SPS-308 IOL Design & Characteristics II | ASCRS
2020 ASCRS Virtual Annual Meeting

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Papers in this Session
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Surface Deposits Mimicking Calcification on a Hydrophobic Acrylic Intraocular Lens
Authors
Liliana Werner, MD, PhD
John K. Wallace, MD
Vaishnavi Balendiran, MD
Caleb L. Shumway, MD
Nathan C. Ellis, MD
Nick Mamalis, MD

Methods
The 3-piece hydrophobic acrylic lens was explanted from OS and rinsed with distilled water. The IOL was then allowed to dry at room temperature for 72 hours, and further analyzed under environmental scanning electron microscopy (ESEM) and energy-dispersive X-ray spectroscopy (EDS) to analyze the elemental composition of any surface deposits on anterior and posterior surfaces. After that, it was stained for visualization of proteins attached to its surfaces (Coomassie blue dye).

Results
Examination of the lens under the light microscope showed the presence of multiple deposits irregular in shape and size covering significant areas of anterior and posterior IOL optic surfaces. ESEM confirmed the presence of multiple irregular deposits on both surfaces. EDS analyses performed on multiple spots of both surfaces did not detect the presence of any calcium (Ca) or phosphorus (P) peaks, ruling out the presence of calcification. The deposits on anterior and posterior optic surfaces stained positive in blue.

Conclusion
To the best of our knowledge, there is to date no case of calcification of hydrophobic acrylic lenses, proven through laboratorial analyses of the explanted lens demonstrating the presence of Ca/P. However, surgeons must be aware that postoperative findings, such as the morphological aspects of the case describe here, may mimic calcification.
Clinical Evaluation of Surface Modified Intraocular Lenses for 9 Years
Authors
Mayumi Nagata, MD, PhD
Hiroyuki Matsushima, MD, PhD
Tadashi Senoo, MD, PhD

Methods
Subjects comprised 30 patients, 60 eyes that underwent phacoemulsification. The mean age of patients is 70.8±8.6. Surface modified hydrophobic acrylic IOL (SP2, HOYA) or multiple pieces IOL (FY-60AD, HOYA) were randomly implanted. Images were taken using an EAS-1000 (NIDEK) after 1, 2, 3, 4 and 5 year postoperatively, to analyze the light scattering and posterior sub-capsular opacification (PCO). The images were photographed from 2 directions (0 and 90 degree) and the densities on surface (sub-surface nano glistening), center (glistening) and PCO of IOLs were measured and compared. The probability of survival ratio about YAG laser capsulotomy were also measured at 9 years.

Results
The densities on surface of SP2 and FY-60AD were 2.1 CCT and 5.5 CCT after 5 years. The center was 1.4 CCT and 2.2 CCT. The posterior was 6.5 CCT and 11.4 CCT respectively. There were statistically significances. The survival rates of YAG laser capsulotomy were 74.8% in SP2 and 13.7% in FY-60AD 9 years postoperatively.

Conclusion
Surface modified hydrophobic acrylic IOL (SP2) is prevented PCO for more than 9 years. And the material is also stable during the same periods.
Experimental Safety Evaluation of Intraocular Lenses Using Rabbit Cataract Model
Authors
Hiroyuki Matsushima, MD, PhD
Mayumi Nagata, MD, PhD
Tadashi Senoo, MD, PhD

Methods
Eyes of 8 weeks albino rabbits had phacoemulsification after that, 5 types of hydrophobic acrylic IOLs (SN60WF before changing production process by Alcon (Q code), SN60WF after changing (A code), ZCB00 Johnson and Johnson, YP2.2 Kowa, XY1 HOYA) were implanted. After 6 months post operation, the IOLs were extracted and cleaned to remove attachment proteins. The IOLs were placed in our model eye maintaining a constant temperature. The surface and inner light scatterings of the IOLs were imaged and analyzed with an anterior segment analyzer (EAS-1000, NIDEK). The intensity of light scattering was quantified in a selected area of surface or inner of IOL using densitometry.

