Inhibition of anterior capsule opacification and contraction by the elevated anterior rim of the intraocular lens optic.

PURPOSE: To verify the anterior capsule opacification (ACO) and contraction (ACC) of the ZCB00V intraocular lens (IOL), made of the same material as the AR40e with a high ACC rate. STUDY DESIGN: Retrospective cohort study. METHODS: We evaluated 35 patients at 1 week, 1, 3 and 6 months post phacoemulsification with either a ZCB00V (n = 35) or FY-60AD (n = 34) IOL implantation. The ACC rate was calculated using retroillumination images of the anterior segment, and the ACO was measured using anterior segment photographs and image analysis software. The contact grade between the IOL and anterior capsule was estimated from the Pentacam® images. RESULTS: The postoperative ACC rates (mean ± standard deviation) at 3 months were 1.03%±2.54% for the ZCB00V and, and 7.12%±9.47% for the FY-60AD. The ZCB00V-implanted eyes showed a significantly lower postoperative ACC at 1 week, 3 months, and 6 months (P < 0.01). On the other hand, the FY-60AD-implanted eyes had more pronounced ACO, and a significantly larger area of opacification (62.24%±21.32% vs. 16.90%±8.34%; P = 0.0005). Pentacam® analysis revealed a space between the anterior capsule and IOL surface in the ZCB00V-implanted eyes, whereas the anterior capsule firmly adhered to the IOL surface in the FY-60AD-implanted eyes. CONCLUSION: The ACC and ACO were significantly lower in eyes with ZCB00V IOLs compared to those with the FY-60AD. The anterior segment image analysis revealed that the elevated anterior rim of the ZCB00V IOL prevented adhesion between the anterior capsule and IOL optic surface, suggesting an open capsule effect.

Relationship between anterior capsule opening and direction of intraocular lens decentration.

PURPOSE: To compare intraocular lens (IOL) decentration between patients in whom the continuous curvilinear capsulorhexis (CCC) completely covers the IOL optic and those in whom it incompletely covers the IOL optic and determine how an incompletely covered CCC affects the IOL position. SETTING: Tertiary hospital in Japan. DESIGN: Single-center retrospective study. METHODS: 57 eyes of 57 patients (mean age 70.8 ± 6.2 years) that underwent phacoemulsification and IOL (SN60WF) implantation in the bag between April 2010 and April 2015 were included in this study. The patients were classified based on whether the CCC completely (CC group) or incompletely (NCC group) covered the IOL optic using an anterior eye segment analysis system (EAS-1000). The IOL decentration of the groups was analyzed using EAS-1000 at 1 week, 1 month, 3 months, and 6 months postoperatively and compared. The relationship between the NCC location and the IOL direction at 3 months postoperatively was analyzed. RESULTS: The NCC group (25 eyes) had a significantly higher amount of IOL decentration than the CC group (32 eyes) at 1 week, 1 month, 3 months, and 6 months postoperatively ( P < .05). There was a correlation between the direction of IOL decentration and the NCC location, and IOL decentration in the NCC group occurred in the opposite direction to the NCC area. CONCLUSIONS: An anterior capsule opening that completely covers the IOL optic is important to control IOL decentration.

[Clinical Functionality of Dispersive OVDs: Improvement of One of the Properties of 3% Hyaluronic Acid and 4% Chondroitin Sulfate Combination].

Ophthalmic viscosurgical devices (OVDs) are mainly divided into two general categories: cohesive and dispersive. Dispersive OVDs such as the 3% hyaluronic acid and 4% chondroitin sulfate (HA/CS) combination have excellent adhesion to ocular tissues and protect the corneal endothelium to a greater extent than cohesive OVDs. Herein, we summarize our recent findings regarding one of the properties of the HA/CS combination related to clinical performance. (i) The room temperature stability of OVDs and needle clogging by OVDs remain clinical issues. We demonstrated that adding d-sorbitol to the HA/CS combination preserved its viscosity, which was equivalent after 2 year-storage at room temperature to the viscosity of HA/CS combination stored under refrigeration for 2 years without d-sorbitol. Besides, the HA/CS combination with d-sorbitol could be used repeatedly without cleaning or replacing the needle, suggesting that the addition of d-sorbitol prevents drying and solidification of the OVD on the needle. (ii) Although it can be inferred from numerous studies that the tissue adhesion of OVDs influences their retention by the eye, little is known about the physical properties of OVDs that contribute to intraocular retention. To address this issue, we compared two types of adhesive forces, detachment force and repulsive force, for each OVD. Compared with other dispersive OVDs, the HA/CS combination showed higher values for both adhesive forces. These results suggest that adhesive forces may be used as an index of dispersive OVD retention in the eye.

