Hydrophilic acrylic intraocular lens exchange: Five-year experience

PURPOSE: To evaluate clinical outcomes of opacified SC60B-0UV intraocular lens (IOL) (MDR, Inc.) and clear SC60B-0UV IOL exchange. SETTING: Department of Ophthalmology, Queen's Hospital, Burton-on-Trent, United Kingdom. METHODS: In a prospective audit, 149 patients with 152 SC60B-0UV hydrophilic acrylic IOLs were monitored over 5 years. Perioperative complications were evaluated. The best spectacle-corrected visual acuity, subjective quality of vision, and VF-14 scores were compared preoperatively and postoperatively. RESULTS: Ninety-eight IOLs developed opacification; 52 IOLs were exchanged between February 1999 and October 2004. The lens exchange procedure was uneventful in 39 eyes (75%). Perioperative complications included zonular dehiscence and posterior capsule rupture in 12 eyes (23.1%), total capsule-IOL extraction in 4 eyes (7.7%), iridodialysis in 3 eyes (5.8%), hyphema in 2 eyes (3.8%), and retained haptics in 5 eyes (9.6%). The mean logMAR visual acuity and mean VF-14 scores improved significantly after IOL exchange (P < .01). Forty-seven patients (90.4%) reported improvement in the subjective quality of vision after IOL exchange. However, after the exchange, visual acuity worsened in 5 patients (9.6%) and subjective quality of vision worsened in 3 patients (5.8%); the VF-14 scores decreased in 5 (14.7%) of the 34 patients tested. CONCLUSIONS: Visual function and quality of life were better after IOL exchange. However, poor outcomes in some patients mandate an extensive informed consent procedure for clear IOL exchange.     

Complications and clinical outcomes of intraocular lens exchange in patients with calcified hydrogel lenses

PURPOSE: To evaluate the outcomes of intraocular lens (IOL) exchange in patients with calcified hydrogel IOLs. SETTING: Ophthalmology departments of 2 university hospitals in Hong Kong, China. METHODS: Fifteen patients developed loss of vision resulting from calcification of hydrogel IOLs. The calcified IOLs were explanted and replaced with new IOLs. The best corrected visual acuity before and after surgery was measured and compared. RESULTS: The mean visual acuity was 0.03 (range 0.01 to 0.20) before IOL exchange and 0.20 (range 0.01 to 0.50) 3 months after; the difference was significant (P <.001). Acuity improved approximately 5 Snellen lines. Complications included posterior capsule rupture in 2 patients and zonular dehiscence in 3 patients; the secondary IOL was placed in the anterior chamber or ciliary sulcus in these patients. Three patients required cutting of the haptics before the calcified IOL could be removed. CONCLUSION: Intraocular lens exchange was an effective treatment in patients with calcified hydrogel IOLs.     

Surgical and visual outcomes following exchange of opacified Hydroview intraocular lenses

AIM: To report the clinical and surgical outcomes following exchange of opacified Hydroview intraocular lenses (IOLs), and to relate the final visual and anatomic results to clinical and surgical variables. METHODS: This is a prospective study of seventy-three eyes that underwent exchange of opacified Hydroview IOLs in Waterford Regional Hospital, Ireland. Preoperative, intraoperative and postoperative details were recorded. RESULTS: This study comprised 73 eyes of 71 consecutive patients undergoing IOL exchange, performed at mean (+/-SD) intervals of 36.64 (+/-9.9) months following the primary cataract surgery. The mean (+/-SE) follow-up following the exchange procedure was 13 (+/-1) months (range: 1-45 months). The secondary IOL was placed in the capsular bag, in the sulcus, and in the anterior chamber in 22 (30.1%), 24 (32.9%) and 27 (37%) cases, respectively. The IOL exchange procedure was uneventful in 36 eyes (49.3%), whereas intraoperative events such as posterior capsule rupture, vitreous loss and zonular dehiscence were seen in the remainder (50.7%). Following the IOL exchange procedure, a significant improvement in best corrected visual acuity (BCVA) was noted at one and at three months, and at the final visit (Wilcoxon signed ranks test: p<0.001, p = 0.006, and p<0.001, respectively). Following exclusion of eyes with visually consequential ocular comorbidity, a better final BCVA was noted among those eyes where the secondary IOL was placed in the capsular bag or in the sulcus when compared with placement of the secondary IOL in the anterior chamber (IOL in the bag or sulcus: 26 eyes (35.6%), median (IQR) final BCVA: 0.2 (0.10-0.40); IOL in the anterior chamber: 19 eyes (26.02%), median (IQR) final BCVA: 0.5 (0.20-0.60); Mann Whitney U Test: p = 0.004). CONCLUSION: IOL exchange is a technically challenging, but visually rewarding procedure. However, placement of the secondary IOL in the anterior chamber is associated with a poorer visual outcome when compared with placement of the secondary IOL in the sulcus or in the capsular bag.     

