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Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients.

Four patients with diabetes mellitus had cataract extraction with implantation of a hydrophilic acrylic intraocular lens (IOL) (ACRL-C160, Ophthalmed). The IOLs showed progressive and generalized opacification 10 to 20 months after implantation, decreasing visual acuity. All 4 IOLs were removed. By light microscopic examination, the IOL surfaces were wrinkled and encrusted with microspheres. Electron microscopy revealed the material to be crystalline in nature. Energy dispersive x-ray spectrum analysis showed that the deposits were mainly composed of calcium and phosphate.

Acrylic Resins↗

Interlenticular opacification of piggyback acrylic intraocular lenses.

A dense interlenticular opacification developed 18 months after cataract surgery in a hyperopic patient with 2 acrylic piggyback intraocular lenses (IOLs) placed in the capsular bag. The patient developed a hyperopic shift with decreased vision, requiring explantation of the lenses. The dense interlenticular opacification did not allow separation of the lenses intraoperatively because of the tight adherence of the 2 IOLs.

Acrylic Resins↗

Opacification of a hydrophilic acrylic intraocular lens with exacerbation of Behçet's uveitis.

Behçet's disease is 1 of the most common causes of uveitis in the Eastern world. Its common ocular complications are uveitis, cataract, and obliteration of retinal vessels. Phacoemulsification with intraocular lens (IOL) implantation in patients with Behçet's disease is known to be a safe procedure. We managed a patient with Behçet's disease who had aggravated uveitis and opacification of a hydrophilic acrylic IOL (ACRL-C160, Ophthalmed) 4 months after cataract surgery. Recalcitrant uveitis despite maximum tolerable medication and IOL opacification with vitreous opacity necessitated an IOL exchange and trans pars plana vitrectomy. After the procedure, the eye became quiescent. However, the visual acuity was 20/200 because of the obliteration of retinal vessels.

Acrylic Resins↗

Comparison of AcrySof MA30BA and Sensar AR40 acrylic intraocular lenses.

PURPOSE: To compare differences in anterior (ACO) and posterior (PCO) capsule opacification and subjective glare between 2 acrylic intraocular lenses (IOLs): AcrySof MA30BA (Alcon) and Sensar AR40 (Allergan). SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: This retrospective study comprised 100 cataract patients who had phacoemulsification and IOL implantation. Fifty eyes of 50 patients received an MA30BA and 50 eyes of 50 patients, an AR40. The mean postoperative follow-up was 25 months (range 20 to 31 months) and 22 months (range 19 to 29 months), respectively. Examiners subjectively evaluated ACO, and a photographic image-analysis system was used to assess PCO. All patients received a questionnaire to evaluate the incidence of subjective photic phenomena. RESULTS: In the MA30BA group, 60% had no ACO, 19% had mild ACO, and 21% had anterior capsule fibrosis. In the AR40 group, 55% had no ACO, 27% had mild ACO, and 18% had anterior capsule fibrosis. In the MA30BA group, the mean PCO score measured by image-analysis was 0.043 (range 0.000 to 0.084) at 1 year and 0.125 (range 0.000 to 0.197) at 2 years and in the AR40 group, 0.071 (range 0.000 to 0.157) and 0.230 (range 0.091 to 0.628), respectively. Although the ACO percentages and the PCO scores at 1 year were not statistically different between the 2 groups (P >.05), the MA30BA group had statistically less PCO at 2 years (P <.05). In the MA30BA group, 36 patients had trouble reading in a dim environment, 25 had difficulty driving at night, 25 were mildly bothered by the lights of other vehicles, and 17 saw halos when looking at the lights of other vehicles and 17, when looking at lights at night. In the AR40 group, 7 patients had trouble reading in a dim environment and 11 had difficulty driving at night. At 6 months, the AR40 group had a statistically significantly lower incidence of photic phenomena than the MA30BA group (P <.05). In the MA30BA group 1 year after surgery, 13 patients had trouble reading in a dim environment and 12 had difficulty driving at night. In the AR40 group, 5 patients had trouble reading in a dim environment and 8 had difficulty driving at night. One year after surgery, the difference between the 2 groups in photic phenomena was not statistically significant (P >.05). CONCLUSIONS: The findings indicate that the AcrySof MA30BA has a lower incidence of PCO than the Sensar AR40. The AR40 IOL induced less glare; however, the glare phenomena did not disturb those with an MA30BA lens and the symptoms decreased by 1 year after surgery. These results suggest that both optic design and haptic material influence postoperative clinical results.

