Lorenz Vock

Posterior capsule opacification and neodymium:YAG laser capsulotomy rates with a round-edged silicone and a sharp-edged hydrophobic acrylic intraocular lens 10 years after surgery.

PURPOSE: To compare posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) laser capsulotomy rates 10 years after surgery between two 3‐piece intraocular lenses (IOLs): a silicone IOL with round optic edges and a hydrophobic acrylic IOL with sharp optic edges. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. METHODS: Patients having had cataract surgery and implantation of at least 1 study IOL by the same surgeon between 1994 and 1999 were retrospectively examined. The number of Nd:YAG laser capsulotomies performed was noted. The PCO intensity was assessed using digital retroilluminated photographs and Automated Quantification of After‐Cataract (AQUA) software. The AQUA scores in eyes with Nd:YAG capsulotomy were estimated with a multiple‐imputation procedure. Anterior capsule opacification (ACO) and fibrotic PCO were graded subjectively at the slitlamp. RESULTS: The study evaluated 143 eyes (98 patients). Eight (18%) of 44 eyes with a silicone IOL and 41 (42%) of 99 eyes with an acrylic IOL had Nd:YAG capsulotomy after 10 years (P = .007). The AQUA scores were lower with the silicone IOLs. The median difference in AQUA scores was significantly different after missing values of the Nd:YAG capsulotomies were imputed. There was no difference in ACO. There was more fibrotic PCO with round‐edged silicone IOLs than with sharp‐edged acrylic IOLs. CONCLUSIONS: Ten years after surgery, acrylic IOLs seemed to lose their PCO preventive effect, despite their sharp optic edges. The increasingly longer life expectancy and earlier cataract surgery mandate reconsideration of preferences regarding optic materials and design elements of IOLs.

Rotational stability and posterior capsule opacification of a plate-haptic and an open-loop-haptic intraocular lens

PURPOSE: To compare the rotational stability and posterior capsule opacification (PCO) rate in eyes with a 1‐piece or 3‐piece acrylic intraocular lens (IOL). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Prospective randomized masked clinical trial. METHODS: Patients with age‐related cataract received a plate‐haptic acrylic IOL (Acri.Smart 46S) in 1 eye and a 3‐piece loop‐haptic acrylic IOL (Acri.Lyc 53N) in the other eye. Retroillumination images were taken 1 hour, 1 week, and 1, 6, and 12 months postoperatively. Intraocular lens rotation was measured using standard software (Adobe Photoshop). The amount of PCO was assessed subjectively at the slitlamp and objectively using an automated image‐analysis software (AQUA). RESULTS: The study enrolled 80 eyes of 40 patients. The IOL rotation measurements showed excellent reproducibility, with a deviation of less than 0.8 degrees. Both IOLs had comparable and good rotational stability; rotation was less than 4 degrees in 71% of eyes 1 year postoperatively. The mean absolute rotation was 2.6 degrees ± 1.9 (SD) in the plate‐haptic IOL group and 3.1 ± 2.4 degrees in the loop‐haptic IOL group. The mean AQUA PCO score (scale 0 to 10) was 0.4 in both IOL groups (P=.7). CONCLUSION: The 2 IOL models had comparable, excellent rotational stability and low PCO intensity 1 year postoperatively. Thus, the plate‐haptic IOL may be a good platform for a toric model. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Effect of the hydrophilicity of acrylic intraocular lens material and haptic angulation on anterior capsule opacification

Aim: To evaluate the influence of hydrophilic and hydrophobic acrylic material and haptic angulation on anterior capsule opacification (ACO). Methods: Prospective study on 53 patients with bilateral age-related cataract. Patients underwent standard cataract surgery by the same surgeon and randomly received a hydrophilic acrylic intraocular lens (IOL) in one eye and a hydrophobic acrylic IOL in the other eye. Forty five of these patients completed the one-year follow-up. The following parameters were assessed: decentration, buttonholing, anterolenticular gap (ALG), ACO, outgrowth and refractive outcome. Results: At the one-year follow-up, ACO was seen in 80% of the hydrophilic and 100% of the hydrophobic IOLs. ACO was more intense in the hydrophobic IOLs (p<0.001). Outgrowth was seen in 42% of the hydrophilic and 2% of the hydrophobic IOLs (p = 0.0003). No case of persisting ALG was seen in the hydrophobic IOLs, but in 42% of the hydrophilic IOLs. The refractive outcome was −0.29 (SD 0.56) dioptres for the hydrophilic and 0.003 (SD 0.44) dioptres for the hydrophobic IOLs (p<0.001). Conclusion: These results suggest that there is less ACO in hydrophilic acrylic than in hydrophobic acrylic IOLs. Although material properties might play a role, the angulated haptics of the hydrophilic IOLs exert an additional effect by the persisting ALG and a lack of contact between the IOL and the anterior capsule.

