Biocompatibility of hydrophilic intraocular lenses

PURPOSE: To assess the biocompatibility of 3 hydrophilic acrylic intraocular lenses (IOLs) by evaluating the postoperative cell reaction on the IOL surface, anterior capsule opacification (ACO) rate, and presence of membrane growth over the anterior IOL surface. SETTING: University Eye Clinic of Trieste, Trieste, Italy. METHODS: In this prospective study, 73 patients were randomized to receive 1 of 3 types of hydrogel IOLs after phacoemulsification: Storz Hydroview H60M, Corneal ACR6D, or Ioltech Stabibag. To analyze and photograph the anterior IOL surface, slitlamp biomicroscopy and specular microscopy were performed 7, 30, 90, and 180 days after surgery. Small, epithelioid, and giant inflammatory cell reaction was evaluated. In addition, ACO and membrane growth on the anterior IOL surface were assessed. RESULTS: Low inflammatory cell adhesion was observed on the anterior surface of all 3 IOLs. The Stabibag group had a significantly higher grade of small inflammatory cell reaction 7 and 30 days after surgery. A significantly higher rate of ACO was observed in the ACR6D group. The Hydroview and ACR6D groups had a significantly higher percentage of membrane growth from the capsulorhexis edge onto the anterior IOL surface than the Stabibag group. CONCLUSIONS: Clinically, the 3 hydrophilic IOLs behaved in a different manner, showing the different forms of biocompatibility. Results indicate that a different chemical composition determines correspondingly different protein absorption on IOL surfaces. This might result in a different adhesion pattern and spreading of lens epithelial and inflammatory cells.     

Cellular reaction following cataract surgery with implantation of the heparin-surface-modified intraocular lens in rabbits with experimental uveitis.

The inflammatory response after cataract surgery and intraocular lens (IOL) implantation was studied in rabbits with endotoxin-induced uveitis. On days 1, 3, 7, 14, and 30 postoperatively the rabbits were sacrificed and the number of white blood cells in the aqueous humor and cellular deposits on the IOLs were estimated. On days 14 and 30 the rabbits also had slitlamp examination to study the clinical outcome of the surgery. At day 1 after lens extraction and IOL implantation, the number of white blood cells in the aqueous humor was significantly lower (P < .05) in eyes with heparin-surface-modified (HSM) IOLs (795.2 +/- 262.9; mean +/- SEM) than in eyes with poly(methyl methacrylate) (PMMA) lenses (1386.5 +/- 247.9). No differences were seen at day 3, 7, 14, or 30 postoperatively. The choice of IOL material had no effect on the amount of cell deposits on the IOL surface or on clinical parameters such as anterior synechias, posterior synechias, fibrosis, and posterior capsular opacification. There was a trend toward a greater number of cellular deposits on the PMMA lenses, but this was not statistically significant. This study provides further evidence of improved biocompatibility of the HSM PMMA lens, as demonstrated by a decreased acute inflammatory response.     

Aqueous flare induced by heparin-surface-modified poly(methyl methacrylate) and acrylic lenses implanted through the same-size incision in patients with diabetes.

PURPOSE: To compare the degree of blood-aqueous barrier (BAB) breakdown in eyes of diabetic patients after phacoemulsification and implantation of heparin-surface-modified poly(methyl methacrylate) (PMMA) or soft hydrophobic acrylic intraocular lenses (IOLs) performed using the same technique with the same incision size to determine the influence of the IOLs on postoperative inflammation independent of other surgical factors. SETTING: Department of Ophthalmology, University of Paris XIII, Bobigny, France. METHODS: In a prospective study, 44 eyes of 31 diabetic patients with or without mild to moderate diabetic retinopathy were randomly assigned to receive an HSM PMMA IOL (22 eyes) or a soft hydrophobic acrylic IOL (22 eyes) after standardized phacoemulsification surgery. Both types of IOLs had a 6.0 mm optic, were inserted unfolded, and were placed in the bag through a calibrated 6.0 mm superior scleral incision. Anterior chamber flare was measured preoperatively and 1, 7, 30, and 240 days postoperatively using the Kowa 500 laser flare meter. RESULTS: The mean flare value was higher on the first postoperative day in both groups. There were no statistically significant between-group differences in flare scores or clinical parameters preoperatively or at any postoperative visit. CONCLUSIONS: No significant difference was observed in inflammation between eyes having HSM PMMA IOL implantation or those having soft hydrophobic acrylic IOL implantation through the same-size incision. This indicates that hydrophobic acrylic and HSM PMMA materials induce the same degree of BAB breakdown after phacoemulsification in eyes of diabetic patients.     

