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LABORATORY SCIENCE

Evaluating and defining the sharpness


of intraocular lenses
Microedge structure of commercially available
square-edged hydrophobic lenses
Liliana Werner, MD, PhD, Matthias Muller, PhD, Manfred Tetz, MD

PURPOSE: To evaluate the microstructure of the edges of currently available square-edged hydrophobic intraocular lenses (IOLs) in terms of their deviation from an ideal square.
SETTING: Berlin Eye Research Institute, Berlin, Germany.
METHODS: Sixteen designs of hydrophobic acrylic or silicone IOLs were studied. For each design,
a C20.0 diopter (D) IOL and a C0.0 D IOL (or the lowest available plus dioptric power) were
evaluated. The IOL edge was imaged under high-magnification scanning electron microscopy using
a standardized technique. The area above the lateralposterior edge, representing the deviation
from a perfect square, was measured in square microns using reference circles of 40 mm and
60 mm of radius and the AutoCAD LT 2000 system (Autodesk). The IOLs were compared with an
experimental square-edged poly(methyl methacrylate) (PMMA) IOL (reference IOL) with an edge
design that effectively stopped lens epithelial cell growth in culture in a preliminary study. Two
round-edged silicone IOLs were used as controls.
RESULTS: The hydrophobic IOLs used, labeled as square-edged IOLs, had an area of deviation from
a perfect square ranging from 4.8 to 338.4 mm2 (40 mm radius reference circle) and from 0.2 to
524.4 mm2 (60 mm radius circle). The deviation area for the square-edged PMMA IOL was 34.0 mm2
with a 40 mm radius circle and 37.5 mm2 with a 60 mm radius circle. The respective values for
the C20.0 D control silicone IOL were 729.3 mm2 and 1525.3 mm2 and for the C0.0 D control
silicone IOL, 727.3 mm2 and 1512.7 mm2. Seven silicone IOLs of 5 designs had area values that
were close to those of the reference square-edged PMMA IOL. Several differences in edge finishing
between the IOLs analyzed were also observed.
CONCLUSIONS: There was a large variation in the deviation area from a perfect square as well as in
the edge finishing, not only between different IOL designs but also between different powers of the
same design. Clinically, factors such as the shrink-wrapping of the IOL by the capsule may even out
or modify the influence of these variations in terms of preventing posterior capsule opacification.
J Cataract Refract Surg 2008; 34:310317 Q 2008 ASCRS and ESCRS

Posterior chamber intraocular lenses (IOLs) with


a square posterior optic edge, regardless of the
material used in their manufacture, have been associated with better results in terms of posterior capsule
opacification (PCO) prevention.15 This IOL design
feature can be appropriately assessed in morphological
studies using scanning electron microscopy (SEM).
However, SEM studies of new IOLs have generally
focused on the quality of the optic surface or optic
finishing, with no specifications on how sharp the optic
edge must be to effectively prevent lens epithelial cells
(LECs) from growing onto the posterior capsule.6,7
310

Q 2008 ASCRS and ESCRS


Published by Elsevier Inc.

In a preliminary study, Tetz and Wildeck8 made the


first attempt to evaluate and quantify the edge structure of IOLs at the microscopic level. They experimentally evaluated the optimum microedge profile of an
IOL to prevent LEC migration in cell culture. Experimental poly(methyl methacrylate) (PMMA) IOLs
with different edge profiles were imaged under SEM,
and the area above the edge, representing the deviation from an ideal square, was calculated with a digital
system based on the Evaluation of Posterior Capsule
Opacification System (EPCO 2000 program9). In this
current follow-up study, we used improved
0886-3350/07/$dsee front matter
doi:10.1016/j.jcrs.2007.09.024

