Anterior chamber lenses. Part II: A laboratory study.

An analysis of 606 surgically removed anterior chamber intraocular lens (IOL) specimens revealed that 351 or 58% of these were small-diameter, round loop, closed-loop styles. Because of the extremely high percentage of IOLs with this design received in our laboratory and the correlation of clinical histories with our histopathologic findings, we have concluded that such IOLs do not provide the safety and efficacy achieved by other anterior chamber lens designs. The finely polished, one-piece, all-PMMA styles fared well in our study. Although these one-piece styles comprise well over 50% of the American market share of anterior chamber IOLs, they comprise only 14% of all anterior chamber IOLs accessioned in our laboratory, compared to 58% for closed-loop designs. We believe that implantation of anterior chamber lenses with small-diameter, round, closed loops is no longer warranted. Patients in whom these IOLs have already been implanted should be carefully followed. It is our opinion that the FDA should recall or closely monitor all IOLs of this design and that implantation of closed-loop lenses should be discontinued in the United States. Furthermore, we believe that an IOL deemed to be not medically sound or worthy of implantation in the United States should not be marketed or donated outside of this country.

Complications of intraocular lenses. A historical and histopathological review.

Recent improvements in intraocular lens (IOL) design, manufacturing techniques, and surgical techniques have greatly reduced the incidence of complications following implantation, and many authors now consider IOL implantation to be among the most safe and effective major surgical procedures. However, adverse reactions are still seen--some as late sequelae of earlier IOL designs and implantation techniques and some as sequelae of more recent implantations using "state-of-the-art" lenses and surgical techniques. Complications may be due to various factors, including surgical technique, IOL design, or the inability of some eyes with preexisting disease to tolerate an implant. The authors trace the evolution of IOLs since Ridley's first implant, summarizing the modifications in lenses and surgical techniques that were made as complications were recognized. They then review the clinical and histopathological features of selected cases from more than 200 IOLs and/or globes removed due to IOL-related complications and studied in the University of Utah Ocular Pathology Laboratory. It is hoped that this review will provide insights into the pathogenesis of IOL complications, enhancing the current success of implant procedures and stimulating further basic and clinical research in this area.

Histopathology and ultrastructure of krypton and argon laser lesions in a human retina-choroid.

The authors studied a normal eye 24 hours after retinal treatment with argon and krypton photocoagulation. The findings indicate the relative sparing of the inner retina and greater choroidal effects of krypton when compared with argon photocoagulation. Bruch's membrane was not completely ruptured as long as the energy densities of burns were kept low. Krypton wavelengths are transmitted more effectively to the pigment epithelium and choroid. Therefore, the use of relatively lower and therefore safer power densities compared with the argon laser should suffice for the treatment of diseases at this level.

Biocompatibility of implant materials: a review and scanning electron microscopic study.

The evolution of various plastic materials used in the manufacture of intraocular lenses is reviewed, with special reference to the problem of biocompatibility of lens haptic materials. To date, polypropylene has been found and continues to be a highly effective, relatively inert material, providing good surgical results. However, the present study and other morphologic and chemical studies have provided evidence that indicates long-term alteration of polypropylene may occur. For this reason we believe that further studies of this particular polymer are warranted. Also, a continuing search and trial of other plastics to discover an equivalent or even more efficacious haptic material seems desirable. There is a need for careful long-term follow-up of patients after intraocular lens implantation, particularly of young patients.

Effects of chronic denervation in type I cutaneous mechanoreceptors (Haarscheiben).

Cutaneous type I receptor sites (Haarscheiben or tactile domes) were examined at intervals of 4 to 275 days after chronic denervation of the skin. The number of domes decreased with denervation time, and only about one-third of the domes originally present were still visible at 275 days. Most but not all of the Merkel cells from these domes were absent by 48 days, and the epithelium was significantly thinner than in nondenervated domes. Only a few of the examined domes appeared to be completely devoid of Merkel cells. It is concluded that after nerve transection, domes degenerate but do not always disappear entirely. The remnants may thus act as target sites which either attract regenerating type I nerve fibers or facilitate the formation of new dome structures after nerve regeneration.

Development of rat Merkel cells.

The ultrastructure of Merkel cells and cutaneous nerves was examined in fetal, newborn, and 7-day-old rats. The earliest observation of cells having some, but not all, of the features of mature Merkel cells was at 16 days gestation in snout skin. These early presumptive Merkel cells resembled the neighboring keratocytes, except that they contained dense-cored vesicles scattered in the cytoplasm. Presumptive Merkel cells were seen only in the epidermis, although a careful search was made of the dermis. Developing neurons were not observed to penetrate the epidermal basal lamina when presumptive Merkel cells were first seen. The earliest observation of identifiable nerve axons in the snout epidermis was at 17-171/2 days gestation. Study of the presumptive Merkel cells through successively older gestational stages showed that the cells became innervated and progressively developed the characteristics of adult Merkel cells. We suggest that Merkel cells arise from keratocyte-like precursors in rat epidermis, at a time when skin nerves may still be several micrometers away.