Effect of primary posterior continuous curvilinear capsulorhexis with and without posterior optic buttonholing on postoperative anterior chamber flare

PURPOSE: To evaluate the effect of primary posterior continuous curvilinear capsulorhexis (PCCC) with and without posterior optic buttonholing (POBH) on the anterior chamber reaction after small‐incision cataract surgery. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Consecutive patients with age‐related cataract having cataract surgery in both eyes under topical anesthesia were prospectively enrolled in a randomized clinical trial. In randomized order, cataract surgery with combined primary PCCC and POBH was performed in 1 eye; in the other eye, cataract surgery was performed with primary PCCC and in‐the‐bag implantation of an intraocular lens. Intraocular flare was measured with an FC‐1000 laser flare–cell meter preoperatively and postoperatively at 1, 4 to 6, and 24 hours, 1 week, and 1 month. RESULTS: Thirty patients (60 eyes) were evaluated. The peak of intraocular flare was 1 hour postoperatively in all study eyes. In both groups, the response steadily decreased thereafter. Anterior chamber flare was statistically significantly higher in eyes with primary PCCC without POBH than in eyes with combined primary PCCC–POBH at all postoperative testing points (P<.001), including at 1 month (P = .01). CONCLUSIONS: Cataract surgery with combined primary PCCC–POBH led to significantly lower postoperative anterior chamber reaction than conventional in‐the‐bag implantation during a 4‐week follow‐up. The tight capsule–optic diaphragm effectively prevented the ophthalmic viscosurgical device captured behind the optic from entering the anterior chamber postoperatively.

Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults

Aim: Combining primary posterior capsulorhexis (PPC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPC and POBH to conventional in-the-bag implantation of the IOL. Methods: Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively into a prospective, randomised clinical trial. In randomised order, cataract surgery with combined PPC and POBH was performed in one eye; in the other eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12 and 24 h postoperatively, as well as 1 week and 1 month postoperatively, using a KOWA FC-1000 laser flare cell meter. Results: The peak of intraocular flare was observed in POBH eyes and eyes with in-the-bag IOL implantation 1 h postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, small though statistically significant higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). At 1 week and 1 month postoperatively, intraocular flare measurements were comparable again (p>0.05). Conclusion: Cataract surgery with combined PPC/POBH showed slightly lower postoperative anterior chamber reaction compared to conventional in-the-bag implantation during 4-week follow-up, indicating that POBH might trigger somewhat less inflammatory response. This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.

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 2½‐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.

Influence of a variable overall diameter hydrophilic acrylic sharp-edged single-piece intra-ocular lens on capsule opacification one year after surgery.

ABSTRACT Background: To investigate the influence of the overall intraocular lens (IOL) diameter on posterior capsule opacification (PCO) formation. Methods: In this prospective randomized clinical trial, 124 eyes of 62 patients with bilateral age-related cataract were included. Each patient received a Corneal A501D IOL in one eye and a Corneal J501D IOL in the fellow eye. Best corrected visual acuity (BCVA) and digital slitlamp photographs were taken a 1 h, 1 week, 1, 3, 6 and 12 months postoperatively. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software. Results: We found a mean BCVA of 0.81 ± 0.2 for the Corneal A501D group and 0.79 ± 0.21 for the Corneal J501D group. There was no significant difference 12 months after surgery between the two IOLs (p > 0.05). Objective PCO assessment resulted in a mean PCO score (scale 0–10) of 1.65 ± 1.71 was found for the Corneal J501D group and a score of 1.54 ± 1.64 was found for the Corneal A501D group (p > 0.05). The subjective PCO assessment at 1 year resulted in a mean PCO score of 2.0 ± 1.74 in the Corneal J501D group and 2.13 ± 1.64 in the Corneal A501D group (p > 0.05). Conclusion: Both investigated IOLs showed good clinical performance regarding PCO and BCVA. Our study suggests that the use of an IOL with variable total diameter seems not to influence the rate of PCO formation.