A Case of Pigment Dispersion Syndrome after Placement of Sulcus Intraocular Lens with 7-mm Optic Diameter after Posterior Capsule Rupture.

A 48-year-old woman diagnosed with primary angle closure suspect (PACS) in the right eye underwent cataract surgery, and a 7-mm optic diameter intraocular lens (IOL) was placed in the ciliary sulcus after intraoperative posterior capsule rupture. The patient developed uveitis and blurred vision the next day. The IOL was fixed between the iris and the anterior capsule. Irregularly shaped pupils due to posterior synechia and pigmentation on the IOL surface were observed. In the Scheimpflug image, the IOL on the anterior capsule was observed and the anterior chamber depth was 2.92 mm. A diagnosis of pigment dispersion syndrome and elevated intraocular pressure due to sulcus IOL placement was made. The patient underwent intrascleral IOL fixation surgery using an already inserted IOL to reposition the IOL under the anterior capsule. After 1 week, the blurred vision, anterior chamber inflammation, and IOL surface pigmentation were resolved. The right eye IOP was 15 mm Hg and the pupil became a regular circle. Scheimpflug images showed the IOL located behind the anterior capsule and an anterior chamber depth of 3.88 mm. Because the patient had a slightly shorter axial length of 22.89 mm and PACS, pigment dispersion may have occurred due to friction between the iris and the shape of the optic edge with a large optic diameter. In cases of posterior capsule rupture with short axial length and PACS, the use of a 7-mm optic diameter IOL in the sulcus should be avoided, or intrascleral IOL fixation should be selected as the surgical technique.

Advances in Understanding the Mechanism of Ophthalmic Viscosurgical Device Retention in the Anterior Chamber or on the Corneal Surface during Ocular Surgery.

Retention durability, especially in the eye, is one of the most important properties of ophthalmic viscosurgical devices (OVDs) during ocular surgery. However, the information on the physical properties of OVDs is insufficient to explain their retention durability. The purpose of this study is to clarify the mechanism of OVD retention to improve understanding of the behavior of OVDs during ocular surgery. To elucidate the mechanism of OVD retention, we have developed a new test method for measuring repulsive force. As a result, the maximum repulsive force of OVDs was positively and well correlated with the retention durability of investigated OVDs. Consequently, we demonstrated that the repulsive force could be used as an index of retention durability on the ocular surface and in the eye. We directly compared the intraocular retention durability of three OVDs (Shellgan, Viscoat, and Opegan-Hi) in ex vivo porcine eyes. Opegan-Hi was immediately removed from the anterior chamber, but Shellgan and Viscoat remained largely in the anterior chamber as determined by fluorescence imaging. These results showed that the intraocular retention behavior of OVDs was similar to their ocular surface behavior in our previous report, suggesting that retention durability is dependent on the OVD itself. The retention durability of Shellgan seemed to be higher than that of Viscoat, and the maximum repulsive force of Shellgan was 1.35-fold higher than that of Viscoat. Therefore, the repulsive force might be a useful index for assessing the difference in the retention durability between OVDs such as Shellgan and Viscoat.

Quantitative Assessment of Ophthalmic Viscosurgical Devices on Visibility, Spreadability, and Durability as Corneal Wetting Agents for the Wet Shell Technique.

