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Purpose: To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL)., Design: Intraindividual, randomized, double-masked, controlled clinical trial., Participants: Patients scheduled for sequential same-day bilateral cataract surgery., Methods: All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT., Main Outcome Measures: Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months., Results: One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively., Conclusions: Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years., Design: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison., Methods: Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Patient Population: Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye., Observation Procedures: Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA)., Main Outcome Measure: PCO score (scale, 0-10)., Results: The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P = .23)., Conclusion: The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The performance of a primary posterior capsulorhexis (PPC) with and without posterior optic buttonholing (POBH) may significantly influence the intraocular pressure (IOP) after cataract surgery in age-related cataract patients., Methods: The prospective randomized clinical study was performed at the department of Ophthalmology, Medical University of Vienna, Austria. Thirty consecutive cataract patients with bilateral same-day cataract surgery (60 eyes) under topical anesthesia were enrolled. In randomized order, cataract surgery with combined PPC/POBH was performed in one eye; in the other eye, cataract surgery was performed with PPC and in-the-bag implantation of the intraocular lens (IOL). Standardized IOP measurements by Goldmann applanation tonometry were performed preoperatively, 1, 2, 4, 6, 8 and 24 hours postoperatively, as well as 1 week and 1 month postoperatively., Results: During the first 24 hours after surgery, all IOP measurements were significantly lower in eyes with combined PPC/POBH when compared to eyes with solitary PPC (p < 0.001). No IOP peaks of more than 27 mmHg were observed with combined PPC/POBH. In contrast, in eyes with PPC and in-the-bag IOL implantation, seven patients had an IOP peak of more than 27 mmHg and four IOP peaks of more than 30 mmHg. One week and 1 month postoperatively, IOP measurements were statistically comparable, and no significant differences could be observed between the two groups (p > 0.05)., Conclusion: Postoperative IOP peaks after cataract surgery with sole PPC can be effectively prevented by the buttonholing of the IOL through the posterior capsulorhexis.

Purpose: To compare posterior capsule opacification (PCO) between 2 three-piece intraocular lenses (IOLs) both with sharp-optic edges and open loop haptics, one made of silicone and the other made of hydrophobic acrylate, 6 years after surgery., Design: Randomized, controlled, patient- and examiner-masked trial with intra-patient comparison., Methods: One hundred and six eyes in 53 patients were included initially. Forty-four eyes of 22 patients with age-related bilateral cataract were available for the 6 years follow-up. Each patient had standard cataract surgery and randomly received a silicone (CeeOn 911A; AMO, Santa Ana, California, USA) or hydrophobic acrylic (AcrySof MA60BM; Alcon, Fort Worth, Texas, USA) IOL in the first eye, the other type of IOL in the fellow eye. Follow-up examinations were at 1, 3, and 6 years after surgery. The intensity of posterior capsule opacification (PCO) was assessed using digital retro-illuminated photos and the "automated quantification of after-cataract" (AQUA) software. Neodymium-yttrium-aluminum-garnet-laser capsulotomies (YAG-LC) performed were noted., Results: Six years after surgery, the AQUA scores were 2.3 +/- 1.4 for the silicone and 3.8 +/- 2.0 for the acrylic IOLs (P = .0016). The acrylic IOL eyes also had a significant increase in AQUA score from the 3-year to the 6-year follow-up. YAG-LC were performed in 2 silicone and 6 acrylic IOLs (P = .01)., Conclusions: An angulated three-piece hydrophobic acrylic IOL had more PCO 6 years after surgery than a silicone IOL of otherwise similar design. Apart from an optic material effect, differences in haptic design and the degree of optic edge sharpness may play a role.

