CLINICAL EXPERIENCE WITH
HYDROPHILIC ACRYLIC LENSES
Ehud I. Assia, MD,
Fani Segev MD,
Yoanis ZacharopoulosMD,
Simona Jaeger-Roshu MD
Department of Ophthalmology,
Meir Hospital, Sapir Medical Center,
Kfar-Saba, Israel
Acrylic lenses
The leading foldable IOLs in the market:
Hydrophobic
Hydrophilic
Hydrophilic Acrylic lenses
Optical performance
Posterior capsule opacification
Lens opacification
physical properties (fragility, folding)
Very little data in literature
?
Hydrophilic Acrylic lenses
B-lens, Hanita Lenses, Israel
Hydrophilic acrylic - 25% water content
Refractive index – 1.462 (35oC)
Copolymer – HEMA / EOEMA
Dimensions – 6.0 mm / 12.5 mm
Sqaure edge, biconvex
Modified C loops
5 deg. Angulation
Hydrophilic Acrylic lenses
Material provided by Benz R&D, FL, USA
Implantation started 1998
Excellent performance
No case of IOL opacification
(as reported with hydrophilic acrylic IOLs of other
manufacturers)
B-Lens
Implanted – over 1000 IOLs
Report - 100 patients
Follow up – one
year
F: M = 60 : 40 %
Age – 69.4 y (39 – 88)
Visual acuity
Pre op
49
50
45
17 % > 6/12
40
35
29
34 % > 6/15
30
23
21
18 17
22
> 6/60
15
10
0
0
6/6
<6/9
<6/12
5
2
1
<6/15
1
0
<6/30
0
<6/60
<6/120
pre-op
Visual Acuity
22% < 6/120
Number of
Patients
20
17
55 % > 6/30
78 %
25
post-op
Visual acuity
Post op
49 % = 6/6
78 % > 6/7.5
96 % > 6/12
In all cases VA improved by at least 2 lines
Visual acuity
Poor visual performance
6/20 - CSME
6/30 - s/p RD op, NPDR, AMD
6/30 - corneal opacity, AMD
CF 1m - large atrophic AMD
Refraction
62 %
87 %
98 %
+ 0.5 D
+ 1.0 D
+ 1.5 D
62
0.50 D
1.00 D
1.50 D
25
2.00 D
>2.00 D
11
1
1
70
60
50
40 Number of
30 Patients
20
10
0
Refraction
Mean D Ref = 0.506 (myopia)
Results improved when A constant
refined and surgeon factor modified
Posterior Capsule Opacification
ANY opacity behind the IOL optic
Central / peripheral
Clinical grading 0 – 4
0 = clear
1 = minimal
2 = definite, but retina clear
3 = retinal details blurred
4 = retinal vessels undetected
Posterior Capsule Opacification
one year results
absolutely clear – 69%
0–1
Central
Peripheral
3 pts
1 pt
(6/7.5 – 6/10)
(6/6.5)
Posterior Capsule Opacification
one year results
+1
Central
Peripheral
6 pts
4 pts
+1 - +2
Central
Peripheral
1 pt
1 pt
(6/6 – 6/10)
(6/6 - 3 pts
6/20 - 1 pt CSME)
(6/30 – corneal scar, AMD)
(6/7.5)
Posterior Capsule Opacification
one year results
Nd:YAG capsulotomy – 3 pts
1 at 4 months
2 at 1 year
All regained 6/6 vision
Posterior Capsule Opacification
one year results
16%
2% 3%
Total
10%
69%
0
M
(+)1
(+)2
Nd:YAG laser
2% 3%
Clinically
Significant
95%
Posterior Capsule Opacification
one year results
Summary:
None
trace to +1
= 69
= 28
> 6/10 ( 19 > 6/7.5)
3 < 6/12 (DR, cornea, AMD)
25
YAG capsulotomy = 3
Mechanical properties
Good durability in folding / unfolding
No folding signs
Haptic tear during implantation - 4 cases
Mild decentration – 1 case (VA = 6/8.5)
Mechanical properties
cause: trailing loop is trapped between
plunger and cartridge
Prevention of breaks
Bend loops towards optic
“Pump” plunger to release trapped haptic
Push plunger all the way out
Using proper injection technique – no tears
If haptic tears < ½ loop –
can leave in the bag
Flexibility
In 7 cases: optic –haptic contact
No decentration
No clinical significance
Implantation technique
Forceps –
always with viscoelastics
Injection –
viscoelastics or
chamber maintainer
Implantation
Conclusions
One year results of hydrophilic acrylic
lenses:
Very good optical performance
Low rate of clinical PCO
Excellent centration