Modified capsular tension ring for patients with congenital loss of zonular support

PURPOSE: To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Ninety eyes of 57 patients with congenital loss of zonular support (Weill-Marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). RESULTS: At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months +/- 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). CONCLUSIONS: Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.     

A survey of intraocular lens explantation: a retrospective analysis of 23 IOLs explanted during 2005

PURPOSE: To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005. METHODS: The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared. RESULTS: Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.562+/-0.279 and 0.627+/-0.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test). CONCLUSIONS: The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.     

不同设计人工晶状体植入术后3年后囊膜混浊的研究

目的研究不同材料和不同设计的人工晶状体植入术后3年的后囊膜混浊(posterior capsular opacification,PCO)发生率及PCO形态。方法回顾性研究132眼老年性白内障患者,由同一医生进行超声乳化联合人工晶状体(in-traocular lens,IOL)植入术,根据IOL的不同分为4组:Storz Hydroview H60M组(33眼),Silicone折叠式硅胶IOL组(29眼),AcrySof三片式IOL组(36眼)和聚甲基丙稀酸甲酯(poly-methyl methacrylate,PMMA)组(34眼)。术后3年随访患眼的最佳矫正视力(best corrected visual acuity,BCVA),扩瞳后采集PCO数码图像,分析不同IOL组PCO的形态及PCO发生率。结果各种IOL的PCO形态各异,H60M组和AcrySof组分别有10眼和15眼后囊形成皱折,而Silicone和PMMA组为片状混浊。虽然各组BCVA和BCVA下降率差异没有显著性(P>0.05),但PCO发生率差异有非常显著性,分别是AcySof组5.6%,Silicone组30.3%,H60M组31%和PMMA组55.9%。结论AcrySof疏水丙烯酸酯三片式折叠IOL,有直角边缘设计,术后3年能明显降低PCO的发生。     

Perioperative complications and clinical outcomes of intraocular lens exchange in patients with opacified lenses

Background

To evaluate the perioperative complications and the outcomes of intraocular lens (IOL) exchange in patients with opacified lenses.

Methods

Retrospective multicentrical consecutive series of cases that comprised 22 eyes from 21 patients who had previous phacoemulsification with implantation of an IOL in the capsular bag and developed severe late opacification of the IOL. All patients had loss of vision and reported light disturbances. The IOLs were explanted and replaced with new IOLs. The perioperative complications were evaluated. The best spectacle-corrected visual acuity (BSCVA) before and after the surgery was compared.

Results

The mean time lapsed between the original cataract surgery and the IOL exchange surgery was 89.1?±?33.6 [48–216] months. The IOL exchange was uneventful in 14 eyes (63.6 %). Anterior vitrectomy was needed in seven cases (31.8 %). Other complications included zonular dehiscence in one case (4.5 %). In most of the cases, 14 eyes (63.6 %), the IOL was implanted in the sulcus. The most explanted IOL was the Hydroview H60M (Bausch & Lomb). The mean BSCVA (LogMAR) before and after the surgery were 0.57?±?0.69 (0.10–3) and 0.18?±?0.22 (0.0–1.10) respectively (t paired test, p?<?0.001). After the operation, 20 eyes (90.9 %) achieved a BSCVA?≤?0.3. No eye lost 1 or more lines of corrected vision after the surgery.