Inflammation after phacoemulsification in diabetic retinopathy. Foldable acrylic versus heparin-surface-modified poly(methyl methacrylate) intraocular lenses

PURPOSE: To evaluate inflammation after cataract surgery in patients with nonproliferative diabetic retinopathy (NPDR) and compare results with 2 intraocular lenses (IOLs): a foldable hydrophobic acrylic and a heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA). SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: Patients with NPDR were randomized for implantation of an HSM PMMA IOL (811C, Pharmacia) through a 6.0 mm sclerocorneal incision (30 patients) or a foldable hydrophobic acrylic IOL (AcrySof, Alcon) through a 4.0 mm sclerocorneal incision (32 patients). Both IOLs had 6.0 mm optics. All patients were treated according to a standardized protocol. The degree of flare in the anterior chamber was measured with the Kowa 1000 laser flare-cell meter 1 day preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS: In both IOL groups, flare was highest on the first postoperative day and decreased to preoperative levels by 3 months after surgery. There was no statistically significant difference in relative flare values between the 2 groups. CONCLUSION: There was no difference in postoperative inflammation in eyes with a foldable hydrophobic acrylic IOL implanted through a small incision and those with a rigid HSM PMMA IOL. Postoperative inflammation results indicate that the lenses are equally suitable for the use in patients with diabetic retinopathy.     

Cellular reactions on heparin surface-modified versus regular PMMA lenses during the first postoperative month. A double-masked and randomized study using specular microphotography

Specular microscopy was used for investigation of cellular reactions on the intraocular lens (IOL) anterior surface of Heparin surface-modified (HSM) versus regular polymethylmethacrylate (PMMA) lenses (Pharmacia types 700C versus 700B, respectively). The double-masked randomized study included 53 patients investigated at 1 and 4 weeks postoperatively. Giant cells were only found on control lenses and more frequently at 4 weeks. Small cells were found on both lens types, but in a higher frequency on the control lenses. The number of small cells decreased during the first 4 weeks on both the control and HSM lenses. However, those control lenses that had giant cells on their surface showed an increase in the number of small cells during the same time. The results of the current study show that HSM lenses give rise to less postoperative inflammatory cellular reactions than regular PMMA lenses.     

F-heparin modified intraocular lenses in Rhesus monkeys

AIM: In order to improve the biocompatibility of intraocular lenses (IOL), the polymethylmethacrylate (PMMA) IOL was modified with F-heparin. METHODS: The PMMA IOL was modified with F ions and heparin by the technique of ion beam combined with low temperature and low pressure plasma. The monkeys (20 eyes) with cataract partly were randomly classified into 2 groups and implanted with PMMA IOL and modified IOL respectively for 180 days. All of the eyes were examined by slit-lamp microscope at postoperative 15, 30, 60, 90, 180 days. The extracted IOL was analyzed with computer image analysis, light microscope (LM) and scanning electron microscope (SEM) at postoperative 180 days. RESULTS: The early inflammatory reactions postoperatively include anterior chamber exudation and aqueous cell count. The modified IOL group showed less than the non-modified IOL group. The late foreign body cell reaction that adhered to the surface of non-modified IOL was more predominant. The morphologic and pathological changes of posterior capsule opacification (PCO) in monkeys' eyes included fibrosis-type, pearl-type and soemmerring's ring. There was a significant difference between the two groups. CONCLUSION: F-heparin modified IOL has good uveal and capsular biocompatibility.     

