Explantation of a sutureless scleral fixated Carlevale intraocular lens due to calcification: a clinical and laboratory report.

BACKGROUND: Hydrophilic intraocular lens opacification is a rare complication due to calcification. With current new surgical techniques, including lamellar endothelial keratoplasty and vitrectomies, this irreversible complication is becoming more common. In this case study, we present clinical and laboratory features of a case of Carlevale hydrophilic acrylic IOL calcification. CASE PRESENTATION: Observational case report of a single incident case. An 83-year-old man was referred to our ophthalmic department complaining of right eye vision blurring for six months. Slit-lamp biomicroscopy revealed IOL opacification. Deposits of calcium phosphate were found both on the IOL's surface and inside it, according to thorough investigation using optical, scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX) spectrometry. CONCLUSIONS: To the best of our knowledge, this is the first case to describe the laboratory evidence of Carlevale hydrophilic IOL calcification, suggesting possible explanation mechanisms based on underlying pathology and surgical technique. It reminds us that these findings suggest that physicians should be aware of possible hydrophilic IOL calcification.

Hydrophobic versus hydrophilic acrylic intraocular lens on posterior capsule opacification: a Meta-analysis.

AIM: To conduct a Meta-analysis pooling randomized controlled trials (RCTs) to compare hydrophobic with hydrophilic acrylic intraocular lenses in terms of posterior capsule opacification (PCO) development. METHODS: Electronic databases including PubMed, Embase, and the Cochrane Library were queried from their starting till January 2020. RCTs investigating the impact of hydrophobic versus hydrophilic acrylic intraocular lenses on PCO were considered eligible in this study. The pooled effect estimates were calculated using the random-effects model. RESULTS: Thirteen RCTs comprising of 939 patients (1263 eyes) were covered in this study. Patients with hydrophobic acrylic intraocular lenses had a lower PCO score than those with a hydrophilic acrylic intraocular lenses [standard mean difference: -1.80; 95% confidence interval (CI): -2.62 to -0.98; P<0.001]. Moreover, the frequency of neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy in patients with hydrophobic acrylic intraocular lenses was significantly lower than patients with hydrophilic acrylic intraocular lenses (relative risk: 0.38; 95%CI: 0.20-0.71; P=0.003). CONCLUSION: These findings suggest that hydrophobic acrylic intraocular lenses are superior to hydrophilic acrylic intraocular lenses in patients after cataract surgery due to lower PCO score and reduced Nd:YAG capsulotomy. While similar studies are conducted by other researchers, the present study conducted subgroup analyses that show superior results with hydrophobic lenses in trials conducted in western countries.

[Influence of models of hydrophobic acrylic intraocular lenses on the development of posterior lens capsule opacifications (preliminary results)]. / Vliyanie razlichnykh modelei gidrofobnoi akrilovoi intraokulyarnoi linzy na razvitie pomutnenii zadnei kapsuly khrustalika (predvaritel'nye rezul'taty).

The search for optimal design and material of the intraocular lens (IOL) that would prevent posterior capsule opacification (PCO) is still a relevant problem. PURPOSE: To compare the influence of three models of hydrophobic acrylic IOLs on the development of PCO within one year after phaco surgery. MATERIAL AND METHODS: The study included 72 patients (91 eyes) who were followed up for 12 months after implantation of one of three models of posterior chamber hydrophobic acrylic IOLs: MIOL-2 (Reper-NN, Russia, 24 eyes, 1st group), SA60AT and US60MP (Alcon, USA, 41 and 26 eyes, 2nd and 3rd groups, respectively). Posterior capsule images were taken and then processed with the EPCO 2000 (Evaluation of Posterior Capsular Opacification) software. The area of posterior capsule adjacent to the center of IOL's optic of 4.0 mm in diameter was estimated. PCO score was calculated as the weighted sum of opacification areas multiplied by the degree (from 0 to 4). RESULTS: Within 1 year of the follow-up, mean visual acuity was at least 1.0 (20/20). Significant PCO progression was observed as early as 3 months after surgery. Despite that, opacification density in all three groups at every follow-up visit did not exceed grade 2; maximal PCO score (0.0315, median) was seen 12 month after surgery in the 1st group. At the same time, differences in PCO score between the groups were not significant. Nd:YAG laser posterior capsulotomy was performed only in one patient from the 1st group 12 month after surgery. Difference in the percentage of clear posterior capsules was significant only 12 month after surgery between the 1st and 3rd groups (p=0.024). CONCLUSION: All three models of hydrophobic acrylic IOLs showed comparably high vision outcomess during 12 months of the follow-up with somewhat better PCO score and percentage of clear posterior capsules in eyes with US60MP.