PURPOSE: To evaluate ophthalmic viscosurgical devices (OVDs) as corneal wetting agents for the wet shell technique, a common procedure in Japan to maintain the wettability of corneal surfaces. METHODS: We surveyed Japanese ophthalmologists to determine the current state of the wet shell technique. After developing three ex vivo testing methods, we evaluated the corneal wetting properties of OVDs including 3% hyaluronic acid (HA) solution and OVD products, Opegan, Opelead, Viscoat, Shellgan, Discovisc, and Opegan-Hi. RESULTS: Overall, 214 ophthalmologists (70%) had performed the wet shell technique, and 91% of ophthalmologists who performed vitreous surgery had performed this technique. Using a questionnaire, we evaluated the performance of OVD as corneal wetting agents as follows: (i) visibility, smoothness of OVD surface; (ii) spreadability, coverage of the cornea; and (iii) retention durability, residual ratio of OVD on the corneal surface. The smoothness and spreadability of Opegan, Opelead, and 3% HA were superior to other OVDs. Adding an appropriate amount of balanced salt solution to the other OVDs improved smoothness and spreadability similar to that of Opelead or 3% HA. Shellgan and Viscoat, combination OVDs consisting of 3% HA and 4% chondroitin sulfate, showed high retention durability, resulting in remaining longer on the cornea compared with other OVDs. CONCLUSIONS: Physical properties of OVDs tested in this study may provide useful information for ophthalmologists to select a suitable OVD when performing the wet shell technique.

Addition Of D-Sorbitol Improves The Usability Of Ophthalmic Viscosurgical Devices.

PURPOSE: To evaluate the effects of D-sorbitol addition on changes in the extrusion force of ophthalmic viscosurgical devices (OVDs). METHODS: OVD formulations; the mixtures of 3% hyaluronic acid (HA) and 4% chondroitin sulfate (CS) containing 0%, 0.5%, or 1.0% D-sorbitol were prepared. Each prefilled syringe of OVD was stored at room temperature for 0, 15, 30, 60, or 120 mins after a small amount of viscoelastic agent was discharged from the needle. The extrusion force values (kgf) of these OVDs when reused after storage were measured with a texture analyzer. Moreover, 10 healthy adults (5 men and 5 women) used a pinch sensor to measure the extrusion force values for the HA/CS combination without D-sorbitol which was stored in the above manner, and used a 4-step scale to score the usability of OVD. RESULTS: For the HA/CS combination without D-sorbitol, the extrusion force value was increased from its initial value (storage duration, 0 min) as storage duration increased. However, for the HA/CS combination containing 0.5% or 1.0% D-sorbitol, this value remained almost unchanged over time. Likewise, the pinch sensor-determined extrusion force values of HA/CS combination without D-sorbitol increased, depending on storage duration. CONCLUSION: The addition of D-sorbitol to viscoelastic agent may suppress the needle clogging that occurs with OVD storage, and may improve the usability of OVDs during surgery.

Open-capsule intraocular lens to prevent posterior capsule opacification.

PURPOSE: To develop a single-piece open-capsule intraocular lens (IOL) that can be inserted through a small incision and that prevents posterior capsule opacification (PCO) by expanding the capsule and circulating aqueous humor into the capsular bag. SETTING: Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan. DESIGN: Experimental study. METHOD: Using the same hydrophobic acrylic material as the NY-60 IOL, a prototype open-capsule IOL was constructed. The IOL has a single optic and 2 haptics, with a 2.8 mm high spacer and holes through which aqueous humor circulates into the capsular bag by separating the anterior capsule from the posterior capsule and expanding the capsule. The open-capsule IOL or NY-60 (as a control group) was inserted in rabbit eyes. Posterior capsule opacification development was evaluated by measuring the thickness of the cell layer at the center of the posterior capsule on histopathologic specimens and statistically comparing the thickness between the open-capsule IOL group and control group. RESULTS: The open-capsule IOL could be inserted through a 3.2 mm corneal incision using a D cartridge. The mean thickness of the cell layer at the center of the posterior capsule was 4.78 µm ± 2.61 (SD) in the open-capsule IOL group and 101.14 ± 25.19 µm in the control group and was significantly smaller in the open-capsule IOL group. CONCLUSION: The prototype single-piece IOL could be implanted through a small incision and prevented PCO by expanding the lens capsule and circulating aqueous humor into the capsular bag.

Effects of decentration and tilt on the optical performance of 6 aspheric intraocular lens designs in a model eye.