Acrylic Resins↗

Single-action implantation of a 3-piece acrylic intraocular lens with an injector.

We report a method to insert a 3-piece AcrySof MA30BA acrylic foldable intraocular lens (IOL) (Alcon) in a single action using a Monarch II (Alcon) injector. The technique was used in 134 eyes. The incision widths ranged from 3.00 to 3.75 mm. The IOLs were successfully inserted in the capsular bag. Complications included cracks in the IOL optic in 3 eyes (3%), haptic damage in 3 eyes (3%), and inadequate self-sealing of the incision in 18 eyes (13%).

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Nitric oxide levels in aqueous humor after lens extraction and poly(methyl methacrylate) and foldable acrylic intraocular lens implantation in rabbit eyes.

PURPOSE: To measure the nitric oxide (NO) level in the aqueous humor of rabbit eyes after common cataract surgery techniques. SETTING: Department of Ophthalmology, Military Medical University, and Department of Immunology and Immunotoxicology of Respiratory System, Clinic of Pneumonology and Allergology, Medical University of Łódź, Łódź, Poland. METHODS: Thirty rabbits were randomly divided into 4 groups, and surgery was performed as follows: Group 1, extracapsular cataract extraction (ECCE) and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation; Group 2, ECCE; Group 3, phacoemulsification and foldable acrylic IOL implantation; Group 4, phacoemulsification. The aqueous humor specimens were collected on days 1, 3, and 5. Nitric oxide measurements were performed indirectly with a spectrophotometer. The NO level in the aqueous humor collected before surgery served as a control group. RESULTS: In the physiological condition, the concentration of NO was 26.52 nm/dL +/- 4.86 (SD). Postoperatively, the highest NO level in each groups was as follows: Group 1, 46.26 +/- 5.23 nm/dL on day 3; Group 2, 72.46 +/- 6.94 nm/dL on day 1; Group 3, 41.04 +/- 7.31 nm/dL on day 1; and Group 4, 32.67 +/- 2.84 nm/dL on day 3. Significantly higher levels of NO (P <.05) were observed in Groups 1 and 2 at each follow-up day; in Group 3, on days 1 and 3; and in Group 4, on day 3. CONCLUSIONS: Techniques of cataract extraction caused the NO level to increase; however, phacoemulsification with a foldable IOL caused the smallest release of NO. Rapid postoperative NO changes may theoretically contribute to blood-aqueous barrier breakdown secondary to cataract surgery.

Acrylic Resins↗

In-the-bag dislocation of a hydrophilic acrylic intraocular lens.

We report a case of a dislocated hydrophilic acrylic intraocular lens (IOL) inducing astigmatism and causing chronic pain and cystoid macular edema as a result of a folded haptics, which mechanically irritated the iris. Scanning electron micrographs of the explanted IOL, including the capsular bag, showed a folded IOL haptic incarcerated in the capsular bag.

Acrylic Resins↗

Posterior capsule opacification and neodymium: YAG capsulotomy rates with AcrySof acrylic and PhacoFlex II silicone intraocular lenses.

PURPOSE: To compare the incidence and severity of posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between AcrySof(R) MA30BA acrylic (Alcon) and PhacoFlex(R) II SI-40NB silicone (AMO) intraocular lenses (IOLs). SETTING: Outpatient Cataract Surgery Center, TLC Eyecare and Laser Center, Jackson, Michigan, USA. METHODS: AcrySof and PhacoFlex II IOLs were implanted in fellow eyes of 156 patients requiring bilateral cataract extraction. The patients were followed for a mean of approximately 3 years for the incidence and severity of PCO and the Nd:YAG capsulotomy rates. RESULTS: Of the 63 eyes that were free of PCO throughout the study, 42 had the AcrySof IOL and 21 had the PhacoFlex II IOL. Of eyes that developed PCO, the mean severity in the AcrySof group was 16% less than that in the PhacoFlex II group. Of the 50 eyes that had an Nd:YAG capsulotomy, 17 were in the AcrySof group and 33 were in the PhacoFlex II group. All differences between groups were statistically significant (P<.05). CONCLUSION: The AcrySof MA30BA IOL was associated with less PCO proliferation and thus fewer Nd:YAG laser posterior capsulotomies than the PhacoFlex II SI-40NB IOL.

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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.

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Posterior capsule opacification after phacoemulsification: silicone CeeOn Edge versus acrylate AcrySof intraocular lens.

