Results of hydrophilic acrylic,hydrophobic acrylic,and silicone intraocular lenses in uveitic eyes with cataract: comparison to a control group

PURPOSE: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses (IOLs) in eyes with uveitis. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective study comprised 72 eyes with uveitis and 68 control eyes having phacoemulsification and IOL implantation by 1 surgeon. Patients received 1 of the following IOLs: foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia). Postoperative evaluations were at 1, 3, and 7 days and 1, 3, and 6 months. Cell reaction was evaluated by specular microscopy of the anterior IOL surface and the anterior and posterior capsule reaction, by biomicroscopy. RESULTS: Small round cell deposition was observed on all IOLs in the immediate postoperative period, especially in eyes with uveitis. This reaction decreased 3 to 6 months after surgery. Although the CeeOn 911 had a higher mean grade of small cells, there was no statistical difference between the 3 IOL types after 6 months in the uveitis and control groups. Foreign-body giant cells (FBGCs) increased after 1 week to 1 month. The AcrySof IOLs had the highest number of FBGCs; after 6 months, there was a statistically significant difference between the AcrySof and Hydroview uveitis groups (P =.036) and the AcrySof and CeeOn 911 uveitis groups (P =.003) but there was no difference among the 3 IOL types in the control group. Lens epithelial cell outgrowth persisted on the Hydroview IOLs in control eyes and regressed on all 3 IOL types in uveitic eyes and on the AcrySof and CeeOn 911 IOLs in control eyes (P =.0001). Anterior capsule opacification (ACO) was more severe on all IOL types in uveitic eyes and on the CeeOn 911 IOL in control eyes. Posterior capsule opacification (PCO) was more severe in uveitic eyes. The Hydroview group had more severe PCO than the AcrySof and the CeeOn 911 groups in uveitis and control eyes. Six months postoperatively, the difference was significant (P =.0001). There was no significant difference between the AcrySof and CeeOn 911 IOLs. CONCLUSIONS: Intraocular lens biocompatibility is inversely related to inflammation. Hydrophilic acrylic material had good uveal but worse capsular biocompatibility. Hydrophobic acrylic material had lower uveal but better capsular biocompatibility. Silicone showed a higher small cell count (mild) and more severe ACO but achieved PCO results comparable to FBGC results and better than those with the AcrySof lens 6 months after surgery. Despite the differences in IOL biocompatibility, all patients benefited from the surgery.     

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

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

不同材料和不同设计的人工晶状体对后囊膜混浊的预防作用比较

目的比较三组不同材料、不同设计的一片式折叠人工晶状体(IOL)在预防后囊膜混浊(PCO)中的作用。方法疏水丙烯酸材料直角边缘组(AcrySof)52眼,亲水丙烯酸材料直角边缘组(ISO)40眼,亲水丙烯酸材料非直角边缘组(Hydroview)32眼,术后12个月扩瞳观察前囊膜混浊(ACO)和PCO的情况并进行统计学分析。结果术后12个月PCO发生率AcrySof组明显低于Hydroview组,ISO组介于二者之间,差异有显著统计学意义(P<0.01);而ACO的发生率三组比较,差异无显著统计学意义(P>0.05)。结论光学边缘锐利的疏水丙烯酸材料折叠式IOL可以更有效地减少PCO的发生。     

Inflammation after implantation of hydrophilic acrylic,hydrophobic acrylic,or silicone intraocular lenses in eyes with cataract and uveitis: comparison to a control group

PURPOSE: To compare the course of inflammation after small-incision cataract surgery with implantation of 1 of 3 types of foldable intraocular lenses (IOLs) in eyes with uveitis. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: Seventy-four eyes with uveitis and cataract and 68 control eyes with cataract were prospectively selected to receive a foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia) IOL. All surgery was performed by the same surgeon using a standardized protocol: clear corneal incision, capsulorhexis, phacoemulsification, and in-the-bag IOL implantation. Preoperative and postoperative inflammation was evaluated by measuring aqueous flare preoperatively and 1, 3, 7, 28, 90, and 180 days after surgery using the Kowa FC-1000 laser flare-cell meter. All uveitic eyes were in remission for at least 3 months before surgery. RESULTS: In the uveitic eyes, there was no statistically significant difference in the postoperative course of flare and cell among the 3 IOL groups. Six months after surgery in uveitic eyes, flare values reached preoperative levels and the cell count was lower than preoperatively in all 3 IOL groups. Relative flare values were higher in the eyes with uveitis and a CeeOn 911 IOL; however, the difference between this group and the 2 acrylic IOL groups was not significant. CONCLUSIONS: There were no significant differences in inflammation after implantation of foldable IOLs in uveitic eyes. Although absolute flare values and cell counts in eyes with uveitis were higher than in control eyes, primarily because of a damaged blood-aqueous barrier (BAB), BAB recovery was similar between the 2 groups. The changes in the BAB indicate that foldable IOL implantation is safe in uveitic eyes.     