Conclusions

IOL exchange surgery, although associated with a high incidence of complications, restores and significantly improves the visual acuity of patients with opacified IOLs.     

Risk factors for anterior capsule contraction syndrome with polypropylene or poly(methyl methacrylate) haptics.

PURPOSE: To determine the effect of haptic composition on the development of anterior capsule contraction syndrome (CCS) requiring neodymium: YAG anterior capsulotomy. SETTING: Ophthalmology practice in Lancaster, Pennsylvania, USA. METHODS: This retrospective study covered a 30 month period during which 1 surgeon discontinued implanting AMO SI-30NB intraocular lenses (IOLs) with polypropylene haptics (n = 216) in favor of SI-40NB IOLs with poly(methyl methacrylate) (PMMA) haptics (n = 127). The transition was motivated by the suspicion that the PMMA haptics would maintain the capsulorhexis opening better and reduce the need for an anterior capsulotomy. RESULTS: Three eyes with SI-30NB IOLs (1.4%) required anterior capsulotomies; 2 eyes had preoperative pseudoexfoliation syndrome and required the capsulotomy within 3 months of surgery. Three eyes with SI-40NB IOLs (2.4%) required anterior capsulotomies within 4 months; 2 eyes had preoperative pseudoexfoliation syndrome and 1 had traumatic zonular weakness. The incidence of anterior capsulotomy did not differ significantly between the 2 IOL populations (P > .5), although preoperative pseudoexfoliation syndrome was a significant risk factor in both groups (P < .005). CONCLUSIONS: The polypropylene haptics of the SI-30NB IOL and the PMMA haptics of the SI-40NB IOL did not differ significantly in their ability to prevent CCS requiring anterior capsulotomy. Regardless of IOL haptic composition, eyes with preoperative zonular weakness associated with pseudoexfoliation syndrome or ocular trauma can develop CCS within 3 months of surgery and should, therefore, be followed closely in the early postoperative weeks to minimize the sequelae of anterior capsule fibrosis.     

Intraocular lens exchange through a 3.2-mm corneal incision for opacified intraocular lenses

Aim:

The aim was to evaluate visual and refractive results and complications of intraocular lens (IOL) exchange through a 3.2 mm corneal incision for opacified IOLs.

Materials and Methods:

This retrospective study comprised 33 eyes of 32 patients with IOL opacification requiring an IOL exchange between July 2003 and March 2007. Exchange surgery was performed through a 3.2-mm temporal clear corneal incision followed by implantation of a new foldable hydrophobic IOL. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), topographical astigmatism, and refractive cylinder were evaluated. Surgically induced astigmatism (SIA) was calculated and complications were recorded.

Results:

Opacification was observed in 25 eyes (76%) with Aqua-Sense, 3 eyes (9%) with Hydroview, 3 eyes (9%) with MemoryLens IOLs, and 2 eyes (6%) with DgR. The mean follow-up period was 36.54 months. An uneventful IOL exchange was achieved in 18 eyes (55%). Zonular dehiscence occurred in 9 eyes (27%), and posterior capsule tear developed in 4 eyes (12%). The mean preoperative BSCVA (mean ± standard deviation, decimal scale) was 0.13 ± 0.08 (mean: 20/150, range 20/2000 to 20/60) and improved to 0.63 ± 0.18 (mean: 20/32, range 20/60 to 20/20, P < 0.001). The mean SIA was 0.70 D. Seven eyes (21%) had 0.5 D or lower SIA.

Conclusion:

IOL exchange is a technically challenging procedure with potential risks of reversing the advantages of a prior small-incision cataract surgery. The use of a small corneal incision for IOL exchange could preserve the advantages of modern phacoemulsification surgery with acceptable SIA related to the procedure.     