PURPOSE: To compare the rates and morphologic features of posterior capsule opacification (PCO) after small-incision phacoemulsification and in-the-bag implantation of 2 foldable intraocular lenses (IOLs) over an 18-month follow-up. SETTING: Departments of Ophthalmology, Hospital of Conegliano, Conegliano, and Maggiore Hospital of Bologna, Bologna, Italy. METHODS: In an open clinical study, 78 cataract patients were randomly selected to have implantation of a silicone CeeOn Edge (Pharmacia) or acrylate AcrySof (Alcon) IOL after phacoemulsification cataract surgery. All the patients were operated on using a standard technique and in-the-bag IOL implantation. One eye in each patient was studied. Morphologic evaluation of PCO was performed using Evaluation of Posterior Capsule Opacification software. RESULTS: At 18 months in the CeeOn Edge group, 36 eyes (90%) had a clear posterior capsule and 4 (10%) had PCO that did not affect visual acuity. In the AcrySof group, 26 eyes (68%) had a clear posterior capsule, 11 (29%) had PCO that did not affect visual acuity, and 1 (3%) had PCO with a decrease of 2 or more lines of visual acuity that required a neodymium:YAG laser capsulotomy. No eye developed Elschnig pearls or stretched folds in the bag. The postoperative best corrected visual acuity ranged from 0.8 to 1.0 in 96% in the CeeOn Edge group and in 92% in the AcrySof group. No IOL haze or discoloration was observed in the CeeOn Edge group. Mild IOL decentration and tilting occurred in 4 AcrySof eyes; however, no glistenings were found any AcrySof IOL. CONCLUSIONS: Both the CeeOn Edge and AcrySof groups had a low incidence of PCO after an 18-month follow-up. The CeeOn Edge group had significantly less PCO than the AcrySof group. These results confirm that IOLs with square truncated edges create a barrier effect at the optic edge, reducing the overall incidence of PCO.

Acrylic Resins↗

Implantation of a single-piece, hydrophilic, acrylic, minus-power foldable posterior chamber intraocular lens in a rabbit model: clinicopathologic study of posterior capsule opacification.

PURPOSE: To compare the extent of posterior capsule opacification (PCO) after implantation of a standard-power biconvex Centerflex intraocular lens (IOL) and a newly introduced biconcave high-minus-power Centerflex design in rabbit eyes. SETTING: The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, and the David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. METHODS: Twelve rabbits had phacoemulsification and implantation of 2 foldable single-piece hydrophilic acrylic Centerflex posterior chamber IOLs. The right eyes received a standard-power (+21.00 diopters [D]) biconvex-optic lens and the left eyes, a minus-power (-7.00 D) biconcave-optic IOL. Formation of PCO was evaluated 3 weeks after surgery using the Miyake-Apple posterior photography technique. Histological sections from each globe were prepared to analyze capsular bag status and assess postsurgical intracapsular lens epithelial cell (LEC) proliferation, especially ingrowth of LECs across the visual axis. The data were analyzed using the Kruskal-Wallis 1-way analysis of variance for nonparametric measurements and the Mann-Whitney rank sum test. RESULTS: There was no significant difference in Soemmering's ring formation between the 2 IOL models. The biconcave minus-power IOL showed significantly lower central and peripheral PCO scores than the biconvex standard-power lens (P<.05). Pathological evaluations revealed that the effective site of blockage of LECs was at the truncated optic edge of both lenses, even in the presence of retained and/or regenerative cortical material. CONCLUSIONS: This study confirms the efficacy of a truncated IOL optic in helping reduce the incidence of PCO. Both IOL designs have optic geometries that create clear-cut barrier effects. However, the biconcave minus-power IOL, which has a thicker, square, truncated optic edge with a ridge that encircles the periphery of the optic for 360 degrees, appears to have an enhanced barrier effect, especially at the optic-haptic junction. This further minimizes the ingrowth of migrating LECs toward the visual axis.

Acrylic Resins↗

Implantation of AcrySof acrylic intraocular lenses.

A surgical technique is described to facilitate safe implantation of acrylic posterior chamber intraocular lenses through the smallest incisions allowed by currently available implantation technology. The technique includes warming the lens before insertion, protecting the optic with viscoelastic before grasping it with insertion forceps, and using a Sinskey hook through the side port during lens rotation and unfolding.

Acrylates↗

Capsular bag distension with an acrylic intraocular lens.