Cellular reaction on the anterior surface of 4 types of intraocular lenses

PURPOSE: To assess the cellular reaction on the anterior surface of 4 types of foldable intraocular lenses (IOLs). SETTING: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. METHODS: One hundred eyes scheduled for cataract surgery were prospectively randomized into 4 groups of 25 eyes each using random number tables. Group 1 received a Hydroview IOL (Bausch & Lomb), Group 2 an AcrySof IOL (Alcon), Group 3 a MemoryLens IOL (ORC), and Group 4 a CeeOn 920 IOL (Pharmacia). Patients were examined 1, 3, 7, 30, 90, and 180 days postoperatively. Postoperative biomicroscopic examinations were done with a slitlamp, and a specular microscope was used to document the presence of cell deposits and identify areas with the highest density of cells. RESULTS: The local tissue response revealed 2 patterns: a nonspecific foreign-body reaction to the IOL (small round, fibroblast-like, epithelioid, and giant cells) and a lens epithelial cell (LEC) reaction. The highest incidence of LECs was in the Hydroview group, in which LECs were present on 81.8% of lenses 180 days postoperatively. During the first postoperative days, small round and fibroblast-like cells were found on all IOLs. From 7 days on, the incidence and density of these cells were less severe in the Hydroview and CeeOn 920 groups. After several weeks, epithelioid cells and foreign-body giant cells were seen on some IOLs. These cells appeared more often on AcrySof, MemoryLens, and CeeOn IOLs. CONCLUSION: This study found IOL-related differences in cellular reaction after cataract surgery. The incidence of a nonspecific foreign-body reaction to 4 IOLs is consistent with the results of previous studies. The incidence of LECs was highest in the Hydroview group and lowest in the AcrySof group. The CeeOn 920 group had the lowest incidence of all types of cells.     

Uveal and capsular biocompatibility of 2 foldable acrylic intraocular lenses in patients with uveitis or pseudoexfoliation syndrome: comparison to a control group

PURPOSE: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic (Hydroview) and hydrophobic acrylic (AcrySof) intraocular lenses (IOLs) after phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) or uveitis and compare the results with those in a control group. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria.METHODS: This prospective nonrandomized comparative trial comprised 143 eyes recruited consecutively. Of these, 49 eyes had PEX, 43 had uveitis, and 51 served as controls. A standardized surgical protocol was used. Cell reaction, anterior (ACO) and posterior (PCO) capsule opacification, and flare were evaluated 1 year after cataract surgery. RESULTS: Regarding uveal biocompatibility, the number of foreign-body giant cells (FBGCs) increased in proportion to associated ocular pathologies in both IOL groups. The difference between the Hydroview control and Hydroview uveitis groups was statistically significant. The number of FBGCs was greater on AcrySof IOLs than on Hydroview IOLs in all 3 groups. The difference in FBGCs between the 2 IOL types was statistically significant in the control and PEX groups. Regarding capsular biocompatibility, lens epithelial cell (LEC) outgrowth was inversely correlated with intraocular inflammation. Outgrowth was statistically significantly higher with Hydroview IOLs, occurring in 85% in the control group, 45% in the PEX group, and 28% in the uveitis group (P <.0001). With AcrySof lenses, the percentages were 0%, 8%, and 4%, respectively. The PEX and uveitis groups were more likely to develop ACO than the control group (P <.012). There was no statistically significant difference in ACO between the 2 IOL types in the 3 patient groups. The PCO was statistically significantly greater in the uveitis group than in the control group (P <.026) and statistically significantly more dense on Hydroview than on AcrySof IOLs in all 3 patient groups (P <.002). Flare was statistically significantly higher in the uveitis group than in the PEX and control groups with both IOL types (P <.012). There was no statistically significant difference in flare between the 2 IOL types. CONCLUSIONS: Uveal and capsular biocompatibility depends on the intensity of ocular inflammation. The greater the inflammation, the less the biocompatibility of hydrophilic and hydrophobic acrylic materials. AcrySof stimulated more FBGCs. The Hydroview material had better uveal but poorer capsular biocompatibility than AcrySof. The sharp optic edge effect of the AcrySof IOL and the advantages of the Hydroview lens in normal eyes are less apparent in compromised eyes.     

