follow-up showed the iris-fixated toric pIOL was effective in correcting high ametropia and astigmatism.     

Long-term pathological follow-up of 2-loop iridocapsular intraocular lens

We analyzed an enucleated postmortem eye from an 86-year-old donor who had a 2-loop iridocapsular intraocular lens (IOL) that had been implanted at least 30 years earlier. High-frequency ultrasound showed a relatively well-centered iris-supported optic in front of the pupil. Gross and light microscopic analyses of the eye and the IOL showed loop fixation outside the capsular bag remnants, a thickened cornea, mild attenuation of the corneal endothelium, multiple areas of iris trauma secondary to haptic abrasion, fragments of iris tissue attached to the haptics, as well as pigment dispersion within the eye with pigmented epithelial cells attached to the IOL haptics. Histopathological examination of the posterior segment was unremarkable.     

Tetraflex拟调节人工晶状体术后1年疗效的研究

目的 研究白内障超声乳化吸除联合Tetraflex拟调节人工晶状体(intraocular lens,IOL)植入术后1年的疗效.方法 临床病例对照研究.对2006年8月29日至2011年1月2日在温州医学院附属眼视光医院行白内障超声乳化吸除联合IOL植入术的患者,试验组20例(20只眼)植入Tetraflex拟调节IOL,对照组20例(20只眼)植入传统单焦点人工晶状体.随访1年时的视力、单眼近附加和调节幅度.结果 术后两组均能获得较好的裸眼远视力、最佳矫正远视力及最佳矫正近视力,差异均无统计学意义.试验组的裸眼近视力及远视力矫正下的近视力明显优于对照组(P＜0.01).近附加试验组为(2.04±0.29)D,对照组为(2.47±0.39)D,差异有统计学意义(P＜0.01).术眼调节幅度试验组为(1.86±1.01)D,对照组为(1.15±0.48)D,差异有统计学意义(P =0.008).结论 与传统单焦点IOL相比,Tetreflex拟调节IOL术后1年可获得较大的调节幅度,所需近附加减少,可同时提供较好的远、近视力.