LABORATORY SCIENCE: MICROEDGE STRUCTURE OF COMMERCIALLY AVAILABLE SQUARE-EDGED HYDROPHOBIC IOLS

methodology to evaluate the optic microedge


structure of currently available hydrophobic IOLs
marketed as square-edged IOLs. The experimental
square-edged PMMA IOL in the study by Tetz and
Wildeck, with an edge design that effectively stopped
LEC growth in culture, was used as the reference IOL
with which the currently available square-edged IOLs
were compared.
MATERIALS AND METHODS
Commercially available hydrophobic IOLs with an optic
component manufactured from hydrophobic acrylic or
silicone materials were provided by the respective manufacturers for use in this study. All the IOLs are marketed as having a square optic edge. Two IOLs of each design were
evaluated: a C20.0 diopter (D) IOL and a C0.0 D IOL when
available. If an IOL design was not available in C0.0 D,
the lowest dioptric power for that design was used. The
commercially available IOLs were compared with an experimental square-edged PMMA IOL (reference IOL) manufactured for use in the preliminary study.8 The edge design
of the experimental IOL effectively stopped cell growth in
culture (area above the edge of 13.5 mm2 measured with
the EPCO 2000 system). Two silicone IOLs (C20.0 D and
C0.0 D) manufactured with round optic edges (model 733D,
Acri.Tec) were used as controls.
The SEM analyses were performed by an experienced
technician trained in edge analyses at the Technische Universitat, Berlin. Each IOL was carefully removed from its original packaging with a toothless forceps. This was done by
grasping the IOL by the haptics to prevent alteration of the
optic component. The IOLs were sputter-coated with gold,
mounted on a round sample aluminum stub for imaging,
and examined under a Hitachi S-2700 scanning electron microscope. During SEM examination, the analysis of each optic edge was done from a perpendicular view. To assist with
the perpendicular orientation of the specimen, information
Accepted for publication September 23, 2007.
From the Berlin Eye Research Institute (Werner, Muller, Tetz),
Berlin, Germany, and John A. Moran Eye Center (Werner), University
of Utah, Salt Lake City, Utah, USA.
No author has a financial or proprietary interest in any material or
method mentioned.
Presented in part at the XXV Congress of the European Society of
Cataract & Refractive Surgeons, Stockholm, Sweden, September
2007.
Supported in part by unrestricted research grants to the BERI from
Alcon, AMO, WaveLight, Hoya, and Advanced Vision Science, and
by a 2007 ESCRS research grant (Werner).
Jorg Nissen, Dipl.-Ing. (FH), Zentraleinrichtung Elektronenmikroskopie, Technische Universitat, Berlin, Germany, assisted with the
scanning electron microscopy analyses.
Corresponding author: Liliana Werner, MD, PhD, Berlin Eye
Research Institute, Alt-Moabit 98/99, D-10559, Berlin, Germany.
E-mail: werner.liliana@gmail.com.

311

on the radius of anterior and posterior IOL surfaces was obtained from the respective manufacturers as some biconvex
IOL designs are not equiconvex. The authors signed
confidentiality agreements with the respective manufacturers;
as this type of information is generally confidential, it is not included in this report. Photographs of the optic edge of each
IOL from a perpendicular view were obtained at 3 magnifications: 25, 300, and 1000. The first 2 magnifications were
used to document the overall orientation of the specimen,
and the 1000 magnification photographs were used for the
microedge analysis (Figure 1, A and B).
The following procedures were performed by the same
observer (L.W.): The SEM photographs of each IOL were
saved as electronic, high-resolution JPEG files. They were
then imported into the AutoCAD LT 2000 system (Autodesk). This program, which is commonly used in engineering and architecture, allows accurate area calculations. The
first step was to adjust the scale of the photograph into the
program using the reference bar incorporated on the right
bottom corner of each SEM photograph. After the scale on
each photograph was confirmed by measuring the reference
bar and obtaining the corresponding value, a reference circle
of known radius, divided into 4 quadrants by 2 perpendicular lines passing through its center, was projected onto the
photograph. The position of the circle was adjusted so that
the end of both perpendicular lines touched the lateral and
posterior IOL optic edges. The area of the lateralposterior
IOL edge deviating from a perfect square defined by the 2
perpendicular lines inside the reference circle was easily delineated using the computer mouse. The measurement of the
area was then calculated by the program and provided in
square micrometers. This was done using 2 reference circles
with a different radius: 40 mm and 60 mm (Figure 1, C and D).
The minimum radius size of 40 mm was chosen as a function
of the size of the human LEC, which in vivo was shown to
have a size ranging from 8 to 21 mm in diameter, with larger
lengths.10 The area evaluated was therefore the area of interaction of at least 1 LEC with the optic edge.