PURPOSE: To compare the effect of decentration and tilt on the optical performance of 6 aspheric intraocular lens (IOL) designs in a model eye. SETTING: Department of Ophthalmology, Graduate School of Medicine, Dokkyo Medical University, Tochigi, Japan. DESIGN: Experimental study. METHODS: In theoretical simulations, the amount of spherical aberration in the IOL was varied to produce residual ocular spherical aberration (range -0.15 to 0.30 µm) at a 6.0 mm entrance pupil. Wavefront aberration analyses were performed with the ZEMAX optical design program (version August 20, 2014) to obtain the ocular root-mean-square values of astigmatism, coma, trefoil, and higher-order aberrations (HOAs) when the IOL was centered on the insertion position and misaligned at a 4.0 mm entrance pupil. The retinal visual images were calculated using the same conditions. Six 20.0 diopter (D) aspheric IOLs and one 20.0 D spherical IOL were used for the experimental studies. Each IOL was inserted in the model eye. The actual alignments were measured using a Scheimpflug camera (EAS-1000). The wavefront aberrations and visual images were gauged using a wavefront analyzer (KR-1W) at several IOL alignments. RESULTS: Intraocular lens decentration and tilt increased wavefront aberrations and degraded optical performance. Astigmatism, coma, and HOAs generated by misaligned IOLs were related to the amount of spherical aberration correction of the IOLs. The extent of spherical aberration remained unchanged by the amount of misalignment. Experimental model eye results showed trends similar to theoretical results. CONCLUSIONS: The spherical aberration correction amount in the aspheric IOL design was critical for the astigmatism, coma, and HOAs generated by the IOL misalignment. Additional spherical aberration corrections led to a more sensitive optical performance degradation resulting from IOL misalignment.

Intrascleral fixation of intraocular lens haptics: histological advantages in a comparison with scleral suture fixation in rabbits.

PURPOSE: To disclose histological advantages of intrascleral fixation of intraocular lens haptics, in comparison with scleral suture fixation, in a study with rabbits. METHODS: Ten white rabbits, 10 weeks of age, were used in this experimental histopathological study. After unilateral lensectomy and anterior vitrectomy, an intraocular lens haptic was inserted into one eye of each rabbit. Intrascleral fixation was performed in five rabbits, whereas scleral suture fixation was performed in the others. At postoperative 1 week, the globe was enucleated in two rabbits in each group; at postoperative 8 weeks, the globe was enucleated in the remaining three rabbits in each group. Sections of the sclera around haptics and sutures were evaluated with haematoxylin and eosin and immunohistochemical staining methods. We assessed severity of inflammation on histopathological photos, taken near the haptic or suture in the sclera, by counting white blood cells. The Mann-Whitney U test was performed to analyse differences in the severity of inflammation between the groups. RESULTS: Samples in the intrascleral fixation group demonstrated reduced irregularity of collagen fibres; reduced infiltration of fibroblasts, giant cells, lymphocytes, neovascular cells, neutrophils and eosinophils and weaker staining for fibronectin (indicating tissue repair) and heat shock protein 70 (indicating cell damage). In addition, reduced white blood cell infiltration was observed in the intrascleral fixation samples at 8 weeks in both shallow sclera (p = 0.001) and deep sclera (p = 0.002). CONCLUSIONS: Histological analysis showed that intrascleral fixation caused fewer inflammatory changes than scleral suture fixation, with reduced fibroblast migration and production of cytotoxic factors.

Decreased visual acuity resulting from glistening and sub-surface nano-glistening formation in intraocular lenses: A retrospective analysis of 5 cases.