Posterior capsule opacification after implantation of CeeOn Edge 911A, PhacoFlex SI-40NB, and AcrySof MA60BM lenses: one-year results of an intraindividual comparison multicenter study

PURPOSE: To perform an intraindividual comparison of posterior capsule opacification (PCO) with 2 foldable intraocular lenses (IOLs) and a foldable acrylic IOL 1 year after in-the-bag implantation. SETTINGS: Seven German ophthalmology centers. METHODS: In an open prospective randomized multicenter study, each center intraindividually compared a high-refractive-index, sharp-edged optic silicone IOL (CeeOn Edge 911A, Pharmacia) with a high-refractive-index, round-edged optic silicone IOL (PhacoFlex SI-40NB, Allergan) or a sharp-edged optic acrylic IOL (AcrySof MA60BM, Alcon). Of 288 randomized patients, 247 had standard phacoemulsification with in-the-bag IOL implantation in both eyes by the same surgeon. One eye of each patient received a CeeOn Edge IOL and the fellow eye, an AcrySof or PhacoFlex IOL. A morphologic evaluation of PCO was performed using the Evaluation of Posterior Capsule Opacification (EPCO) system 1 to 2 weeks and 11 to 14 months after surgery. The digital pictures were evaluated by an independent investigator who was blind to the type of IOL. Intraindividual differences in EPCO scores were statistically evaluated by a 1-sided binomial test at an alpha-level of 5%. RESULTS: One year after surgery, 127 patients with the AcrySof IOL and 102 patients with the PhacoFlex IOL in the control eye were reexamined. Functional results, safety, and handling were not significantly different between the 3 IOLs. All reexamined eyes had a very low PCO grade. The EPCO values revealed less PCO in eyes with the CeeOn Edge IOL than in eyes with the AcrySof or PhacoFlex IOL, but the difference was not statistically significant. A neodymium:YAG laser capsulotomy was performed in 1 eye with a CeeOn Edge IOL, 1 eye with an AcrySof IOL, and 2 eyes with a PhacoFlex IOL. CONCLUSIONS: The EPCO PCO grade was low 1 year after implantation of CeeOn Edge 911A, PhacoFlex SI-40NB, and AcrySof MA60BM IOLs; there was no statistically significant difference between the IOLs. The impact of IOL material and edge design on PCO development might be relevant in a long-term follow-up of this study.     

Lens epithelial cell migration between posterior capsule and intraocular lens with variously finished posterior optic edge and two haptic angulations

PURPOSE: To compare lens epithelial cell migration between intraocular lens (IOL) optics and the posterior capsule of IOLs with various edges and haptic angulations. METHODS: Experimental acrylic IOLs with 3 types of finishing (none, polishing, tumbling and polishing) and 2 types of haptic angulation (10 and 15 degrees ) as well as 3 (AcrySof MA30BA, Sensar AR40, CeeOn 911) clinically implanted IOLs were inserted in rabbit eyes. Scanning electron-microscopic examination of IOLs was carried out before surgery and histological examination of lens capsules 3 weeks after surgery. The grading of lens epithelial cell migration under the IOL was made by scoring. RESULTS: Scanning electron-microscopic examination showed that the optic edge sharpness decreased according to the finishing in experimental IOLs. The AcrySof and CeeOn lenses had sharp edges and the Sensar had a rounded edge. The migration score was highest in the IOL with a rounded edge whereas it was lowest in IOLs with a sharp edge and large haptic angulation. There was no significant difference between the scores of clinically implanted IOLs. CONCLUSION: Sharpness of the optic edge may be a critical factor for the prevention of posterior capsule opacification and more important than haptic angulation in acrylic IOLs.     