RESULTS
Table 1 shows the characteristics of the IOLs used in
this study, including the values of the area representing the deviation from an ideal square measured in
each IOL with the AutoCAD system. Figure 2 shows
SEM photographs of the lateralposterior edge of all
IOLs analyzed incorporated into the AutoCAD analysis screen. The Hydromax IOLs and the L200 and the
L450 IOLs were received in the laboratory in nonsterile
IOL containers. The C0.0 D X-60 IOL was manufactured for this study and was also provided in a nonsterile container. All remaining IOLs were received in their
original commercial packages. Two dioptric powers
were analyzed for each IOL design except the L200
and the L450 IOLs, for which only the C20.0 D model
was analyzed. A C19.0 D rather than a C20.0 D Hydromax IOL was analyzed.
For the square-edged PMMA IOL, the value of the
area measured with the AutoCAD system with the
40 mm radius circle and 60 mm radius circle was
34.0 mm2 and 37.5 mm2, respectively. The respective

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LABORATORY SCIENCE: MICROEDGE STRUCTURE OF COMMERCIALLY AVAILABLE SQUARE-EDGED HYDROPHOBIC IOLS

Figure 1. Scanning electron microscopy and AutoCAD analyses of 1 IOL used in this study. A: Perpendicular view of the optic edge
obtained with a magnification of 25. All IOLs were oriented with the lateral edge up and the anterior and posterior surfaces on the right
and left sides, respectively. The SEM photographs of the 25 and 300 helped to control the orientation of the specimens. In this case, the
IOL is equiconvex; that is, the distance between the right edge and the anterior surface and between the left edge and the posterior surface
(bottom of photograph) is the same. B: Perpendicular view of the lateralposterior optic edge obtained with 1000 magnification. The 30 mm
bar was used to adjust the scale of the photograph into the AutoCAD program. C and D: AutoCAD screens of the analyses of the photograph in B using 40 mm radius and 60 mm radius circles, respectively. The magnification of the photographs on the screens was adjusted
to incorporate the entire bottom-right quadrant of each circle. The area in red corresponds to the deviation from the ideal square, which
was measured as 281.4 mm2 and 520.4 mm2, respectively.

values for the C20.0 D control silicone IOL were


729.3 mm2 and 1525.3 mm2 and for the C0.0 D control
silicone IOL, 727.3 mm2 and 1512.7 mm2. The value
for the square-edged PMMA IOL measured with the
60 mm radius circle was similar (1.1 times larger) to
the value measured with the 40 mm radius circle. The
values for the C20.0 D and C0.0 D silicone control
IOLs measured with the 60 mm radius circle were twice
the values measured with the 40 mm radius circle. Intraocular lenses 10, 19, 23, 26, and 27 had area values
measured with both reference circles that were smaller
than the corresponding values of the reference squareedged PMMA IOL, and IOLs 25 and 28 had values that
were close to those of the reference IOL. Four of the
above-mentioned 7 IOLs were C20.0 D; the other 3
were C0.0 D (n Z 1) or of the lowest dioptric power
available for the design (n Z 2). All were silicone
IOLs. The difference between acrylic and silicone
IOLs in the area measured with the AutoCAD system
with the 40 mm radius circle and 60 mm radius circle
was statistically significant (P Z .0017 for both radii,
Wilcoxon 2-sample test). The area value measured

on all 7 IOLs with the 60 mm radius reference circle


was similar (maximum 1.2 times larger) to the corresponding value measured with the 40 mm circle, as
with the square-edged PMMA IOL. This was also
observed with IOLs 2, 8, and 22.
For IOLs 16 and 26, the area values measured with
the 60 mm radius circle were smaller than the values
measured with the 40 mm radius circle. This can be
explained by the projection angles formed by the lateral and posterior optic edges of the IOLs, which are
smaller than 90 degrees (Figure 3). In contrast, it
appeared that the projection angle formed by the lateral and posterior optic edges of some IOLs was larger
than 90 degrees (Figure 3). This was especially
observed with IOL 6, leading to an area value with the
60 mm radius circle that was 1.95 times larger than the
value with the 40 mm radius circle. All remaining
IOLs had area values with the 60 mm radius circle
that were from 1.3 to 2.0 times larger than the values
with the 40 mm radius circle, and this was mostly
a function of the convexity of the IOLs posterior optic
surface. For the following designs, the values

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Table 1. Characteristics of the IOLs used in the study.