Clinical effects of primary posterior continuous curvilinear capsulorhexis in eyes with single-piece hydrophilic acrylic intraocular lenses with and without haptic angulation

PURPOSE: To evaluate the clinical effects of a primary posterior continuous curvilinear capsulorhexis (PCCC) on the intraocular performance of hydrophilic acrylic single-piece intraocular lenses (IOLs) with and without haptic angulation. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A prospective study comprised 52 patients with bilateral age-related cataract who had standard cataract surgery including a PCCC. One eye of each patient was randomized to receive a hydrophilic acrylic IOL with haptic angulation (ACR6D SE, Laboratoires Cornéal) and the contralateral eye, a hydrophilic acrylic IOL without haptic angulation (C-flex 570C, Rayner). The following parameters were assessed: regeneratory posterior opacification (RPO) in the central, intermediate, and peripheral areas (scale 0 to 10); anterior capsule opacification (ACO); best corrected visual acuity (BCVA); and contrast sensitivity (CSF). RESULTS: Thirty-one patients completed the 1(1/2)-year follow-up. In both IOL groups, RPO within the PCCC was slight in the central area, with a mean score of 0.33 +/- 0.84 (SD) in the angulated IOL group and 0.16 +/- 0.57 in the nonangulated IOL group (P = .29). The mean RPO score in the peripheral area was 2.07 +/- 1.37 and 2.35 +/- 1.45, respectively (P = .12). The difference between the central and peripheral areas was 1.74 in the angulated IOL group (P<.00001) and 2.19 in the nonangulated IOL group (P<.00001). Haptic deformation occurred in 9 eyes (29%) with an angulated IOL and no eye with a nonangulated IOL. There was significantly more ACO in the nonangulated IOL group (P = .012). There were no significant differences in BCVA or CSF between the 2 groups. CONCLUSIONS: Creating a PCCC led to significantly lower RPO intensity within the PCCC area than in the peripheral area in eyes with hydrophilic acrylic IOLs with and without haptic angulation. Haptic angulation had no apparent significant influence on the intensity of RPO or on BCVA and CSF. Haptic deformation may occur in hydrophilic IOLs with angulated haptics.     

Effect of anterior capsule polishing on fibrotic capsule opacification: three-year results

PURPOSE: To evaluate the long-term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This randomized double-blind study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients received round-edged intraocular lenses (IOLs); 26 received an SI-40 IOL (Advanced Medical Optics Inc.) in both eyes, and 26 received a Silens6 IOL (Domilens) in both eyes. Both IOLs consist of different silicone material and have different haptic angulation. The SI-40 IOL has 13.0 mm open-loop poly(methyl methacrylate) (PMMA) haptics angulated by 10 degrees. The Silens6 IOL has 12.5 mm open-loop PMMA haptics with no angulation. In 1 eye, the anterior capsule was extensively polished. The anterior capsule was left unpolished in the contralateral eye, which acted as a control. Digital slitlamp photographs of the ACO and fibrotic PCO were taken with a standardized technique for 3 years postoperatively. The intensity of ACO was measured objectively (score 0% to 100%) using Adobe Photoshop software. Fibrotic PCO was graded subjectively (score 0 to 4). RESULTS: The mean ACO was 17% in the polished eyes and 26% in the control eyes (P = .0001). The mean fibrotic PCO score was 0.5 and 1.0, respectively (P = .0007). The mean ACO was 15% in the polished SI-40 eyes and 26% in the control SI-40 eyes (P = .01). It was 19% in the polished Silens6 eyes and 26% in the control Silens6 eyes (P = .003). The mean fibrotic PCO score was 0.4 in the polished SI-40 eyes and 1.1 in the control SI-40 eyes (P = .0006). It was 0.6 in the polished Silens6 eyes and 0.9 in the control Silens6 eyes (P = .08). CONCLUSIONS: Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round-edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.     

Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: bilateral case report and clinicopathologic correlation

OBJECTIVE: To report clinicopathologic and ultrastructural features of two opacified single-piece hydrophilic acrylic intraocular lenses (IOLs) explanted from a diabetic patient. DESIGN: Interventional case report with clinicopathologic correlation. SETTING: A 64-year-old white female underwent phacoemulsification and implantation of a single-piece hydrophilic acrylic lens (SC60B-OUV; Medical Developmental Research, Inc., Clear Water, FL) in October 1998 in the left eye and in July 1999 in the right eye. The best-corrected visual acuity after surgery was 20/60 in the left eye and 20/50 in the right eye. The patient had a marked decrease in visual acuity in June 2000 as a result of a milky, white opalescence of both lenses. Intraocular lens explantation and exchange was performed in both eyes and the explanted IOLs were submitted to our center for detailed pathologic, histochemical, and ultrastructural evaluation. They were stained with alizarin red and the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. MAIN OUTCOME MEASURES: Documentation of calcium deposits confirmed by histochemical stains and surface analyses. RESULTS: Opacification of the IOL was found to be the cause of decreased visual acuity. The opacification involved both the IOL optic and the haptics in the left eye and was confined to the IOL optic in the right eye. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic and haptics. CONCLUSIONS: There are two features that distinguish this case from those reported earlier. This is the first clinicopathologic report of lens opacification that has involved completely the lens optic and the haptics. Second, these two explanted IOLs document the first bilateral case. This process of intraoptic and haptic opacification represents dystrophic calcification of unknown cause. Diabetic patients appear to be more severely and more often affected by lens opacification. Long-term follow-up of diabetic patients implanted with this IOL design should be maintained by surgeons and manufacturers.     

虹膜拉钩联合可缝合囊袋张力环在马方综合征晶状体半脱位患者中的应用

目的探讨虹膜拉钩联合可缝合囊袋张力环（MCTR）在马方综合征晶状体半脱位患者中应用的有效性和安全性。方法马方综合征晶状体半脱位患者5例（7只眼）。行3．2mm透明角膜隧道切口及连续环形撕囊后,使用2-4个一次性尼龙虹膜拉钩钩住撕囊边缘,以稳定晶状体囊袋,并使其居中,完成晶状体抽吸、MCTR植入及缝合固定。于晶状体囊袋内植入折叠人工晶状体。结果6只眼术后12个月最佳矫正视力≥0．8,1只眼为0．7。眼前段分析系统获得Scheimpflug图像分析人工晶状体居中性好。超声活体显微镜显示所有患者人工晶状体襻及MCTR均位于晶状体囊袋内,MCTR的固定钩稳定地位于虹膜与晶状体囊膜间。反光裂隙灯显微镜照相分析显示1只眼出现较明显晶状体后囊膜混浊。无玻璃体脱出、视网膜脱离等术中术后并发症的发生。结论虹膜拉钩的使用可维持术中晶状体囊袋的稳定及手术过程的操作安全。MCTR植入可维持术后人工晶状体的长期稳定性,安全有效地避免马方综合征患者进行性加重的晶状体悬韧带异常导致的术后人工晶状体脱位。     

Intraocular lens decentration and posterior capsule opacification: anatomo-pathologic findings after implantation of AMOSI40 IOLS