BACKGROUND: To report on five patients with decreased visual acuity due to glistening and severe sub-surface nano-glistening (SSNG) formation within their intraocular lenses (IOLs). DESIGN: Case reports and analysis of extracted IOLs. PARTICIPANTS AND SAMPLES: We report improved visual acuity when IOLs with severe glistening and SSNG were exchanged for clear IOLs in five patients. METHODS: Case reports. MAIN OUTCOME MEASURES: The main outcome measure was visual acuity. The secondary outcome measure was light transmission. Explanted IOLs were subjected to investigation. Pre- and postoperative slit lamp images of the anterior eye and microscopic images of the extracted IOLs were taken and compared. Light transmission of the IOL was measured using a double beam type spectrophotometer. An integrated value of the percentage light transmittance in the visible light spectrum was calculated. RESULTS: We report on five patients whose visual acuity improved when IOLs were exchanged because of severe glistening and SSNG. All of the affected IOLs were MA60BM (Alcon, Forth Wroth Texas, USA) and the original implantation had occurred over a range of 6-15 years prior to the IOL exchange. Light transmission was decreased in all affected lenses compared to a similar control IOL. CONCLUSIONS: Although only a few reports of cases in which glistening and SSNG have progressed to the level of decreased visual function have been published, the likelihood is that this phenomena will increase as the severity and incidence of these inclusions have been shown to increase with time. Appropriate evaluations of visual function in such patients are needed and consideration should be given to IOL exchange in symptomatic patients.

Influence of intraocular lens implantation on anterior capsule contraction and posterior capsule opacification.

PURPOSE: To evaluate whether and how intraocular lens (IOL) implantation influences the development of anterior capsule contraction and posterior capsule opacification (PCO). SETTING: Department of Ophthalmology, Dokkyo Medical University, Mibu, Tochigi, Japan. DESIGN: Experimental study. METHODS: Phacoemulsification was performed in 8-week-old white rabbits. A hydrophobic acrylate IOL (12.5 mm) (YA-60BBR) was implanted in 1 eye and no IOL was implanted in the fellow eye. Slitlamp microscopy and anterior segment analysis were performed to evaluate anterior capsule contraction after the surgery. Four weeks postoperatively, sections of the eyes were made, and the thickness of the proliferated lens epithelial cell (LEC) layer at the posterior capsule was measured to assess the PCO. In addition, LECs from white rabbits were cultured in medium containing 50% aqueous humor or in medium containing 50% saline to determine the influence of the aqueous humor on LECs and to compare the degree of LEC proliferation. RESULTS: Starting 2 weeks after surgery, anterior capsule contraction progressed more significantly in the IOL group than in the group without IOLs. Four weeks postoperatively, LEC thickness at the posterior capsule was significantly less in the group without IOLs than in the IOL group. In the culture study, LEC proliferation was more inhibited in the aqueous humor group than in the saline group. CONCLUSIONS: Progression of anterior capsule contraction and PCO is less likely in aphakic eyes than in IOL-implanted eyes. The mechanism of prevention may involve aqueous humor-induced inhibition of LEC proliferation.

Evaluation of the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor.

AIMS: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) from a multicenter clinical trial in Japan. METHODS: A retrospective multicenter review of the data of patients who received intravitreal anti-VEGF injections between January 2007 and March 2011 was undertaken. Cases with the clinical diagnosis of endophthalmitis resulting from intravitreal injection were identified and reviewed. RESULTS: A total of 5,236 intravitreal anti-VEGF injections (1,209 intravitreal injections of bevacizumab, 3,827 injections of ranibizumab, and 200 injections of pegaptanib sodium) had been administered. Five patients (0.095%), all of whom had received bevacizumab, were diagnosed as having endophthalmitis after the intravitreal injection. All patients visited the institutes for re-examination within 1-2 days after the injection. Among the 5 patients, 2 (0.038%) were culture positive for Streptococcus oralis and Enterococcus faecalis, respectively. The remaining 3 eyes (0.057%) developed presumed noninfectious endophthalmitis. CONCLUSION: Although endophthalmitis is a rare complication associated with intravitreal injection, in this series intravitreal anti-VEGF injection caused infectious or noninfectious endophthalmitis at a relatively high frequency. Further investigations are needed to consider an appropriate injection protocol for minimizing the incidence rates of endophthalmitis, and to assess the optimal treatment protocol for intravitreal injection-related endophthalmitis although it was difficult to differentiate these two entities.

Decreased visual function due to high-level light scattering in a hydrophobic acrylic intraocular lens.

