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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
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
312
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.
313
IOL Model
IOL Manufacturer
Dioptric Power
Optic Material
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
314
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
Figure 2 (cont.)
315
316
REFERENCES
1. Schauersberger J, Amon M, Kruger A, et al. Comparison of the
biocompatibility of 2 foldable intraocular lenses with sharp optic
edges. J Cataract Refract Surg 2001; 27:15791585
2. Buehl W, Findl O, Menapace R, et al. Effect of an acrylic
intraocular lens with a sharp posterior optic edge on posterior
capsule opacification. J Cataract Refract Surg 2002;
28:11051111
3. Prosdocimo G, Tassinari G, Sala M, et al. Posterior capsule
opacification after phacoemulsification: silicone CeeOn Edge
versus acrylate AcrySof intraocular lens. J Cataract Refract
Surg 2003; 29:15511555
4. Auffarth GU, Golescu A, Becker KA, Volcker HE. Quantification
of posterior capsule opacification with round and sharp edge
intraocular lenses. Ophthalmology 2003; 110:772780
317
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