PURPOSE: To evaluate the incidence of intraocular lens (IOL) decentration and posterior capsule opacification (PCO) after implantation of a three-piece posterior chamber silicone IOL in a series of eyes examined postmortem. METHODS: Twenty-three pseudophakic enucleated human cadaver eyes, implanted with AMO SI40NB IOLs after phacoemulsification, were analyzed. Eyes obtained postmortem were sectioned at the equatorial plane and the anterior segment photographed from a posterior view. Location of IOL optic and haptics, type of fixation, and centration of IOL was evaluated. PCO was graded and the presence of Nd:YAG laser posterior capsulotomy was noted. RESULTS: Mean age at the time of surgery was 77.83 years, mean time since implantation was 18.26 months. In all the eyes examined, IOL haptics were positioned in the capsular bag. Mean decentration was 0.20+/-0.16 mm. No correlation was found between IOL decentration and time since implantation. The degree of peripheral PCO ranged from none (13.0%) to mild (39.1%) to moderate (26.1%) to severe (21.7%). The degree of central PCO ranged from none (52.2%) to mild (30.4%) to moderate (4.3%). Three patients (13.0%) underwent Nd:YAG laser posterior capsulotomy. CONCLUSIONS: A very good centration can be obtained when silicone AMOSI40NB IOLs are correctly implanted with the haptics inside the capsular bag. About half of the implants showed no central PCO while Nd:YAG laser posterior capsulotomy rates documented a relatively low PCO 18 months after surgery. A careful in the bag haptics placement is needed in order to reduce the IOL decentration and to prevent central PCO.     

Optical coherence tomography evaluation of posterior capsule opacification related to intraocular lens design

PURPOSE: To evaluate posterior capsule opacification (PCO) and the impact of different intraocular lens (IOL) models on PCO characteristics using optical coherence tomography (OCT). METHODS: Eighty-three eyes with PCO (fibrosis or pearl type) and 32 pseudophakic eyes without PCO were included. Horizontal 3.0 mm long OCT scans of the posterior capsule were obtained. Measurements and means of the peak posterior capsule intensity (PCI) and posterior capsule thickness (PCT) (distance between 2 spikes at posterior capsule) at 3 scan points were recorded. The PCI and PCT were compared with best corrected visual acuity (BCVA) and IOL data. RESULTS: The PCT was high for IOLs with a rounded edge (P = .001) and with poly(methyl methacrylate) (PMMA) IOLs (P<.001). If the IOL optic was concave-convex, the PCT was higher than if the optic was biconvex (P = .001). The PCT of hydrophilic acrylic IOLs was higher than of hydrophobic acrylic IOLs (P = .04). Multivariate analysis of PCT showed that PMMA was the only factor statistically associated with PCT (P = .02). The worse logMAR BCVA correlated significantly with a higher PCT value (P<.001) but not with PCI (P = .42). An IOL size of 12.5 mm was related to fibrosis-type PCO (odds ratio, 3.14; P = .04). CONCLUSIONS: The PCT was most affected by IOL characteristics. Poly(methyl methacrylate) IOLs and IOLs with rounded edges were associated with higher PCT. Hydrophilic acrylic IOLs were associated with greater PCT than hydrophobic IOLs. Posterior capsule thickness was a factor in decreased BCVA.     

Effect of primary posterior continuous curvilinear capsulorhexis on clinical performance of ACR6D SE single-piece hydrophilic acrylic intraocular lenses

PURPOSE: To evaluate the effects of a primary posterior continuous curvilinear capsulorhexis (PCCC) on the clinical performance of a single-piece hydrophilic acrylic intraocular lens (IOL) with haptic angulation. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A prospective study of 52 patients with bilateral age-related cataract was conducted. Patients had standard cataract surgery with implantation of the same IOL in both eyes. Randomly, a PCCC was created in 1 eye and the posterior capsule was left intact in the fellow eye. Assessed parameters were visual axis opacification (VAO) in eyes with a PCCC or regeneratory posterior capsule opacification (PCO) in eyes without PCCC (scale 0 to 10) in the central (3.0 mm eccentricity), intermediate (3.0 to 4.5 mm eccentricity), and peripheral (>4.5 mm eccentricity [capsulorhexis edge]) areas; neodymium:YAG (Nd:YAG) laser capsulotomy or laser polishing of ongrowing lens epithelium; anterior capsule opacification (ACO); best corrected visual acuity (BCVA); and contrast sensitivity. RESULTS: Thirty patients completed the 2(1/2)-year follow-up. Visual axis opacification was significantly lower in the central region in the PCCC group (mean 0.5 +/- 0.7 [SD]) than PCO in the central region of the non-PCCC group (mean 1.1 +/- 1.1) (P = .02). Forty percent in the non-PCCC group had an Nd:YAG laser capsulotomy during the follow-up period; none in the PCCC group had laser polishing. There were no significant differences in ACO, SE, BCVA, or contrast sensitivity. There was no additional gain in BCVA or contrast sensitivity in eyes with a PCCC compared with eyes without a PCCC when VAO and PCO were low. CONCLUSION: A PCCC significantly reduced PCO formation within the central 3.0 mm eccentricity as well as the need for Nd:YAG laser capsulotomy in eyes with a single-piece hydrophilic acrylic IOL with angulated haptics.     