PURPOSE: To investigate the effects of light scattering from the surface of hydrophobic acrylic intraocular lenses (IOLs) on visual function. METHODS: A 67-year-old man was implanted with an IOL (MA60BM) in January 1998, but became aware of decreased visual function in May 2008. Observation with a slit lamp revealed light scattering throughout the entire optic of the IOL, which was extracted and replaced. Postoperative visual function improved at 1 month. The cause of light scattering was investigated with a focus on water permeating the IOL material. To confirm the effect of light scattering on visual function, light transmission of the extracted IOL was measured in physiological saline at 33 °C, and the simulated retinal image was evaluated in a model eye. RESULTS: Observation of the extracted IOL showed light scattering from the optic surface layer, the main cause of which was phase-separated water within the IOL material. Light transmission in the extracted IOL was 16.3% lower than that in an unused IOL in the visible range. Moreover, the simulated retinal image was hazy compared to that of the unused IOL. CONCLUSION: Severe surface light scattering from an IOL optic may decrease visual function.

Clinical evaluation of the transparency of hydrophobic acrylic intraocular lens optics.

PURPOSE: To clinically evaluate postoperative changes in the transparency of hydrophobic acrylic intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan. DESIGN: Case-control study. METHODS: Eyes having phacoemulsification were randomly assigned to have implantation of 1 of 3 hydrophobic acrylic IOL models. The IOLs were photographed at 0 degree and 90 degrees 1 week, 6 months, and 1 year after implantation using a Nidek EAS-1000 anterior chamber analyzer in slit mode. The images were used to determine the intensity of light scattering in the surface and middle regions of the IOL optic. RESULTS: The study comprised 65 eyes of 57 patients with a mean age of 72.5 years. The rate of increase in light-scattering intensity was similar in the middle and surface regions of the Tecnis ZA9003 aspheric IOL. The increase in light-scattering intensity in both regions of the AF-1 VA-60BB spherical IOL was greater than that in the aspheric IOL at all the measurement points. The intensity of light scattering was highest and tended to increase over time in both regions of the AcrySof SA60AT spherical IOL; the rate of increase in intensity was higher in the surface region than in the middle region, and the difference was significantly greater at 6 months and 1 year than at 1 week. CONCLUSION: Our results suggest that AcrySof SA60AT and AF-1 VA-60BB IOLs are likely to develop glistenings over time and that the former may develop whitening.

Analysis of surface whitening of extracted hydrophobic acrylic intraocular lenses.

PURPOSE: To identify the cause of light scattering on the surface (ie, whitening) of extracted AcrySof intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan. METHODS: Dislocated IOLs extracted from 3 patients were stored and the IOL surfaces examined under light microscopy. The effect of whitening on visual function was evaluated by measuring light transmission with a spectrophotometer. To determine the cause of opacification, the IOLs were examined for calcium phosphate deposits using an electron probe X-ray microanalyzer. The IOL surface, including the presence of organic deposits and evidence of hydrolysis, was also examined by Fourier-transform infrared spectrophotometry. The IOLs were then dried, immersed again in physiological saline, and serially examined for changes in opacification. RESULTS: The optic surfaces of all IOLs had opacification due to whitening. Light transmission in the visible range of 360 to 800 nm was 4% less than that of unused IOLs. The X-ray microanalysis showed no calcium phosphate deposits. Fourier-transform infrared spectrophotometry of the IOL optic material showed no evidence of hydrolysis. Opacification disappeared after the IOLs were dried and then reappeared over time when the IOL was immersed again in physiologic saline. CONCLUSIONS: The findings strongly suggest that whitening of the hydrophobic acrylic IOL was due to trace water molecules that infiltrate the optic. Within the 3-dimensional network of the polymeric lens material, the molecules are too small to form observable voids but can form water aggregates of sufficient size to scatter visible light, causing opacification (ie, whitening).

Efficacy of ophthalmic nonsteroidal antiinflammatory drugs in suppressing anterior capsule contraction and secondary posterior capsule opacification.