氟-肝素表面修饰人工晶状体的实验研究

目的 研究氟—肝素表面修饰人工晶状体(fluorine—heparin surface modified in—traocular lenses，F—HSM IOLs)的生物相容性，为开发新型IOL并应用于临床提供理论和实验依据。方法 采用载能离于束联合低温等离子体技术对聚甲基丙烯酸甲酯人工晶状体(polymethyl methacrylate intraocular lenses,PMMA IOLs)进行氟离子与肝素双重表面修饰。通过理化及光学方法检测其性能。体外通过细胞粘附，细胞生长实验。体内实验进行兔眼、猕猴眼内植入，进行相关的基础及体内研究。比较F—HSM IOLs与普通PMMA IOLs的生物相容性。结果 F—HSM IOLs呈淡棕色，可阻挡短波光线及紫外线。F—HSM IOLs表面粘附细胞少、无细胞毒性，植入眼内引起的眼部炎症反应轻，血—房水屏障破坏轻，并能在一定程度上减低后囊混浊。结论 F—HSM IOLs较目前常用的PMMA IOLs有更好的生物相容性。已通过国家指定的检测中心，按IOL国际标准检测，性能全部符合国际标准的要求，即将进入临床试用。     

Heparin-surface-modified intraocular lenses in pediatric cataract surgery: prospective randomized study.

PURPOSE: To evaluate the performance of heparin-surface-modified (HSM) intraocular lenses (IOLs) in pediatric eyes after cataract surgery. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This prospective, randomized, double-masked, controlled clinical trial comprised 90 children aged 2 to 14 years with cataract. The patients were consecutively randomized to receive an HSM (Group 1) or an unmodified (Group 2) poly(methyl methacrylate) (PMMA) IOL. Extracapsular cataract extraction (ECCE) with IOL implantation was performed in children 8 years and older and ECCE with primary posterior capsulotomy, anterior vitrectomy, and IOL implantation in children younger than 8 years. Outcome parameters were inflammatory cell deposits on the IOL surface, posterior synechias, and anterior chamber reaction. RESULTS: Follow-up data were available for 73, 70, 60, and 68 patients at 1 week, 1 month, 3 months, and 6 months, respectively. Significantly fewer cell deposits were noted in Group 1 at 1, 3, and 6 months (P < .001). Synechia formation and anterior chamber reaction were comparable in the 2 groups. CONCLUSION: The lower incidence of inflammatory cell deposit formation in eyes with HSM PMMA IOLs indicates that these IOLs have greater bicompatibility than unmodified IOLs in pediatric cataract surgery.     

A retrospective analysis of Heparin-surface-modified intraocular lenses versus regular polymethylmethacrylate intraocular lenses in patients with uveitis

Background: Several studies described the benefits of the heparin-surface-modified intraocular lens (HSM IOL) with regard to the reduced inflammation in routine extracapsular cataract extractions. However, limited information is available about the advantages of the HSM IOL in patients with an intraocular inflammation. Aim: To assess the eventual benefits of the HSM IOL compared to the regular polymethylmethacrylate intraocular lens (PMMA IOL) in patients with uveitis. Methods: A retrospective study of 43 patients with uveitis of various origins who underwent an extracapsular cataract extraction (24 with HSM, 19 with PMMA IOL). The activity of intraocular inflammation, visual acuity, eventual complications, and medications were examined. Standardized follow-up dates were used (before surgery, one and fourteen days, five and eleven months after surgery.) Results: No difference in the inflammatory activity was noted between HSM and PMMA groups; neither at short term clinical evaluation, nor at five months after surgery. Despite a slightly better visual acuity in the HSM group before surgery, no long term differences were observed. After surgery the increase in visual acuity was similar for both groups, as well as the frequency of cystoid macular oedema (CMO) and synechiae. Fewer patients in HSM group required Nd:YAG posterior capsulotomy, but the difference was not significant. Conclusion: No clinical advantage was found when the HSM IOL was compared with the regular PMMA IOL in 43 patients with uveitis.     