Posterior capsule opacification and lens epithelial cell layer formation: Hydroview hydrogel versus AcrySof acrylic intraocular lenses

PURPOSE: To quantitatively compare the incidence of visually significant posterior capsule opacification (PCO) and lens epithelial cell (LEC) layer formation on the anterior surface of Hydroview hydrogel and AcrySof acrylic foldable intraocular lenses (IOLs) after implantation. SETTING: Single-surgeon ophthalmology practice, Orange Base Hospital, and Dudley Private Hospital, Orange, New South Wales, Australia. METHODS: This retrospective study comprised 166 eyes of 150 patients (after exclusions) who had cataract extraction and insertion of a foldable IOL in the capsular bag by a single surgeon using a standardized phacoemulsification technique from December 1997 to September 1998. The mean follow-up was 13.1 months (range 6.0 to 23.6 months). The eyes were divided into 2 groups based on the type of IOL implanted: Storz Hydroview H60M (81 eyes) or Alcon AcrySof MA30BA (85 eyes). A neodymium:YAG posterior capsule laser capsulotomy (PC YAG) was performed for an objective decrease in Snellen best corrected visual acuity (BCVA) of more than 1 line, significant visual symptoms, or both. This was used as a measure of visually significant PCO. An Nd:YAG anterior surface clearance (ASC YAG) was done for LEC layer formation anterior to the IOL to better visualize or facilitate treatment of PCO. The rates of PC YAG and ASC YAG after Hydroview and AcrySof IOL implantation were statistically compared. RESULTS: Forty-five eyes (55.6%) in the Hydroview IOL group and 3 eyes (3.5%) in the AcrySof IOL group required a PC YAG; the risk difference was 52.0% (P <.001). An ASC YAG was required in 27 eyes (33.3%) in the Hydroview group and 1 eye (1.2%) in the AcrySof group; the risk difference was 32.2% (P <.001). Survival analysis demonstrated that the only independent predictor of the incidence of PC YAG and ASC YAG over time was IOL type, with the Hydroview IOL group having a statistically significantly higher incidence of both procedures. CONCLUSION: There was a greater incidence of visually significant PCO and LEC layer formation on the anterior surface of Hydroview IOLs than of AcrySof IOLs.     

A prospective, randomised comparison of single and three piece acrylic foldable intraocular lenses

AIMS: To compare the postoperative performance of single and three piece acrylic foldable intraocular lenses (IOLs). METHODS: 20 patients underwent bilateral cataract surgery with a single piece SA30AL IOL in one eye and a three piece MA30BA IOL in the other eye. The eyes were randomly assigned to either a single or three piece lens. The amount of IOL decentration and tilt, area of anterior capsule opening, and degree of posterior capsule opacification were measured using the Scheimpflug anterior segment analysis system (Nidek EAS-1000). Visual acuity and contrast sensitivity were examined. Measurements were performed by masked examiners before and 1 day, 1 week, 1, 3, 6, and 18 months after surgery. RESULTS: There were no significant differences between the two groups (p>0.05, paired t test) in the amount of IOL decentration, IOL tilt, area of anterior capsule opening, degree of posterior capsule opacification, best corrected visual acuity, and contrast sensitivity throughout the 18 month follow up period. CONCLUSION: The single and three piece acrylic foldable IOLs are equally stable in the eye after surgery.     