Toric Lentis Mplus intraocular lens opacification: A case report.

PURPOSE: To present the case of a patient with Toric Lentis Mplus intraocular lens (IOL) (Oculentis, Berlin, Germany) opacification after vitrectomy and his follow-up. OBSERVATIONS: A 44-year-old man with high myopia and right optic neuritis history complained of visual impairment due to cataract in the right eye. We performed uneventful phacoemulsification and implanted a Toric Lentis Mplus IOL in his right eye. Six months later, he came to us with a retinal detachment in the nasal area of the right eye. We performed a 25-gauge vitrectomy with gas tamponade and endolaser treatment. Ten months after the vitrectomy, he complained of blurred vision in the right eye again. On slit-lamp examination, we observed a wide opacification localized to the anterior surface of the IOL. We explanted the IOL from the right eye and replaced it with a Clareon IOL (Alcon, Fort Worth, TX). The explanted IOL was examined under light microscopy and scanning electron microscopy. CONCLUSIONS AND IMPORTANCE: We described a case of postoperative opacification of Toric Lentis Mplus IOL after vitrectomy. We found calcium aggregate deposits on the anterior surface of the IOL. Given the higher frequency of fundus disease observed in patients with high myopia, hydrophilic acrylic IOLs should be used with caution in patients with high myopia and in young patients. To our knowledge, this is the first report of Toric Lentis Mplus IOL opacification after the 2017 Field Safety Notice by Oculentis in response to the Food and Drug Administration's recall.

Opacification of Akreos Hydrophilic Acrylic Lens After Retinal Detachment Repair with Silicone Oil Tamponade: A Case Report.

We report localized opacification of a sclera-fixated Akreos® hydrophilic acrylic intraocular lens after successful repair of rhegmatogenous retinal detachment with silicone oil tamponade in a nondiabetic patient. No intraoperative lens opacification during air-fluid exchange or lens dislocation was encountered. Granular opacities within the optic were noted at 5 months after surgery, and did not relent to scrubbing with a vitrector during oil removal. Akreos lens opacification under silicone oil is not well documented in the literature. Surgeons must be aware of this potential complication, which is known to occur with various types of hydrophilic acrylic lenses after exposure to air or gas.

Anterior segment optical coherence tomography of intraocular lens opacification.

Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.

Postoperative diffuse opacification of a hydrophilic acrylic intraocular lens: analysis of an explant.

PURPOSE: We describe the clinicopathological and ultrastructural features of an opaque single-piece hydrophilic acrylic intraocular lens (IOL) explanted from a patient. METHOD: The main outcome of this report is the documentation of calcium deposits confirmed by surface analysis. The decrease in visual acuity was due to the opacification of the IOL. The opacification involved both the optic plate and the haptics. RESULTS: The analysis at the scansion electron microscope revealed that the opacity was caused by the deposition of calcium and phosphate within the lens optic and haptics. CONCLUSION: This is the first case about the opacification of an Oculentis L-313. The opacification was characterized by calcium and phosphate deposition probably due to a morphological alteration of the posterior surface of the IOL.

Cataract Surgery with Primary Lens Implantation in Children with Chronic Uveitis.

PURPOSE: To evaluate the evolution of chronic uveitis in children undergoing cataract surgery with primary intraocular lens (IOL) implantation. METHODS: Twelve children with chronic uveitis underwent cataract surgery with primary posterior chamber intraocular lens (IOL) implantation. RESULTS: Fourteen eyes were implanted with a foldable hydrophobic acrylic IOL. The mean follow-up was 35.39 months (8.72-69.57). The mean BCDVA before surgery and at the end of follow-up was 1.11 (0.40-2.30; SD: 0.57) and 0.48 (0-3; SD: 0.77; p=0.007) respectively. The mean oral corticosteroids dosage after surgery and at the end of follow-up was 0.80 mg/kg/day (SD: 0.37) and 0.17 mg/kg/day (SD: 0.24; p=0.001) respectively. All patients except one were treated with methotrexate. Four patients (5 eyes) were additionally treated with anti-tumor necrosis factor agent. CONCLUSIONS: Cataract surgery with primary posterior chamber hydrophobic IOL implantation is possible and leads to a good visual recovery in cases of pediatric chronic uveitis. This surgery requires aggressive anti-inflammatory management with immunosuppressive drugs to control inflammation and reduce the corticosteroids dosage.