肝素处理人工晶体在糖尿病性白内障的应用

为观察肝素表面处理人工晶体在糖尿病性白内障手术后的作用。对４５例糖尿病白内障患者行现代囊外白内障摘除，分别植入ＨＳＭ－ＩＯＬ２２眼和ＰＭＭＡ－ＩＯＬ２３眼，对二组术后视力及眼前节反应等进行了回顾性对比分析。结果：二组比较，矫正视力大于０．５者，在术后２周及３个月时差异最显著（Ｐ＜０．０５）；晶体表面纤维蛋白样渗出和色素沉着均在术后２周时差异最显著（Ｐ＜０．０５）；虹膜后粘连在６个月后差异最显著（Ｐ＜０．０５）。结论：ＨＳＭ—ＩＯＬ在术后能减轻糖尿病白内障术后眼前节炎性反应，提高术后视力。     

Evaluation of cellular adhesions on silicone and poly(methyl methacrylate) intraocular lenses in monkey eyes: An electron microscopic study

PURPOSE: To assess the biocompatibility of intraocular lens (IOL) material by studying the number of cells adhering to IOLs in monkey eyes. SETTING: Department of Ophthalmology, Kyushu University, Fukuoka, Japan. METHODS: Silicone or poly(methyl methacrylate) (PMMA) IOL implantation was performed in 21 monkeys. One eye of each animal had surgery. The IOL-implanted eyes were enucleated 1, 2, 3, 5, and 7 days and 1, 3, 4, 5, and 9 months after the procedure. One eye was studied at each time. Cells on the anterior IOL surface were photographed using a scanning electron microscope, counted and assessed with NEC, Graphtec, and Nikon equipment, and then observed using a transmission electron microscope. RESULTS: Leukocytes, macrophages, and giant cells were found on the anterior IOL surface. Numerous cells were observed on the PMMA IOLs in the early postoperative period; they gradually decreased. Few cells were seen on the silicone IOLs during the course of the study. The giant cells became larger during the postoperative period. CONCLUSION: The foreign-body reaction to silicone IOLs in monkey eyes was less than that to PMMA IOLs.     

Cellular invasion on hydrogel and poly(methyl methacrylate) implants. An in vivo study.

Over a two-year postoperative period, cells on hydrogel (poly HEMA) and poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) were observed by specular microscopy. First small, round cells and fibroblast-like cells and later epithelioid-like cells and foreign-body giant cells could be seen on both IOL types. In eyes with prolonged postoperative inflammation a greater number of cells was observed and the cells remained on the IOL surface for a longer period. We found fewer cell reactions on hydrogel IOLs during the postoperative period of our follow-up. Foreign-body giant cells were observed on only 9%. These cells were smaller than those on PMMA IOLs. This finding may suggest that poly HEMA demonstrates greater biocompatibility, with regard to this foreign-body cell reaction, than PMMA. However, we found more pigment dispersion (50%) on the surface of hydrogel IOLs. These pigment deposits induced no cell reactions and there was less phagocytosis of the pigment debris. In 7% of the cases, dust-like, white precipitates of uncertain origin were seen; in 5% amorphous debris was seen. Fine scratches caused by polishing during the manufacturing process were seen in some cases. The postoperative clinical signs for PMMA and hydrogel IOLs were similar.     

Effect of heparin surface modification in reducing silicone oil adherence to various intraocular lenses.