Two year results: sharp versus rounded optic edges on silicone lenses

To evaluate the role of optic edge design of 2 silicone intraocular lenses (IOLs) in 2 year clinical results.Department of Ophthalmology, University of Vienna, Medical School, Allgemeines Krankenhaus, Austria.In this comparative clinical study, 50 eyes had phacoemulsification and implantation of a high-refractive 3-piece silicone IOL with sharp optic edges (CeeOn model 911F) (n = 25) or a 3-piece silicone lens with rounded optic edges (CeeOn model 920) (n = 25). Biomicroscopic findings, including those of specular microscopic examination of the anterior lens surface, were documented and the results analyzed.After 2 years, a significant between-group difference in posterior capsule opacification (PCO) but not in anterior capsule alterations was observed. Behind all CeeOn 911F sharp-edge IOLs, the capsule remained clear; in 2 of 23 capsules behind the CeeOn 920 rounded-edge, a neodymium: YAG laser capsulotomy had to be performed for dense central fibrotic PCO. Seven of 21 of the remaining eyes had first-degree central fibrotic PCO, 14 of 23 had peripheral mixed fibrotic and slender Elschnig pearl PCO, and 8 of 23 had second-degree peripheral PCO. Specular microscopic findings did not differ between the 2 groups. No severe IOL decentration occurred in any eye; 25% in the sharp-edge group and 40% in the rounded-edge group had minimal decentration.The silicone IOL with the sharp optic edge design was associated with significantly reduced PCO 2 years postoperatively.     

Influence of optic edge design and anterior capsule polishing on posterior capsule fibrosis

PURPOSE: To evaluate the role of posterior optic edge design and the effect of anterior capsule polishing on peripheral fibrotic posterior capsule opacification (PCO). SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This randomized prospective study comprised 144 eyes of 72 patients with bilateral age-related cataract. Each patient had standardized cataract surgery in both eyes by the same surgeon. Group 1 (46 patients) received a round-edged hydrophobic acrylic IOL (AMO Sensar AR40) in 1 eye and a sharp-edged hydrophobic acrylic IOL (AMO Sensar OptiEdge AR40e) in the other eye. Group 2 (26 patients) received a silicone IOL (Pharmacia CeeOn 911A) with a truncated optic in both eyes. In this group, the anterior capsule was extensively polished in 1 eye and was left unpolished in the other eye. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for fibrotic PCO. The intensity of PCO was subjectively graded (score 0 to 4) by 2 masked examiners. RESULTS: Subjective PCO scores correlated well between the 2 examiners (r = 0.88). In Group 1, the mean PCO score was 0.26 for the OptiEdge AR40e IOL and 0.90 for the AR40 IOL (P<.01). In Group 2, the mean PCO score was 0.24 in eyes with a polished capsule and 0.17 in eyes in which the capsule was not polished (P =.31). CONCLUSIONS: The sharp-edged OptiEdge AR40e IOL led to significantly less peripheral fibrotic PCO 1 year postoperatively than the round-edged AR40 IOL. In eyes with the sharp-edged silicone 911A IOL, anterior capsule polishing caused no significant difference in fibrotic PCO.     

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.     

Calcification of Hydroview H60M intraocular lenses: aqueous humor analysis and comparisons with other intraocular lens materials

PURPOSE: To compare the level of calcification on Hydroview H60M hydrophilic acrylic intraocular lenses (IOLs) (Bausch & Lomb) and other IOL materials. SETTING: Omori Medical Center, Department of Ophthalmology, Toho University, Tokyo, Japan. METHODS: The levels of calcification on Hydroview H60M hydrophilic acrylic IOLs, AcrySof SA60AT hydrophobic acrylic IOLs (Alcon Surgical, Inc.), Sensar AR40e hydrophobic acrylic IOLs (Advanced Medical Optics), ClariFlex (Advanced Medical Optics) silicone IOLs, and the MeniFlex ENV13 (Menicon) poly(methyl methacrylate) IOLs were compared in a calcium phosphate solution containing albumin. In a concentration-change experiment, the calcium and phosphate concentration levels were changed and the results observed by scanning electron microscopy. RESULTS: The Hydroview H60M IOL had the largest amount of deposits. Small amounts of deposits were found on the other IOLs in the following decreasing order: AcrySof SA60AT, Sensar AR40e, ClariFlex, and MeniFlex ENV13. The amount of deposits on the Hydroview H60M IOLs was statistically significantly greater than the amount on the other IOLs (P<.01). CONCLUSIONS: The hydrophilic acrylic IOLs (Hydroview H60M) had significantly higher amounts of calcified deposits than IOLs of other materials, indicating that hydrophilic acrylic IOLs easily accumulate calcified deposits in the body when the concentrations of calcium, phosphate, and albumin in the aqueous humor fluctuate as a result of a blood-aqueous barrier breakdown.     