Comparison of polymethylmethacrylate versus hydrophobic acrylic lenses for primary intraocular lens implantation in pediatric cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the visual results and postoperative complications of polymethylmethacrylate(PMMA)and hydrophobic acrylic intraocular lenses(IOLs)in children who underwent cataract extraction with primary IOL implantation.<p>METHODS:This retrospective study included 117 eyes of 63 children with bilateral pediatric cataract undergoing cataract surgery and primary IOL implantation. The patients were divided into two groups, Group I included 58 eyes of 30 patients with PMMA IOLs; Group II included 59 eyes of 33 patients with hydrophobic acrylic IOLs. The clinical features, refraction errors, best corrected visual acuity(BCVA)and surgical complications were compared between two groups.<p>RESULTS:The mean age at the time of surgery was 5.8(2-12)y and mean follow up period was 40.5(6-196)mo. Postoperatively, BCVA was ≥0.5 in 80 eyes(68.4%)and this was comparable in two groups. Visual axis opacification was seen in 28 eyes(48.3%)in Group I and 16 eyes(27.1%)in Group II and this difference was statistically significant(<i>P</i>=0.018). Postoperative IOL dislocation and posterior synechia formation were also noted. When all postoperative complications were considered, there were significantly less complications in the acrylic IOL group than PMMA IOL group(<i>P</i>=0.020).<p>CONCLUSION: Pediatric cataract surgery with primary IOL implantation is a safe procedure. Hydrophobic acrylic IOLs may lead to less postoperative complications compared to PMMA IOLs.

Biocompatibility of Intraocular Lenses.

The performance of an intraocular lens is determined by several factors such as the surgical technique, surgical complications, intraocular lens biomaterial and design, and host reaction to the lens. The factor indicating the biocompatibility of an intraocular lens is the behavior of inflammatory and lens epithelial cells. Hence, the biocompatibility of intraocular lens materials is assessed in terms of uveal biocompatibility, based on the inflammatory foreign-body reaction of the eye against the implant, and in terms of capsular biocompatibility, determined by the relationship of the intraocular lens with residual lens epithelial cells within the capsular bag. Insufficient biocompatibility of intraocular lens materials may result in different clinical entities such as anterior capsule opacification, posterior capsule opacification, and lens epithelial cell ongrowth. Intraocular lenses are increasingly implanted much earlier in life in cases such as refractive lens exchange or pediatric intraocular lens implantation after congenital cataract surgery, and these lenses are expected to exhibit maximum performance for many decades. The materials used in intraocular lens manufacture should, therefore, ensure long-term uveal and capsular biocompatibility. In this article, we review the currently available materials used in the manufacture of intraocular lenses, especially with regard to their uveal and capsular biocompatibility, and discuss efforts to improve the biocompatibility of intraocular lenses.

Akreos Adapt AO Intraocular lens opacification after vitrectomy in a diabetic patient: a case report and review of the literature.