PURPOSE: To describe the postoperative capsular bag distension that occurs with in-the-bag implantation of the soft acrylic (AcrySof) intraocular lens (IOL). SETTING: Jules Stein Eye Institute, University of California, Los Angeles. METHODS: Nine eyes in nine patients had uncomplicated continuous curvilinear capsulorhexis, phacoemulsification, and in-the-bag implantation of the AcrySof lens. Comprehensive ophthalmic examinations were performed 1 day and 1 and 6 weeks postoperatively. Patients had neodymium:YAG laser posterior capsulotomy; refractions were done before and after the capsulotomy. RESULTS: Comprehensive ophthalmic examination revealed variable degrees of anterior chamber shallowing, anterior displacement of the IOL within the bag, and distension of the posterior capsule away from the IOL. Unexpected postoperative myopic correction was seen in all patients. Postcapsulotomy mean spherical equivalent refractive shift was +3.6 diopters (D) with a shift of at least +4.0 D in four of nine eyes. CONCLUSIONS: Capsular bag distension is a previously described postoperative complication that we observed in association with the AcrySof IOL.

Acrylates↗

Bisecting a foldable acrylic intraocular lens for explantation.

We describe a method of explanting an implanted foldable acrylic intraocular lens (IOL) through a small incision at the time of primary implantation without enlarging the original small incision. This method of bisecting foldable IOLs in the anterior chamber is safe and preserves the advantages of the original small incision.

Acrylates↗

Contact zone of piggyback acrylic intraocular lenses.

In a hyperopic cataract patient, surgery was performed with implantation of 2 foldable, acrylic, posterior chamber intraocular lenses (IOLs) in the bag. The IOLs showed a central contact zone during surgery. This contact zone remained after surgery and was documented 2 months postoperatively. The contact zone may induce multifocality similar to that seen with multifocal IOLs.

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Mucoadhesive and cohesive properties of poly(acrylic acid)-cysteine conjugates with regard to their molecular mass.

The objective of this study was to evaluate the influence of the molecular mass and accordingly the polymer chain length on mucoadhesion and cohesion of thiolated polymers. Linear poly(acrylic acid)-cysteine (PAA-Cys) conjugates of 2-, 45-, 250- and 450 kDa (PAA(2)-Cys, PAA(45)-Cys, PAA(250)-Cys and PAA(450)-Cys) and polycarbophil-cysteine (PCP-Cys, 750-3000 kDa), all displaying on average 404.1+/-65.5 microMol thiol groups per gram polymer were compressed into tablets to perform disintegration tests, mucoadhesion studies and viscosity measurements. Moreover, the influence of free unbound cysteine on mucoadhesion was evaluated. Disintegration tests showed a stability of the tablets as following: PAA(2)-Cys<PAA(45)-Cys<PAA(250)-Cys<PAA(450)-Cys=PCP-Cys. According to tensile studies and tests on the rotating cylinder the following rank order in mucoadhesive properties could be established: PAA(2)-Cys<PAA(45)-Cys<PCP-Cys<PAA(250)-Cys<PAA(450)-Cys. Evidence for the formation of disulphide bonds between thiolated polymers and mucin could be provided by the addition of free cysteine resulting in strongly decreased mucoadhesion and by viscosity studies showing comparatively higher viscosity of conjugate/mucin mixtures than of unthiolated polymer/mucin mixtures. The results of the present study contribute to the development of new polymers displaying further improved mucoadhesive properties.

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Adsorption of drugs onto a poly(acrylic acid) grafted cation-exchange membrane.

The influence of pH, ionic strength and the concentration of albumin in the adsorption medium as well as the charge and lipophilicity of a model drug on their adsorption onto poly(acrylic acid) grafted poly(vinylidene fluoride) (PAA-PVDF) membranes was evaluated. The PAA-PVDF membrane is a responsive porous polymer membrane that we have studied for controlled drug delivery. Sodium salicylate (anionic), flunitrazepam (neutral), primidone (neutral), desipramine (cationic) and thioridazine (cationic) were used as model drugs. The extent of drug adsorption was dependent on pH. Drug adsorption was enhanced by the dissociation of the grafted PAA chains and by a positive charge and a high lipophilicity of the drug. Increasing the ionic strength of the medium retarded the adsorption of the cationic drugs. Interestingly, the present results showing that drugs are adsorbed onto the membrane while albumin is not adsorbed onto the membrane suggest that the PAA-PVDF membrane may be suitable for separating drugs from proteinaceous substances for subsequent monitoring and evaluation.

Acrylates↗