Comparison of the biocompatibility of 2 foldable intraocular lenses with sharp optic edges.

PURPOSE: To compare the clinical performance of 2 foldable intraocular lenses (IOLs) with sharp optic edges in terms of uveal and capsular biocompatibility. SETTING: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. METHODS: Fifty eyes scheduled for cataract surgery were included in this comparative study. A standardized surgical protocol was used, and all operations were performed by 1 experienced surgeon. Two posterior chamber lens types of similar design with a 6.0 mm sharp-edged optic and poly(methyl methacrylate) haptics were used. Twenty-five eyes received an AcrySof acrylic IOL (Alcon), and 25 eyes received a CeeOn 911A silicone IOL (Pharmacia). Relevant data were collected at a 3-year follow-up examination. To evaluate uveal biocompatibility, anterior chamber laser flare and cell measurements and inflammatory cell reactions were monitored. Cellular biocompatibility was investigated by examining anterior capsule opacification (ACO), posterior capsule opacification (PCO), and lens epithelial cell (LEC) ongrowth on the IOL's anterior surface. Factors such as intralenticular glistenings and IOL decentration were also evaluated. RESULTS: Anterior chamber flare and cells and the inflammatory cell reaction were significantly lower in the CeeOn 911A group. There was no statistically significant difference in ACO, PCO, and LEC ongrowth between the 2 groups. The AcrySof lenses showed significantly better centration and a higher density of intralenticular glistening. CONCLUSIONS: The findings show that a sharp-edged optic design is, to date, the most effective method of reducing the rate of PCO. Despite a subclinical foreign-body reaction in the AcrySof group, both lenses had a high degree of capsular and uveal biocompatibility.     

Course of postoperative inflammation after implantation of 4 types of foldable intraocular lenses.

PURPOSE: To compare the course of postoperative inflammation after small incision cataract surgery with implantation of 4 types of foldable intraocular lenses (IOLs). SETTING: Department of Ophthalmology, University Hospital of Vienna, Austria. METHODS: One hundred twenty eyes were prospectively randomized to receive a foldable silicone (Pharmacia 920), hydrogel (Bausch & Lomb Hydroview), methyl methacrylate/hydroxyethyl methacrylate (Mentor MemoryLens), or acrylic (Alcon AcrySof) IOL. All surgery was performed by the same experienced surgeon using a standardized surgical protocol: clear corneal incision, capsulorhexis, phacoemulsification, and in-the-bag implantation of the IOL. All patients received standardized postoperative medication and follow-up. Postoperative inflammation was evaluated by measuring aqueous flare preoperatively and 1, 3, 7, 14, 28, 90, and 180 days after surgery using the Kowa 1000 laser flare-cell meter. RESULTS: Except on the first day after surgery, when the AcrySof group had higher flare values than the other groups (P = .0265), no significant differences were found up to 6 months. Re-establishment of the blood-aqueous barrier was similar in eyes with the AcrySof, Hydroview, and MemoryLens IOLs; the course of postoperative inflammation was different in eyes with the silicone IOL. CONCLUSION: Comparison of postoperative flare values after implantation of 4 foldable IOLs showed no clinically relevant differences in the course of postoperative inflammation.     

Preventing lens epithelial cell migration using intraocular lenses with sharp rectangular edges

PURPOSE: To compare the preventive effect on posterior capsule opacification (PCO) of an acrylic intraocular lens (IOL) and a silicone IOL, both with sharp rectangular optic edges. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: After phacoemulsification, an acrylic IOL (AcrySof(R)) was implanted in 1 eye and a silicone IOL (CeeOn 911) in the contralateral eye of 7 rabbits, one of which was omitted from evaluation. RESULTS: The Miyake-Apple view and histopathological findings 3 weeks after surgery revealed that the lens capsule wrapped tightly around the optic edges, conforming to a distinctly sharp bend, with both IOL types in 5 rabbits. Migrating lens epithelial cells (LECs) were inhibited at the site. The AcrySof IOL had a better capsular bend effect in the histological sections, but there was no apparent difference in PCO development between the 2 IOLs. CONCLUSIONS: The CeeOn 911 silicone IOL, with sharp rectangular optic edges, showed an effect on preventing PCO that was similar to that of the AcrySof IOL. When a discontinuous capsular bend is created by an IOL with sharp optic edges, the bend may induce contact inhibition of migrating LECs regardless of the lens' material composition.     