IOL Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

IOL Model

IOL Manufacturer

Dioptric Power

Optic Material

Area 40* (mm2)

Area 60 (mm2)

SA60AT
SA60AT
SN60WF
SN60WF
MA60AC
MA60MA
Z9000
Z9000
Z9002
Z9002
ZA9003
ZA9003
AR40e
AR40M
VA60BB
VA60BB
Hydromax
Hydromax
L200
L450
X-60
X-60
SofPort AO
SofPort AO
SoFlex SE
SoFlex SE
AQ310Ai
AQ310Ai
Matrix acrylic
Matrix acrylic

Alcon
Alcon
Alcon (aspherical)
Alcon (aspherical)
Alcon
Alcon
AMO (aspherical)
AMO (aspherical)
AMO (aspherical)
AMO (aspherical)
AMO (aspherical)
AMO (aspherical)
AMO
AMO
Hoya
Hoya
Zeiss
Zeiss
WaveLight
WaveLight
AVS
AVS
B&L (aspherical)
B&L (aspherical)
Bausch & Lomb
Bausch & Lomb
Staar (aspherical)
Staar (aspherical)
Medennium
Medennium

20.0
6.0
20.0
6.0
20.0
0.0
20.0
5.0
20.0
5.0
20.0
10.0
20.0
0.0
20.0
0.0
19.0
10.0
20.0
20.0
20.0
0.0
20.0
0.0
20.0
0.0
20.0
12.5
20.0
0.0

Acrylic
Acrylic
Acrylic
Acrylic
Acrylic
Acrylic
Silicone
Silicone
Silicone
Silicone
Acrylic
Acrylic
Acrylic
Acrylic
Acrylic
Acrylic
Acrylic
Acrylic
Silicone
Acrylic
Acrylic
Acrylic
Silicone
Silicone
Silicone
Silicone
Silicone
Silicone
Acrylic
Acrylic

97.2
114.5
136.5
100.1
278.9
268.8
281.4
78.2
202.6
17.7
188.4
232.0
196.6
338.4
329.7
169.5
116.5
104.4
28.7
138.8
268.0
202.7
16.9
89.3
40.1
4.8
19.7
38.9
133.8
69.5

157.5
122.4
228.8
159.4
421.0
524.4
520.4
96.5
359.6
21.7
377.8
391.7
403.5
448.3
427.3
111.5
211.2
171.0
30.3
287.3
395.0
232.7
17.5
123.7
39.9
0.2
20.1
39.9
275.5
131.8

*Edge area of deviation from an ideal square measured with the AutoCAD system using the 40 mm radius reference circle
Edge area of deviation from an ideal square measured with the AutoCAD system using the 60 mm radius reference circle

measured on the C20.0 D IOLs with both reference circles were larger than the corresponding values measured on the C0.0 D (or lowest available dioptric
power) IOLs: SN60WF, Z9000, Z9002, VA60BB, Hydromax, X-60, SoFlex SE, and Matrix Acrylic. The difference between C20.0 D and C0.0 D (or lowest
available dioptric power) IOLs regarding the area
measured with the AutoCAD system with 40 mm radius circle and 60 mm radius circle was not statistically
significant (P Z .4419 and P Z .2616, respectively; Wilcoxon 2-sample test).
On SEM evaluation of the surface characteristics of
the optic edge, IOLs 1 through 6 showed various degrees of surface rugosity. Intraocular lenses 7, 8, 19,
22 through 24, 27, and 28, as well as the square-edged
experimental PMMA IOL, had mild to moderate
degrees of surface irregularities. Intraocular lenses
9 through 18, 20, 21, 25, 26, 29, and 30, as well as
the control round-edged silicone IOLs, had overall smooth edge surfaces. Variations in surface

characteristics between the 2 dioptric powers analyzed


were found with the following designs: SA60AT,
SN60WF, MA60AC/MA, Z9000, X-60, and AQ310Ai.
DISCUSSION
A square edge on the posterior optic surface was
found to be the most important IOL-related factor
in PCO prevention. According to experimental studies, this may be due to the mechanical barrier effect
exerted by the square edge,11,12 contact inhibition of
migrating LECs at the capsular bend created by the
sharp optic edge,13,14 higher pressures exerted by
IOLs with a square-edged optic profile on the posterior capsule,15,16 or perhaps to various mechanism
combinations.
In a preliminary study,8 the optimum microedge
design feature of an IOL to prevent LEC migration
was evaluated in an in vitro setting. Plano C0.0 D
PMMA IOLs with 11 defined edge designs were