PURPOSE: To evaluate surface properties of various intraocular lenses (IOLs), including a newly fabricated heparin-surface-modified (HSM) silicone IOL, with special reference to their efficiency in reducing potential silicone oil adherence to the IOL optics. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Five groups of rigid and foldable IOLs were analyzed in an in vitro test for the percentage of silicone oil adherence: a single-piece foldable hydrophilic-acrylic IOL (n = 9); a single-piece rigid poly(methyl methacrylate) (PMMA) IOL with HSM coating of the lens optic (n = 9); a 3-piece foldable silicone optic IOL with HSM coating of the optic (n = 10); a single-piece standard rigid PMMA IOL (n = 7); and a standard 3-piece foldable silicone optic IOL (n = 9). After the IOLs were immersed in water and then in silicone oil, gross photographs taken. Image analysis was performed to evaluate the percentage of silicone oil coverage of the anterior and posterior surfaces of each IOL optic. RESULTS: The mean silicone oil coverage of the hydrophilic-acrylic IOLs was 5.6% +/- 2.5% (SD); of the HSM PMMA IOLs, 6.2% +/- 4.3%; of the HSM silicone optic IOLs, 6.7% +/- 3.2%; and of the standard PMMA IOLs, 20.3% +/- 13.3%. The mean silicone oil coverage was greatest on the standard silicone optic IOLs, 98.2% +/- 3.1%. CONCLUSIONS: Intraocular lenses with a hydrophilic optic have less tendency toward adherence to silicone oil than more hydrophobic designs. A foldable silicone IOL with heparin surface modification can significantly reduce potential silicone oil adherence, comparable to the level achievable with the rigid HSM PMMA designs. Two new foldable IOL styles, the HSM silicone IOL and IOLs in the general class of hydrophilic-acrylic, were highly efficacious in reducing silicone oil adherence. There is now a real choice of foldable lenses for patients with actual or potential vitreoretinal diseases.     

聚甲基丙烯酸甲酯人工晶体的肝素表面处理对白内障囊外摘除术后炎症的研究

目的肝素表面处理后的后房型人工晶体（IOL）与传统的聚甲基丙烯酸甲酯（PMMA）人工晶体对手术后炎症的比较。方法对四个白内障治疗医254例病人进行平行组，双盲法和多中心研究。结果手术后一年，炎症细胞沉积在IOL表面的病人累计数，肝素表面处理组（HSM组）发生率29．8％，对照组（PMMA组）48．8％（P＜0．01），且PMMA组比HSM组有更多的病人发生虹膜后粘连（P＜0．05），两者的合并症很少。结论肝素表面处理能减少PMMAIOL的炎症反应。     

Uveal and capsular biocompatibility of a single-piece, sharp-edged hydrophilic acrylic intraocular lens with collagen (Collamer): 1-year results

PURPOSE: To analyze uveal and capsular biocompatibility 1 year following implantation of a sharp-edged, hydrophilic, collagen-containing posterior chamber intraocular lens (IOL). SETTING: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. METHOD: In a prospective study, a Collamer CC4204BF IOL was implanted in 30 eyes of patients with senile cataract. A standardized surgical technique and postoperative regimen were applied. To assess uveal biocompatibility, cellular inflammation on the anterior IOL surface was evaluated with a specular microscope. Capsular biocompatibility was registered semiquantitatively with a biomicroscope, based on an assessment of fibrosis on the anterior and posterior capsules. Tyndall values were measured with the Kowa FC-1000 laser flare-cell meter. Decentration of the lens was also registered. RESULTS: One year after implantation, the values of flare and cell count in the anterior chamber were lower than preoperatively. Round and spindle-shaped, epithelioid, and foreign-body giant cells were not found on the anterior surface of the IOL. The capsulorhexis rim was moderately fibrosed in 56.6% of cases. Fibrosis of the capsule over the optic was also moderate in 36.6%. The central portion of the posterior capsule was devoid of fibrosis in 43.3% and mildly fibrosed in 50%. Three lenses revealed outgrowth of lens epithelial cells to the anterior surface of the IOL. A neodymium:YAG capsulotomy had to be performed in 1 case. All lenses were well centered in the capsular bag 1 year after implantation. CONCLUSIONS: The absence of inflammatory cells on the anterior surface of the IOL indicates the high uveal biocompatibility of the lens. In terms of capsular biocompatibility, the results were satisfactory.     