Effect of intraocular lens optic edge design and material on fibrotic capsule opacification and capsulorhexis contraction

PURPOSE: To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This randomized controlled patient- and examiner-masked study comprised 210 eyes of 105 patients with bilateral age-related cataract. In Group 1 (n = 53), the Sensar OptiEdge AR40e hydrophobic acrylic IOL with a sharp posterior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex OptiEdge silicone IOL with a sharp posterior optic edge was compared with the PhacoFlex SI-40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digital slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillumination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm(2)) was determined objectively. RESULTS: One year after surgery, the mean ACO score was 32% in eyes with the sharp-edged acrylic IOL and 29% in eyes with the round-edged acrylic IOL (P<.05). In the silicone group, the mean was 31% and 26%, respectively (P<.05). The mean fibrotic PCO score was lower in eyes with a sharp-edged acrylic IOL than in eyes with a round-edged acrylic IOL (0.26 and 0.93, respectively; P<.05) and in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (0.24 and 0.82, respectively; P<.001). At 1 year, the mean capsulorhexis area was statistically significantly smaller in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (P<.05). CONCLUSIONS: Acrylic and silicone IOLs with the sharp OptiEdge design led to significantly less fibrotic PCO but more ACO than round-edged acrylic and silicone IOLs. The sharp-edged silicone IOL caused significantly more capsulorhexis contraction than the round-edged silicone IOL and both acrylic IOLs.     

Adhesion of soluble fibronectin,vitronectin, and collagen type IV to intraocular lens materials

PURPOSE: To evaluate soluble fibronectin, vitronectin, and collagen type IV adhesion to poly(methyl methacrylate) (PMMA), fluorine-surface-modified PMMA, silicone, hydrophobic and hydrophilic acrylate, and hydrogel intraocular lenses (IOLs) and determine whether hydrophobic and hydrophilic acrylate materials have different fibronectin-adhesion properties. SETTING: Department of Medical Biochemistry, University of Oulu, Oulu, Finland. METHODS: One hundred fifty IOLs were incubated for 1 week at 37 degrees C with radioactive-iodine-labeled soluble fibronectin, vitronectin, or collagen type IV. Fifty IOLs were analyzed for each protein, 5 from each of 10 different IOL models (PMMA, Alcon MC60BM; fluorine-surface-modified PMMA, Chiron Fluorilens Centra-55F; silicone, Allergan Medical Optics SI-40NB and Pharmacia and Upjohn CeeOn 911A; hydrophobic soft acrylate, Alcon AcrySof MA60BM and SA30AL and AMO Sensar; hydrophilic soft acrylate, Ioltech Stabibag and Bausch and Lomb BL27; and hydrogel, Bausch and Lomb Hydroview. The amount of adherent protein was measured with a gamma counter at 1 and 7 days and expressed as counts per minute. RESULTS: At 1 week, significantly more fibronectin was bound to the hydrophobic acrylate IOLs than to the 2-hydroxyethyl methacrylate (HEMA) containing hydrophilic acrylate IOLs (P <.05 to.0001). Significantly more vitronectin was bound to the 2 silicone IOLs than to any other IOL (P <.01 to.0001) at 7 days. Collagen type IV adhered best to the hydrophilic acrylate IOLs, which were significantly different (P <.01 to.0001) than the other IOLs at 1 and 7 days. CONCLUSIONS: Each IOL material had a different affinity to each protein. Significant binding to 1 protein does not indicate that the IOL will bind significantly to all proteins; instead, each protein should be studied separately. Fibronectin bound significantly better to hydrophobic acrylate IOLs than to hydrophilic acrylate IOLs, suggesting that the HEMA-containing IOLs should be classified with the hydrogel IOL group.     