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Figure 2. AutoCAD screens of the analyses (40 mm radius circle) of SEM photos obtained from the study IOLs.

manufactured for use in the preliminary study. To obtain different edge designs, the IOLs were removed
from the tumble-polishing machine at different times.
To evaluate the optic edges, standardized SEM pictures with an enlargement of 500 were taken of
1 IOL in each group. A digital computer system

(EPCO 2000 program)9 was used to evaluate the area


above the edges on the SEM photographs. To achieve
this, the area had to be defined as the deviation from
an ideal rectangular projection. The edges ability to
stop cell growth was observed by placing each IOL
into cell culture and observing bovine LEC growth

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Figure 2 (cont.)

over 18 days on average. Only 3 groups of IOLs, those


with the sharpest edge design, prevented the growth
of LECs onto the visual axis of the IOL. The edge design that effectively stopped cell growth was characterized by an area above the edge, measured with
the EPCO system, of 13.5 mm2 at most.
In the current study, we used the AutoCAD
program to calculate the area of deviation from an
ideal square formed by the lateralposterior edges of
currently available square-edged hydrophobic IOLs.
Measurement with this program was easy as it allows

Figure 3. Scanning electron microscopy photographs of IOLs 16, 26,


and 6 (Table 1). The arrows on the bottom photographs show the
projection angle formed by the lateral and posterior edges of the
optic (continuous lines). The punctuated line delineates the theoretical
90-degree angle.

315

great flexibility in the adjustment of the measurement


scale and in the projection of structures of known
dimensions onto the photographs. Projection of the 2
circles of known radius, with 2 perpendicular lines
crossing their centers, helped us standardize the measurements. Indeed, on each 1,000 SEM photograph,
there is only 1 site for each circle where the 2 lines
touch the lateral and posterior edges of the IOL. We
used the square-edged PMMA IOL from the preliminary study8 as the reference IOL in the present study.
Therefore, we remeasured the deviation area of this
IOL according to the technique described in this paper.
The new cutoff limits obtained with the AutoCAD system were 34.0 mm2 and 37.5 mm2 for the 40 mm radius
reference circle and 60 mm radius reference circle,
respectively. Intraocular lenses with deviation areas
close to the cutoff limits (or smaller) had similar values
for the 40 mm and 60 mm radius circles, while the others
had a tendency to present increasing values with the
larger radius, mostly as a function of the convexity
of their posterior optic surface.
Of the 30 commercially available square-edged,
hydrophobic IOLs evaluated, only 7 of 5 designs had
area values that were smaller than, or close to, those
of the reference square-edged PMMA IOL. To our
knowledge, there are no clinical studies in the literature that directly compare these IOL designs (Z9002,
L200, SofPort AO, SoFlex SE, and AQ310Ai) with the
other designs shown in Table 1 in terms of PCO prevention. The AQ310NV (nonaspherical version of the
AQ310Ai IOL used in this study) was compared
with the MA60BM in a clinical study assessing postoperative PCO with an anterior eye segment image analyzer.17 No statistically significant difference was
found between the 2 IOLs in PCO formation 12
months postoperatively. Of the IOLs in Table 1 with
an OptiEdge configuration, only the C5.0 D Z9002
had area values smaller than the reference squareedged PMMA IOL values. All other OptiEdge IOLs
(C20.0 D Z9002, C20.0 D and C10.0 D Z9003,
AR40e, and AR40M) had much higher values. However, incorporation of the posterior square optic edge
design feature (present in the OptiEdge configuration)
clearly improved the outcome of PCO formation with
the Sensar IOL (AR40e), as shown by Buehl et al.2 in
a prospective randomized study. The same finding
was seen in a study comparing the SoFlex SE IOL
with its predecessor, the SoFlex Li61U, with round
edges.5 Similarly, other studies comparing different
IOL designs in terms of PCO formation conclude
that IOLs with a square optic edge provide better
results, regardless of IOL material.1,3,4
If IOLs with different square microedge profiles produce similar outcomes in terms of PCO formation, one
can conclude that other factors play a role in the