Cellular response one year after extracapsular cataract extraction--comparison of regular and heparin surface modified PMMA intraocular lenses

PURPOSE: To compare the heparin-surface-modified and the regular polymethylmethacrylate posterior chamber intraocular lenses regarding cellular reactions one year after extracapsular cataract extraction. MATERIAL AND METHODS: 62 patients of either sex, with senile cataract, without diabetes and any preoperative pathology of the eye, were included in the study. 30 patients received HSM PMMA PC IOL and 32 patients received unmodified PMMA PC IOL. All patients had a standard extracapsular cataract extraction. At the examination after one year the best corrected visual acuity was defined, anterior segment of the eye was evaluated biomicroscopically, cell deposits were assessed and the state of posterior capsule was noticed. RESULTS: One year postoperatively all patients in both groups had the best corrected visual acuity better than 0.5. Significantly fewer eyes with the HSM PMMA PC IOLs had cell deposits on the anterior surface of the lens (20% vs. 37.5%). The amount of cell deposits per patients was small. Irregularity of the pupil with presence of posterior synechias did not differ significantly between the groups. The percentage of patients with clear posterior capsule was greater in the group with implanted heparin-modified artificial lenses. CONCLUSION: The study suggests that heparin-surface-modified posterior intraocular lenses result in less postoperative cellular response observed one year after extracapsular cataract extraction.     

Effect of intraocular lens and anterior capsule opening type on posterior capsule opacification.

PURPOSE: To determine the effect of intraocular lens (IOL) type and anterior capsulectomy technique on the incidence of posterior capsule opacification. SETTING: Department of Ophthalmology, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey. METHODS: Three hundred two eyes of 294 patients were examined retrospectively after IOL implantation in the capsular bag performed between February 1991 and November 1996. Patients were divided into 3 groups according to IOL type: poly(methyl methacrylate) (PMMA); heparin-surface-modified PMMA (HSM PMMA); plate-haptic silicone. Envelope capsulectomy or continuous curvilinear capsulorhexis (CCC) was used. Mean follow-up was 27 months (range 12 to 33 months). RESULTS: Posterior capsule opacification developed in 47 cases (15.6%): 21.7% in the PMMA lens group after planned extracapsular cataract extraction (ECCE), 17.4% in the HSM PMMA lens group after planned ECCE, and 7.7% in the plate-haptic silicone lens group after phacoemulsification. Posterior capsule opacification occurred less in patients who had anterior capsulectomy using the CCC technique (11.5%) than in those having an envelope capsulectomy (24.5%) (P < .05). Posterior capsule opacification was significantly less in eyes with a capsular-bag-fixated plate-haptic silicone lens than in those with a PMMA or HSM PMMA IOL (P < .05). CONCLUSION: This study demonstrated that the anterior capsulectomy technique and the IOL type influence the incidence of PCO.     

氟-肝素表面修饰的人工晶状体植入猕猴眼内的实验研究

目的 评价经氟－肝素表面修饰的人工晶状体（ｉｎｔｒａｏｃｕｌａｒ ｌｅｎｓ,ＩＯＬ）在猕猴眼内的生物相容性。方法 将１３只猕猴（２６只眼）随机分为３组,分别植入经不同表面修饰及未经修饰的ＩＯＬ。于术后第１５、３０、６０、９０、１８０天行裂隙灯、检眼镜及眼压检查,并进行前房穿刺,做房水细胞计数。结果 氟－肝素表面修饰的ＩＯＬ在猕猴眼内引起的炎症反应程度较未做表面修饰的ＩＯＬ轻;后囊混浊程度较其它ＩＯ     

Exfoliation syndrome and heparin surface modified intraocular lenses.

Either heparin surface modified (HSM) or regular polymethyl methacrylate (PMMA) intraocular lenses (IOLs) were implanted after extracapsular cataract extraction in 40 human eyes with exfoliation syndrome in a double-masked, randomized study. The patients were investigated preoperatively, and then 1 day, 1 week, 3, 6 and 12 months postoperatively. In eyes implanted with the HSM IOL, 26% had a fibrinoid reaction anterior to the IOL, while this complication was found in 50% of eyes implanted with the regular IOL. Pigment and cell deposits were more frequent on the regular IOLs than on the HSM lenses postoperatively. Posterior synechia formation between the iris and the implant or lens capsule was more common in the eyes with regular IOL compared to HSM IOL. No difference in visual acuity between the two groups was found either before or after surgery. The results suggest that in eyes with exfoliation syndrome, a heparin surface modified IOL reduces clinical complications associated with cataract surgery.     

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