Analysis of 100 Explanted One-piece and Three-piece Silicone Intraocular Lenses
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Intraocular lenses
About 35% of intraocular lenses now implanted in the United States are narrow profile lenses, measuring on the average 5.0 mm by 6.0 mm. This study sought to determine whether these lenses cause unwanted optical images with a decrease in the quality of vision. Seventy-five eyes with a 5.0 mm × 6.0 mm intraocular lens (IOL) were compared with 75 eyes with a 6.5 mm IOL. All patients had capsulorhexis, phacoemulsification, and capsular fixation of the IOL. There was no statistically significant difference in unwanted visual images (16% and 20%, respectively), ability to drive at night (79% and 69%), or patient satisfaction. Careful patient selection is, however, important.
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Glued intrascleral haptic fixation of an intraocular lens (glued IOL) has evolved as a technique with various modifications that are adopted and practiced by several surgeons. With adequate and appropriate haptic tuck, glued IOL imparts a stable IOL fixation and is a secured method of secondary IOL placement with no pseudophacodonesis.
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This review provides an update of recent advances in understanding the quality and functional significance of contrast sensitivity for the clinician regarding cataract, intraocular lenses and refractive surgery that goes beyond the measurement of visual acuity.New American National Standards Institute standards for contrast sensitivity based on linear sine-wave gratings are discussed that promise rapid advances of understanding and quantifying visual quality and function by unifying clinical results reported using contrast sensitivity. Increased sensitivity of linear sine-wave gratings over proposed bull's-eye radial gratings is discussed. Digital-image-processing software uses contrast sensitivity data to process images to help understand the quality of what the patient sees. Contrast sensitivity measurement is compared with wavefront aberrometry. Contrast sensitivity measures the total visual system quality in terms of contrast, whereas wavefront aberrometry measures the optical quality in terms of spatial distortion. Both measurements are needed to more fully understand the quality of vision.Recent advances provide the clinician with an awareness of why the new contrast-sensitivity standards are based on linear sine-wave gratings and how image-processing software can be used to better understand the quality of functional vision of the patient.
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Difficulties in showing the biologic activity of silicones in vitro have contributed to the controversy over effects of silicone mammary implants in vivo. We adapted a standard lymphocyte stimulation test to detect evidence of cellular immunity in patients with silicone gel implants. Initially, lymphocytes were harvested from 70 implant patients, 76 normal controls without implants or symptoms, and 18 patients with classic rheumatic disorders and without a history of silicone implants. The harvested lymphocytes were stimulated with PWM, PHA, Con A, and pharmaceutical grade colloidal silicon dioxide (silica). Implant patients showed increased SI compared to controls and those with rheumatic disorders. The mean SI of implant patients was 195.0 +/- 19.3, 18-fold that of normal controls (< 0.0001). Patients with rheumatic disease showed the same SI as controls (P = 0.3577). A follow-up study included 220 normal controls without implants, 942 silicone gel implant patients with demonstrable rheumatic symptoms, and 34 implant patients without symptoms at the time of the study. The average SI for the 220 normal controls was 10.0 +/- 0.41. Among the symptomatic implant women, 860 (91.3%) had SI significantly above those of the normal controls. Of these, 171 (18.2%) had SI between 25 and 50, 316 (33.5%) had SI between 50 and 100, and 373 (39.6%) had SI over 100. The data presented confirms that silicone implant patients respond immunologically to the silicon dioxide contained in mammary prostheses.
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In this paper we compare 4 groups of intraocular lenses: PMMA, silicone, hydrogel, acrylic and their influence on posterior capsule opacification is discussed. The possible clinical consequences of different shape in optic part of intraocular lens is also described. This article contains also a short presentation of posterior capsule opacification mechanism and intraocular lens materials biocompatibility in in-vivo and in-vitro experiments.
Posterior Capsule Opacification
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Purpose: To compare surface alterations between preloaded and manually loaded intraocular lens. Methods: Scanning electron microscope was utilized to evaluate surface alteration and deposits in four different types of intraocular lenses: preloaded hydrophobic acrylic, preloaded hydrophilic acrylic, manually loaded hydrophobic acrylic, and manually loaded hydrophilic acrylic. Six lenses with different powers (+6 D, +22 D, and +29 D) were used from each category, to represent different thickness categories of the intraocular lenses. Results: In total, 30 intraocular lenses have been evaluated in this study: 4 from the control group (2 hydrophobic and 2 hydrophilic lenses) and 12 from the preloaded intraocular lens and manually loaded groups (6 hydrophilic and 6 hydrophobic lenses with different powers). Surface deposits were found in eight hydrophobic intraocular lenses compared to a single intraocular lens with scattered deposits on the optical surface of a hydrophilic intraocular lens. In manually loaded intraocular lens group, five hydrophobic and one hydrophilic intraocular lenses showed identifiable marks on the optical surface. In the preloaded intraocular lens group, three hydrophobic intraocular lenses showed identifiable marks on the optical surface and three hydrophobic intraocular lenses showed surface wrinkling. All hydrophilic intraocular lenses revealed no identifiable marks. Conclusion: Surface alterations and deposits are a common finding in both preloaded and manually loaded intraocular lenses. Water content of acrylic intraocular lenses is an important factor predisposing to these changes, and hydrophobic intraocular lenses are more vulnerable than hydrophilic lenses. The impact on the final visual outcome needs further studies.
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Cataract extraction
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