BACKGROUND: Postoperative optic opacification of hydrophilic acrylic intraocular lenses (IOLs) is an uncommon complication leading to IOL explantation. In the past decade, several studies reported that the granular deposits responsible for the opacification were probably calcium and phosphate salts; however, the exact mechanism causing calcification of IOLs is unknown. The aim of this study is to describe clinical and laboratory findings of a case of late postoperative opacification of an aspheric hydrophilic acrylic IOL (Akreos Adapt AO) after vitrectomy. CASE PRESENTATION: A 60-year-old woman diagnosed with cataract and severe nonproliferative diabetic retinopathy (NPDR) underwent uneventful phacoemulsification and hydrophilic acrylic IOL (Akreos Adapt AO, Bausch & Lomb) implantation in both eyes. Seven months later, the woman came back with a complaint of blurry vision in the left eye. Fundus examination revealed vitreous hemorrhage in the left eye veiling the retinal detail. A 23-gauge vitrectomy with endolaser treatment was performed in the left eye. Ten months after the vitrectomy, the patient complained of decreased visual acuity in the left eye again. On slit-lamp examination, we observed a well circumscribed centrally and paracentrally located opacification within the pupillary area localized to the anterior surface of the IOL. The IOL was explanted from the left eye together with the capsular bag, and an iris-claw lens (Artisan Aphakia OPHTEC) was implanted. The explanted IOL was examined under pathological evaluation (alizarin red method). CONCLUSIONS: IOL opacification is a rare event. We described a case of postoperative opacification of the Akreos Adapt AO IOL after vitrectomy in a patient with proliferative diabetic retinopathy and found the deposits on the anterior surface of the IOL consisted of calcium aggregates. Given the higher frequency of postoperative opacification observed in diabetic patients, hydrophilic acrylic IOLs should be used with caution in patients with diabetes.

Clinical Outcome of Ciliary Sulcus-Implanted Single-Piece Foldable Acrylic Intraocular Lens

PURPOSE: To evaluate complications and refractive outcomes of implantation of a single-piece acrylic intraocular lens (SPA-IOL) in the ciliary sulcus during phacoemulsification complicated with posterior capsule tear (PCT). METHODS: This retrospective study included patients who visited our hospital from 2014 January to 2015 June with implantation of a SPA-IOL (RAYNER 920H Superflex) in the ciliary sulcus during phacoemulsification complicated with PCT. Patients had their IOL power reduced by 1 diopter (D) from that calculated for in-the-bag implantation. At 3 months after operation, best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA) and a refraction test were performed. RESULTS: PCT requiring implantation of IOL in the ciliary sulcus occurred in 17 eyes. Postoperative complications included corneal edema (3 eyes), anterior segment inflammation (1 eye), intraocular pressure elevations (3 eyes). However, improvements resulting from proper management and no significant IOL decentration were observed. At 3 months after operation, the mean spherical equivalent was -0.79 ± 0.39 D (-0.25 to -1.5 D), the mean UCVA was 0.77 ± 0.22 (0.4 to 1.0), and the mean BCVA was 0.94 ± 0.08 (0.8 to 1.0). CONCLUSIONS: Sulcus implantation of a SPA-IOL (RAYNER 920H Superflex) has no clinically significant complication, and the mean spherical equivalent after 3 months with a power reduction of 1.0 D was -0.79 ± 0.39 D (-0.25 to -1.5 D).

Comparison of posterior capsule opacification at 360-degree square edge hydrophilic and sharp edge hydrophobic acrylic intraocular lens in diabetic patients.

AIM: To compare posterior capsule opacification (PCO) degree and visual functions after phacoemulsification in eyes implanted with 360-degree square edge hydrophilic acrylic intraocular lens (IOL) (570C C-flex, Rayner) and sharp edge hydrophobic acrylic IOL (Sensar AR40e, AMO) in diabetic patients. METHODS: Sixty diabetic patients underwent uneventful phacoemulsification and randomly implanted one of the two IOLs. The PCO value was measured by retroillumination photographs and Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software at 1, 6, 12, and 24mo after surgery. Visual acuity, and contrast sensitivity in photopic and mesopic conditions were also examined at each follow up time point. The incidence of eye that required Nd:YAG laser posterior capsulotomy were also compared. RESULTS: There was not any statistically significant difference in PCO scores between Rayner C-flex 570C group and Sensar AR40e group at each follow up time point. Visual acuity, Nd:YAG capsulotomy incidence and contrast sensitivity also had no significant difference during the 24mo follow-up. CONCLUSION: For diabetic patients, Rayner 570C C-flex and Sensar AR40e IOLs are same effective for prevent PCO. The 360-degree square edge design maybe is a good alternative technique to improve PCO prevention.

Haptic breakage after transscleral fixation of a single-piece acrylic intraocular lens.