Visual outcomes and complications in surgery for ectopia lentis in children

PURPOSE: To evaluate postoperative visual acuity and complications in eyes with ectopia lentis having surgery with a sutured capsular tension ring (CTR) and intraocular lens (IOL). SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: Thirty-seven eyes of 22 children had surgery for lens dislocation. Two types of capsular rings were used; a Cionni modified CTR and a conventional CTR. In all cases, the rings were sutured to the sclera with a 10-0 polypropylene (Prolene) suture, the CTR and an AcrySof IOL (Alcon) were implanted in the capsular bag, and the posterior capsule was left intact. The preoperative and postoperative best corrected visual acuity (BCVA) and complications were studied retrospectively. RESULTS: The mean age of the patients was 52 months. Thirty-three eyes had implantation of a Cionni modified CTR and 4 eyes, of a conventional CTR. The median preoperative BCVA (22 eyes) was 0.26 (range 0.015 to 0.65). The median postoperative BCVA (36 eyes) was 0.59 (range 0.2 to 1.0). The median follow-up period was 27 months (range 1 to 59 months). Twenty-six eyes had secondary surgery for visual axis opacification, with 5 eyes requiring 2 to 3 reoperations. Two eyes required secondary suturing for IOL decentration. Persistent amblyopia was observed in 3 eyes, with poor postoperative visual development. No eye had serious complications such as retinal detachment, endophthalmitis, or glaucoma. CONCLUSION: Surgery for ectopia lentis with a CTR and an AcrySof IOL implanted in the capsular bag and sutured to the sclera appears to be safe in children.     

Capsulorhexis ovaling and capsular bag stretch after rigid and foldable intraocular lens implantation: experimental study in pediatric human eyes

PURPOSE: To compare the amount of capsulorhexis ovaling and capsular bag stretch produced by various intraocular lenses (IOLs) implanted in pediatric human eyes obtained post-mortem. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Salt Lake City, Utah, USA. METHODS: In this nonrandomized comparative study, 16 pediatric human eyes obtained postmortem were divided into 2 groups: Eight eyes were obtained from children younger than 2 years (Group A), and 8 eyes were obtained from children older than 2 years (Group B). All eyes were prepared according to the Miyake-Apple posterior video technique. Six types of rigid and foldable posterior chamber IOLs manufactured from poly(methyl methacrylate) (single-piece), silicone (plate and loop haptics), and hydrophobic acrylic (single-piece and 3-piece AcrySof, Alcon Laboratories) biomaterials were implanted. The capsulorhexis opening and capsular bag diameters were measured before IOL implantation and after in-the-bag IOL fixation with the haptics (or the main axis) at the 3 to 9 o'clock meridian. The percentage of ovaling of the capsulorhexis opening was calculated by noting the difference in the opening's horizontal diameter before and after IOL implantation. The percentage of capsular bag stretch was also calculated by noting the difference in the horizontal capsular bag diameter before and after IOL implantation. RESULTS: All IOLs produced ovaling of the capsulorhexis opening and stretching of the capsular bag parallel to the IOL haptics. There were significant differences in capsulorhexis ovaling and capsular bag stretch (P<.001, analysis of variance) between the 6 IOL types in each group of eyes. The postimplantation difference was significant only between the single-piece hydrophobic acrylic IOL (AcrySof) and the other IOLs. The single-piece hydrophobic acrylic IOL was associated with significantly less capsulorhexis ovaling and capsular bag stretch in both groups (mean 12.06% +/- 0.59% [SD] and 7.6% +/- 1.47%, respectively). CONCLUSIONS: Modern rigid and foldable IOLs designed for the adult population implanted in the capsular bag of infants and children produced variable degrees of capsulorhexis ovaling and capsular bag stretch. The Miyake-Apple posterior video technique confirmed the well-maintained configuration of the capsular bag (with minimal ovaling) after implantation of a single-piece hydrophobic acrylic IOL because of its flexible haptic design.