Results
The ZCB00V, YP2.2 and XY1 developed a few glistening but no SSNG. However; the Q code developed glistening and mild SSNGs. The A code developed same levels of glistening but SSNGs were decreased.

Conclusion
The long periods implantation in rabbits are useful experiment to evaluate glistening and SSNG in hydrophobic acrylic IOLs. The resent IOLs are designed to prevent water phase separations.
ASCRS/ESCRS Survey on Foldable IOLs Requiring Explantation or Secondary Intervention: 2019 Update
Authors
Nick Mamalis, MD
Sneha Bontu, MD
Sean J. Kennedy, MD

Methods
The survey was available to ASCRS/ESCRS members throughout 2019. Surgeons filled out one form for each explanted foldable IOL. Preoperative data was collected, as well as type of IOL requiring explantation. The patients’ signs and symptoms as well as complications requiring explantation were tabulated. Lastly, postoperative results were assessed.

Results
Complications varied depending on the type of foldable IOL. Dislocation/decentration was the most common complication associated with the one-piece silicone IOLs. Similarly, dislocation/decentration was seen as the most common reason for removal of three-piece silicone and one-piece acrylic lenses. Incorrect lens power as well as glare/optical aberrations were also noted in explantation of IOLs. The number of explanted multifocal IOLs increased over the past year. The most common reason for explantation of these lenses was glare/optical aberrations. Hydrophilic acrylic IOLs were removed most commonly due to calcification/opacification.

Conclusion
The most common complications involving foldable IOLs have changed little over the past five years and may continue to be avoided by excellent surgical technique, quality manufacturing, careful IOL folding and insertion, and accurate IOL measurements. Multifocal IOLs are being explanted more frequently secondary to glare/optical aberrations.
Experimental Model for the Simulation of the Calcification of Hydrophilic Intraocular Lenses in Contact with Air or Gas.
Authors
Panos S. Gartaganis, MD
Panagiota D. Natsi
Sotiria F. Alimisi, MD, PhD
Sotirios P. Gartaganis, MD, PhD
Petros G. Koutsoukos, PhD

Methods
An artificial eye anterior chamber reactor (ACEACR) was developed to simulate Descemet Membrane Endothelial Keratoplasty (DMEK) surgery when using air/gas. The apparatus was thermostated at 37oC in which the IOLs were immersed in SAH, at conditions simulating the eye anterior chamber. The hydrostatic conditions prevailing in the anterior chamber during the completion of the operation may affect the propensity of the intraocular lenses for calcification. However, of key importance is the locally developed supersaturation, which is higher in comparison with the bulk SAH at the meniscus developed between IOL-SAH-AIR interface.

Results
Air injection in the anterior chamber, traps aqueous humor in the pupil aperture between air and hydrophilic surface of the IOLs forming a meniscus. The hydrophilic IOL exposed sequentially to SAH followed by pressurizing the chamber of the cell with air maintaining a constant pressure of 40 mm Hg for a period of 5 hours, yielded calcific deposits at the periphery of the air bubble in contact with IOL exposed in SAH at 37oC. The supersaturation with respect to calcium phosphate at the meniscus with small curvature radius, was higher in comparison with the respective value in bulk SAH.

Conclusion
The presence of air/gas bubble in ACEACR implies increased risk of hydrophilic IOL calcification. The development of a meniscus of SAH on the hydrophilic IOL resulted to significant increase of the supersaturation with respect to calcium phosphate at the IOL- SAH- air interphase area and the concomitant formation of deposits.
Opacified Hydrophilic Acrylic Lenses - a Case Series (No Audio)
Authors
Ashok Rangarajan, MS, DNB, FRCS
Liliana Werner, MD, PhD

Methods
Study Design - Prospective study Methods - All patients who presented with decreased vision due to opacification of the intraocular lenses and who underwent lens exchange were included in the study. The patients underwent detailed systemic and ocular examination prior to IOL exchange surgery. 3 of the explanted lenses were sent for laboratory analysis.The patients were followed up for 6 weeks.