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prevention of this complication. We believe the factor


that may play the most important role in evening out
the differences in the microedge profiles in our study
is shrink-wrapping of the IOL by the capsular bag,
which enhances contact between the posterior IOL
surface and the posterior capsule. The amount of postoperative capsular bag shrinkage has been indirectly
determined in clinical studies by the measurement of
the diameter or area of the capsulorhexis opening at
different postoperative time points. Gonvers et al.18
prospectively evaluated 26 eyes with a single-piece
PMMA IOL and 27 with plate-haptic silicone IOLs.
In their study, the capsulorhexis used with the singlepiece PMMA IOLs had a slight tendency to constrict,
with a mean surface decrease of 0.59 G 2.16 mm2
(4.3%). The capsulorhexis used with plate-haptic
silicone IOLs showed a marked and statistically significant constriction, with a mean decrease of 2.55 G
3.51 mm2 (14.4%). In another prospective study of 38
eyes of 32 patients with a 3-piece hydrophobic acrylic
IOL, Kimura et al.19 found that the postoperative
reduction ratio in capsulorhexis diameter was 2.14%
at 1 week, 3.83% at 1 month, 4.29% at 3 months, and
5.03% at 6 months. Joo et al.20 evaluated 166 pseudophakic eyes 1 week and 1 and 3 months postoperatively by measuring the capsule opening diameter
with an image-analysis system. The capsule opening
diameter was reduced by an average of 13.87% 3
months after capsulorhexis. Tehrani et al.21 found
mean capsular bag shrinkage of 14.8% over a 6-month
postoperative period. They used a different approach.
In their study, 58 eyes were implanted with a 3-piece
hydrophobic acrylic IOL and a Koch capsule measuring ring (HumanOptics). This allowed measurement
of the capsular bag diameter at different postoperative
time points.
Hayashi and Hayashi22 believe that of the different
IOL factors, optic material has the most significant
effect on the degree of anterior capsule contraction.
They evaluated 331 patients scheduled for bilateral
cataract surgery to compare the degree of anterior
capsule contraction in fellow eyes that received IOLs
that were different with regard to the following
factors: (1) optic material: hydrophobic acrylic optic
versus silicone optic; (2) optic design: round edge
versus sharp edge; (3) haptic material: PMMA loop
versus polyvinylidene fluoride loop; and (4) haptic
material and design: single-piece hydrophobic acrylic
versus 3-piece PMMA haptic. The 2 IOLs implanted in
the fellow eyes of each patient had almost the same
material and design except for the specific factor being
compared. The mean percentage reduction of the
anterior capsule opening area was only significantly
greater in eyes with a silicone optic IOL than in eyes
with a hydrophobic acrylic optic IOL. This relates to

the finding of significantly more capsule fibrosis


with silicone IOLs, as demonstrated in studies of
human eyes obtained post-mortem.23,24
We also found several differences in edge finishing
between the IOLs analyzed, not only between different designs but also between different powers of the
same design. Modification of the finishing of the AcrySof IOLs, giving the side walls an unpolished or
textured appearance (so called frosting), was associated with fewer complaints of glare phenomena than
IOLs of earlier design.25 Under 1000 magnification,
this finishing was seen as various degrees of surface
rugosity. The surfaces of the other IOLs ranged from
being overall smooth to having mild or moderate
irregularities.
In summary, analysis of the microstructure of the
optic edge of currently available, square-edged hydrophobic IOLs showed a large variation in the deviation
area from a perfect square and a large variation in the
edge finishing. Both parameters varied between different IOL designs as well as between different dioptric
powers of the same IOL design. We believe that existing and future clinical data will help us better understand the effect of microedge structure and design on
reducing PCO. At present, a cutoff value to clinically
label an IOL as square edged should be sought. This
study may help us better understand differences in microedge structures.
We focused on commercially available hydrophobic
IOLs only. Because of their low water content, we believe the SEM technique used did not cause significant
alterations of the IOL edge profile. The microedge
structure of modern hydrophilic IOLs, most of which
have a water content in the vicinity of 26%, may be
significantly modified during the vacuum required
in standard SEM procedures. Therefore, we are
currently evaluating the microedge structure of hydrophilic IOLs using an environmental SEM technique
that operates with low vacuum and does not require
previous coating.

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First author:
Liliana Werner, MD, PhD
Berlin Eye Research Institute, Berlin,
Germany, and John A. Moran Eye Center,
University of Utah, Salt Lake City, Utah,
USA

J CATARACT REFRACT SURG - VOL 34, FEBRUARY 2008

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