PURPOSE: To evaluate the efficacy of ophthalmic nonsteroidal and steroidal antiinflammatory drugs in preventing anterior capsule contraction and secondary posterior capsule opacification (PCO) using an experimental cataract model. SETTING: Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan. METHODS: Eight-week-old albino rabbits weighing about 2 kg each had phacoemulsification and intraocular lens implantation. After surgery, the rabbits were divided into 3 treatment groups: diclofenac sodium ophthalmic solution, bromfenac sodium ophthalmic solution, and betamethasone ophthalmic solution. In each group, the ophthalmic solution was applied to the left eye of each rabbit twice daily; the right eye served as an untreated control. To evaluate anterior capsule contraction, the percentage of incised anterior capsule opening area was calculated on diaphanoscopic images obtained with an EAS-1000 anterior segment analyzer. For evaluation of PCO, a tissue section was stained with hematoxylin-eosin and observed under a light microscope. The PCO was quantified on the basis of the thickness of the lens epithelial cell layer on the central subcapsular area and compared among groups. RESULTS: Fifteen albino rabbits were used in the study. Treatment with diclofenac sodium and bromfenac sodium ophthalmic solution prevented progression of anterior capsule contraction and PCO. Treatment with bromfenac ophthalmic solution did not prevent either complication. CONCLUSION: Postoperative treatment with ophthalmic nonsteroidal antiinflammatory drug solutions prevented anterior capsule contraction and PCO in rabbit eyes.

Photoprotective effect of yellow-tinted intraocular lenses.

PURPOSE: The aim of this study was to experimentally investigate changes in visible light-induced photo-oxidation and to evaluate the inhibitory effect of various acrylic tinted intraocular lenses (IOLs) on photooxidation. METHODS: Three types of nontinted (VA-60BB, HOYA; SA60AT, Alcon; AU-6, Menicon) and tinted (YA-60BB, HOYA; SN60AT, Alcon; AN-6, Menicon) IOLs were used. In the first experiment, we investigated oxidation related to ultraviolet rays by using a mixed solution of reduced glutathione, nicotinamide adenine dinucleotide phosphate (NADPH), and glutathione reductase. The mixed glutathione solution was irradiated for 30, 60, or 90 min with direct artificial sunlight or artificial sunlight that had been passed through various IOLs. Oxidation was detected at 340 nm. In the second experiment, human retinal pigment epithelium (RPE) cells were prepared and cultured in a 96-well dish until confluent. After light exposure for 30 min or 48 h, lactate dehydrogenase (LDH) levels of the culture supernatant were measured to assess the amount of cell damage. RESULTS: Visible light-induced glutathione oxidation progressed over time. Intraocular lenses inhibited photooxidation, with the inhibitory effect shown to increase when tinted IOLs were used. LDH levels in RPE cells increased as a result of exposure to visible light. There was a higher increase in LDH with nontinted than with tinted IOLs. CONCLUSION: Visible light causes photooxidation, which damages intraocular tissue in vitro. These results suggest that tinted IOLs effectively inhibit tissue damage from visible light.

Comparison of anterior capsule contraction between 5 foldable intraocular lens models.

PURPOSE: To compare anterior capsule contraction in cataract patients having implantation of 1 of 5 foldable intraocular lens (IOL) models and evaluate lens epithelial cell (LEC) adhesion to each model. SETTING: Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan. METHODS: This study comprised 115 patients (126 eyes) without systemic or ocular complications who had phacoemulsification with IOL implantation. The eyes were randomly assigned to receive 1 of the following IOLs: acrylic MA60BM (Alcon), SA60AT (Alcon), AR40e (Advanced Medical Optics), or YA-60BBR (Hoya) or a silicone AQ310NV (Canon). Two weeks and 1, 3, and 6 months postoperatively, the anterior capsule opening area was measured using an anterior segment analysis system (EAS-1000, Nidek) and the percentage of anterior capsule contraction was compared for each postoperative period and IOL. Cell adhesion to each IOL type was evaluated using LECs from albino rabbits. RESULTS: The mean age of the patients was 73.6 years +/- 5.6 (SD). Eyes with the AQ310NV and AR40e IOLs had statistically significantly greater anterior capsule contraction. The rabbit study showed statistically significantly less LEC adhesion on these 2 IOL models. CONCLUSIONS: Anterior capsule contraction was significantly greater with the AQ310NV and AR40e IOLs than with the other IOLs. Results indicate that cell adhesion to the IOL is an important factor in preventing anterior capsule contraction.