Results
967 eyes underwent uncomplicated phacoemulsification with implantation of a single piece hydrophilic acrylic lens between April 2015 and March 2018.24 eyes had opacification of the lenses seen between April 2018 and December 2019.12 patients had diabetes,12 had hypertension and 6 had neither. 4 eyes had moderate NPDR, 1 had PDR and 3 had maculopathy. 23 eyes underwent lens exchange surgery,2 had Iris Claw Lens,1 had PMMA lens and 21 had multipiece lens.At final follow up 16 eyes had ≥ 6/9,3 had ≥6/18,2 ≥ 6/36,2 were lost to follow up.Laboratory analysis showed multiple small granules on the anterior subsurface of the lenses consistent with calcification and stained with 1% alizarin red.

Conclusion
The possibility of late hydrophilic lens opacification necessitating lens exchange must be borne in mind and the patient accordingly counselled, especially diabetics.
Refractive Outcomes with a New Hydrophobic Acrylic IOL
Author
Inder P. Singh, MD

Methods
This was a single surgeon, single site, retrospective evaluation of 30 consecutive patients undergoing routine cataract surgery with IOL (MX60E). Patients with glaucoma, macular degeneration, and other ocular pathology interfering with best corrected visual acuity were excluded. All patients had preoperative ray tracing (iTrace, Tracey technologies), corneal topography (Pentacam, Oculus), and biometry with Barrett Suite calculation formulas (IOL Master 700, Carl Zeiss).

Results
94.74% of patents fell within 0.5D of intended post operative target refraction. Mean IOL Power was 22.5. Mean Axial length was 23.5 mm. 98% were 20/40, 95% were 20/30, 86% were 20/25, 53% were 20/20 uncorrected for distance. 96% were J3, 86% J2, 26% J1 for uncorrected intermediate vision. Reading vision was not assessed in all patients and therefore data not shown. More detailed breakdown of results will be included at the time of the presentation including corneal parameters, HOA, and pupil size.

Conclusion
With the appropriate diagnostic technology, the MX6E appears to provide excellent refractive targeting as well as provides significant intermediate vision.
Using Validated Spectacle Independence and Negative Symptom Surveys of Presbyopia Correcting Iol's for a Monofocal IOL.
Author
Ahad Mahootchi, MD, ABO

Methods
All patients receiving bilateral aspheric, aberration free IOLs of either non-toric or toric models had chart reviews to exclude those with drusen, diabetic retinopathy, co-incident glaucoma procedures, strabismus, and posterior capsule opacity. Those with previous refractive surgery or intentional mono vision of any type ( micro, mini, full ) were excluded. All patients were more than 90 days post op and less than one year. The previously validated surveys PRSIQ (Patient Reported Spectacle Independance Questionaire) and QoV were combined into one questionaire given via Survey Monkey and given to patients online (mostly) or in paper versions for those without internet access.

Results
All patients were within .5 D of emmetropia. All patients had less than .5 D of cylinder. Spectacle independence for distance was high >95% (P < .05) as expected. Spectacle independence for intermediate vision was much higher than expected with >85% independent of glasses for thing 1.5 ft to 5 ft. Spectacle independence for near vision (1.5 feet or less) was low but better than would be anticipated with 20% never using glasses for near. Negative symptoms such as distortion, multiple images, starbursts, halos and glare were not common with >80% of respondents reporting never having those and none reporting frequent complaints (P<.05%)

Conclusion
The IOL delivers beyond its FDA indication. A unique spherical aberration free but aspheric lens has the good quality of vision profile of a monofocal with reliable delivery of spectacle free intermediate vision ( >80%) by previously validated surveys used by regulators. The negative symptoms of multifocal presbyopia correcting IOL were avoided.

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