PURPOSE: To report the case of a patient with a damaged haptic of an acrylic intraocular lens (IOL) after transscleral IOL fixation. METHODS: This is a retrospective and descriptive case report. RESULTS: A 40-year-old man presented with sudden visual loss in the left eye. He had undergone phacoemulsification/aspiration and IOL implantation 3 years previously and IOL repositioning with transscleral fixation 2 years before the initial visit. His visual acuity was 0.3 in the left eye due to corneal edema caused by a foreign body, i.e., the severed haptic tip of the single-piece acrylic IOL, which was surgically removed. The IOL itself was tilted and therefore explanted. The surface of the tip of the haptic suggested that the monofilament suture thread had exerted continuous force across the haptic. CONCLUSIONS: The haptics of acrylic IOLs can be damaged after transscleral fixation.

Neodymium:yttrium-aluminum garnet capsulotomy rates after combined cataract surgery with implantation of a 4% water content hydrophobic acrylic intraocular lens and vitrectomy.

BACKGROUND: The purpose of this study was to examine neodymium:yttrium-aluminum garnet (Nd:YAG) capsulotomy rates after combined cataract surgery with implantation of a three-piece 4% water content hydrophobic acrylic intraocular lens (X-70, Eternity®) and vitrectomy, and compare diabetic retinopathy with nondiabetic retinopathy. METHODS: Nd:YAG capsulotomy rates were evaluated for 72 eyes of 72 patients with diabetic retinopathy and 81 eyes of 81 patients with nondiabetic retinopathy (50 eyes with retinal detachment, 13 eyes with macular hole, nine eyes with epiretinal membrane, seven eyes with branch retinal vein occlusion, and two eyes with uveitis) who underwent combined cataract surgery and vitrectomy and implantation of X-70. RESULTS: Two years after combination surgery, four of 72 eyes (5.6%) in the diabetic retinopathy group and four of 81 eyes (5.0%) in the nondiabetic retinopathy group required Nd:YAG capsulotomies. Kaplan-Meier survival analysis showed no statistically significant differences between the two groups (P=0.30, Mantel-Cox log-rank test). CONCLUSION: The rate of Nd:YAG capsulotomy did not significantly differ between diabetic retinopathy and nondiabetic retinopathy after combined cataract surgery with implantation of the X-70 and vitrectomy. X-70 is an acceptable intraocular lens for patients undergoing combined cataract surgery and vitrectomy.

Softec HD hydrophilic acrylic intraocular lens: biocompatibility and precision.

Intraocular lens development is driven by higher patient expectations for ideal visual outcomes. The recently US Food and Drug Administration-approved Softec HD(™) lens is an aspheric, hydrophilic acrylic intraocular lens (IOL). The hydrophilic design of the lens is optimized to address dysphotopsia while maintaining biocompatibility, optical clarity, resistance to damage, and resistance to biocontamination. Aspheric lenses decrease postoperative spherical aberration. The addition of the Softec lens provides clinicians with another option for IOL placement; however, randomized comparative studies of this lens to others already on the market remain to be completed.

Prediction of Refractive Error in Combined Vitrectomy and Cataract Surgery With One-Piece Acrylic Intraocular Lens

PURPOSE: To compare the predicted and actual refractive errors of hydrophilic, one-piece, C-flex(R)570C (C-flex) intraocular lens (IOL) implantation in simultaneous vitrectomy and lens extraction in various conditions. METHODS: One hundred fifty-nine eyes of patients who had lens extraction between March 2004 and September 2005 were enrolled in a retrospective study. Group 1 had lens extraction and IOL implantation, and Group 2 had lens extraction and IOL implantation with vitrectomy. IOL calculation was done with axial length and keratometry measurements. The actual and predicted refractive errors were compared at 1 and 6 months postoperatively. The factors influencing the postoperative refractive outcomes were analyzed. RESULTS: The mean refractive predictive error (i.e., the actual minus predicted spherical equivalent) was +0.19+/-0.39 D (Diopter) and -0.26+/-0.45 D at 1 and 6 months postoperatively (all: p0.05). CONCLUSIONS: Refractive errors in combined surgery showed myopic shift of -0.50 D and -0.32 D at 1 and 6 months postoperatively compared with C-flex IOL implantation alone. With the hyperopic tendency of IOL and myopic tendency of vitrectomy, the combined surgery made postoperative refractive errors near emmetropia.