后发性白内障相关因素的临床研究

目的观察超声乳化白内障吸除联合折叠人工晶状体植入术后后发性白内障(posteriorcapsuleopacification,PCO)发生的相关因素及其特点。方法随访观察394例(440只眼)白内障患者超声乳化白内障吸除联合囊袋内折叠人工晶状体植入术后的视力,用内置数码摄像头Zeiss120裂隙灯进行眼底后反光裂隙照相,转化成数码图像输入计算机,观察人工晶状体位置、连续环形撕囊和后囊膜混浊等情况。随访时间2～58个月,平均14个月。按照晶状体类型共分为6组Sensar组113例(123只眼),Acrysof三片组129例(157只眼),Acrysof一片组79例(84只眼),SC60B组23例(26只眼),硅凝胶组50例(50只眼)。获得的照片使用德国EPCO2000软件分析,对PCO程度进行评分并将各组进行比较分析。结果完全没有PCO的有19只眼(占4.32%),存在PCO的有421只眼(占95.68%),PCO波及瞳孔中央3mm的有274只眼(占62.27%)。按人工晶状体光学面材料分组的两组中,对应PCO数值进行比较,总分差异无显著性(t=1.470,P=0.143);按照襻的成角分组的四组中,所对应的PCO数值中1级混浊的数值比较,差异有显著性(F=4.054,P=0.007);按边缘设计不同分组的两组中,对应PCO数值比较,总分差异有显著性(t=3.763,P=0.0001);根据连续环形撕囊分组的3组中,所对应的PCO数值比较,总分差异有显著性(F=3.689,P=0.026)。结论后囊膜混浊的发生与人工晶状体材料无相关性;襻与光学面成角为10°的人工晶状体对PCO的早期形成有抑制作用;直角边缘设计可以减少PCO的形成;连续环形撕囊口完全覆盖人工晶状体光学面抑制了后囊膜混浊的发生几率。     

Histology of anterior capsule opacification with a polyHEMA/HOHEXMA hydrophilic hydrogel intraocular lens compared to poly(methyl methacrylate), silicone,and acrylic lenses

To evaluate the biocompatibility of various materials including a poly(2-hydroxyethyl methacrylate [HEMA])/(6-hydroxyhexyl methacrylate [HOHEXMA]) hydrophilic hydrogel intraocular lens (IOL) (Hydroview, Bausch & Lomb).Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan.Ten opacified anterior capsules were extracted, including 3 specimens with the Hydroview IOL. They were processed for light and electron microscopy. Immunohistochemistry for alpha-smooth muscle actin (alpha SMA) and collagen types was also done to evaluate mesenchymal transition in lens epithelial cells (LECs).Anterior capsule opacification (ACO) in the 3 specimens with a polyHEMA/HOHEXMA hydrogel IOL contained more LECs and less extracellular matrix (ECM) than in the specimens with IOLs of other materials. Ultrastructural observation showed a well-organized collagenous ECM in tissues with an IOL of poly(methyl methacrylate), silicone, or soft acrylic material; an immature matrix was seen in specimens with a hydrogel IOL. The alpha SMA-positive LECs and collagen I and III, both types related to capsular wound healing, were detected in ACO.A polyHEMA/HOHEXMA hydrogel IOL facilitated the proliferation of LECs on the anterior capsule compared with other IOLs of other materials but did not completely suppress mesenchymal transition of LECs. Extracellular matrix accumulation appeared immature and less with a polyHEMA/HOHEXMA hydrogel IOL.     

Posterior capsule opacification and Nd:YAG capsulotomy rates after implantation of silicone,hydrogel and soft acrylic intraocular lenses: a two-year follow-up study

PURPOSE: To compare the posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) laser posterior capsulotomy rates associated with three different posterior chamber foldable intraocular lenses (IOL). METHODS: We retrospectively evaluated the rates of PCO and Nd:YAG laser capsulotomy in 1150 eyes two years after standard phacoemulsification with a no-stitch 3.5mm clear corneal incision (CCI) and in-the-bag implantation of one of three types of IOL: 190 eyes received a one-piece round-edged hydrogel IOL (Hydroview H60M, Bausch & Lomb); 475 eyes a three-piece round-edged silicone IOL (AMO PhacoFlex SI-40NB, Allergan); 485 eyes a three-piece square-edged soft acrylic lens (AcrySof MA60MA, Alcon). RESULTS: The PCO and Nd:YAG laser capsulotomy rates were respectively 43.15% and 20.5% in the Hydroview H60M group, 27.57% and 9.68% in the AMO PhacoFlex SI-40NB group, 10.5% and 2.47% in the AcrySof MA60MA group. CONCLUSIONS: PCO and Nd:YAG laser capsulotomy rates were significantly higher in the Hydroview H60M group and significantly lower with the AcrySof MA60MA lenses, which combine a bioactive constitutive material with the square-edged optic design.