Comparison of Long-Term Results between One-piece and Three-piece Acrylate Intraocular Lens

PURPOSE: To compare the long-term clinical results of one-piece Acrysof(R) (SA60AT) hydrophobic acrylic intraocular lens (IOL) implantation compared with implantation of three-piece Acrysof(R) (MA60BM) hydrophobic acrylic IOL. METHODS: We retrospectively analyzed each 50 eyes of 50 patients underwent MA60BM or SA60AT IOL implantation and followed for at least 6 months. RESULTS: Final visual acuity of 0.5 or better was 38 eyes (76%) and 0.8 or better was 20 eyes (40%) in the SA60AT group. In the MA60BM group, it was 41 eyes (82%) and 23 eyes (46%) respectively. There were no significantly differences in predictability, intraocular pressure, endothelial cell density, astigmatism, and incidence of posterior capsule opacification between the two groups. Spherical equivalent at postoperative 1 week was -0.50+/-0.95D in SA60AT group and was -0.31+/-0.88D in MA60BM group (P=0.04). However, there was no significant difference between the two groups during follow up period. In MA60BM group, anterior chamber depth (P=0.02) and distance between iris and IOL (P=0.04) reduced significantly during the first postoperative month. CONCLUSIONS: Early postoperative axial displacement and changes in spherical equivalent can be occurred in MA60BM group. However there was no difference in long-term clinical results between SA60AT and MA60BM groups.

Comparison of High Order Aberration in Pseudophakic Eyes with Different Acrylic Intraocular Lenses (IOLs)

PURPOSE: To compare high order aberrations (HOA) among pseudophakic eyes with three different types of acrylic intraocular lenses (IOLs) and phakic eyes. METHODS: The ocular aberrations were measured within the central 4 mm pupil zone, using the Hartmann-Shack aberrometer in the eyes with acrylic IOLs, such as Acrysof(R) MA60BM, Acrysof(R) SA60AT, or Sensar(R) AR40e, at one month after uneventful cataract surgery and in the phakic eyes. Total HOA root-mean-square (RMS) value, coma, trefoil, and spherical aberration were compared among the groups. RESULTS: A total 49 pseudophakic and 18 phakic eyes were enrolled. Of the acrylic IOLs, Acrysof(R) MA60BMs (Alcon) were inserted in 16 eyes, Acrysof(R) SA60ATs (Alcon) in 16 eyes, Sensar(R) AR40es (Allergan Surgical) in 17 eyes. The average ages and pupil diameters among the four groups were not different (p=0.413, 0.797, respectively). The RMS values of total HOA, coma, and trefoil were not different among the groups (p=0.781, 0.370, 0.509, respectively), whereas the spherical aberration was significantly different among the four groups (p=0.033, Kruskal-Wallis test). There was no difference in the spherical aberration of the three acrylic IOL groups, but eyes with Acrysof(R) MA60BMs, Acrysof(R) SA60ATs had a larger spherical aberration than phakic eyes (p=0.040, 0.021, respectively, Mann-Whitney U test). CONCLUSIONS: There were no statistically significant differences in total HOA, coma, and trefoil among pseudophakias implanted with three different acrylic IOLs and phakic eyes. There was no difference in spherical aberration between the different IOL groups, but eyes with some acrylic IOLs had a larger spherical aberration than phakic eyes.

Clinical Results of Implantation of Hydrophilic Acrylic Intraocular Lenses

PURPOSE: To evaluate the clinical results of Akreos(R) hydrophilic acrylic intraocular lens (IOL) implantation compared with implantation of Acrysof(R) hydrophobic acrylic IOL. METHODS: We retrospectively analyzed each fifty eyes in 50 patients who had undergone phacoemulsification and implantation of Akreos(R) and Acrysof(R) IOLs, with a minimum follow-up period of one year. RESULTS: Final visual acuity better than 0.5 and 0.8 was 70% and 27% in the Akreos(R) implanted group, and 82% and 46% in the Acrysof(R) group. Predictability less than 1.0D was seen in 23 eyes (46%) in the Akreos(R) group. This is a significantly low percentage compared with that seen in 43 eyes (86%) in the Acrysof(R) group. The final spherical equivalent of -0.93+/-0.92D in the Akreos(R) group represented statistically significant myopic refractive error compared with -0.49+/-0.82D in the Acrysof(R) group. CONCLUSIONS: It is necessary to consider the myopic refractive error toDetermine the proper target refraction for the implantation of Akreos(R) IOL.