Purpose: To compare posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) laser capsulotomy rates 10 years after surgery between two 3-piece intraocular lenses (IOLs): a silicone IOL with round optic edges and a hydrophobic acrylic IOL with sharp optic edges., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Methods: Patients having had cataract surgery and implantation of at least 1 study IOL by the same surgeon between 1994 and 1999 were retrospectively examined. The number of Nd:YAG laser capsulotomies performed was noted. The PCO intensity was assessed using digital retroilluminated photographs and Automated Quantification of After-Cataract (AQUA) software. The AQUA scores in eyes with Nd:YAG capsulotomy were estimated with a multiple-imputation procedure. Anterior capsule opacification (ACO) and fibrotic PCO were graded subjectively at the slitlamp., Results: The study evaluated 143 eyes (98 patients). Eight (18%) of 44 eyes with a silicone IOL and 41 (42%) of 99 eyes with an acrylic IOL had Nd:YAG capsulotomy after 10 years (P = .007). The AQUA scores were lower with the silicone IOLs. The median difference in AQUA scores was significantly different after missing values of the Nd:YAG capsulotomies were imputed. There was no difference in ACO. There was more fibrotic PCO with round-edged silicone IOLs than with sharp-edged acrylic IOLs., Conclusions: Ten years after surgery, acrylic IOLs seemed to lose their PCO preventive effect, despite their sharp optic edges. The increasingly longer life expectancy and earlier cataract surgery mandate reconsideration of preferences regarding optic materials and design elements of IOLs.

Purpose: To determine whether a capsular bending ring (CBR) with a rectangular cross-section and sharp edges moves the barrier to the very equator and avoids contact between the capsulorhexis and optic to prevent posterior capsule opacification (PCO) and anterior capsule fibrosis., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: A 0.7 mm high, open poly(methyl methacrylate) CBR was implanted in 60 eyes (patients) in a prospective randomized intraindividual trial. The impact of additional CBR implantation on PCO and anterior capsule fibrosis was compared to that of intraocular lens (IOL) implantation alone using objective scoring., Results: No CBR-related surgical complications occurred. The objective PCO score and area were statistically significantly reduced in the CBR group. In patients with complete follow-up, the mean PCO score (scale 1 to 10) at 1, 2, and 3 years was 0.8, 1.7, and 2.1, respectively, in the CBR group and 2.6, 3.9, and 4.6, respectively, in the no-CBR group. The number of quadrants affected by PCO was 0.9, 1.5, and 1.8 versus 3.2, 3.8, and 3.8. Barrier failures with the CBR were caused by the inherent slight edge blunting and occasional eyelet gaping. Laser capsulotomies were performed in the no-CBR group only. Capsule stress folds and fibrotic anterior capsule opacification were also greatly reduced. The best corrected visual acuity was better in the CBR group., Conclusions: Capsular bending ring implantation was an effective and safe adjunct to in-the-bag IOL fixation. With improvements in technology and design securing exquisitely sharp edges and circumferential capsular bending independent of the capsular bag diameter, this concept has the potential to prevent PCO and anterior capsule fibrosis.

Purpose: To compare the intensity of posterior capsule opacification (PCO) between the 1-piece and 3-piece haptic designs of the foldable hydrophobic acrylic AcrySof intraocular lens (IOL) over a 5-year period., Design: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison., Participants: Fifty-two patients with bilateral age-related cataract (104 eyes)., Methods: Each study patient had cataract surgery in both eyes and received a 1-piece AcrySof IOL in 1 eye and a 3-piece AcrySof IOL in the other eye. Follow-up examinations were performed at 1 week, 1 month, 6 months, and 1, 2, and 5 years. Digital retroillumination images were obtained of each eye. The amount of posterior capsule opacification (score range, 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software 1, 2, and 5 years after surgery., Main Outcome Measure: Posterior capsule opacification score (scale, 0-10)., Results: There was no significant difference between the 1-piece and 3-piece AcrySof IOL in best-corrected visual acuity, overlap of rhexis and IOL, capsular folds, anterior capsule opacification, and posterior capsule opacification (1-piece AcrySof PCO score, 1.7+/-1.7; 3-piece AcrySof PCO score, 1.3+/-1.4; P = 0.30)., Conclusions: Modification of the IOL haptic design of the sharp optic edged AcrySof IOL from a 3-piece to a 1-piece haptic design caused no significant change in PCO intensity and neodymium:yttrium-aluminium-garnet laser treatment rate 5 years after surgery.

Purpose: To compare the posterior capsule opacification (PCO) inhibiting effect of the round anterior and sharp posterior optic edge profile of the Clariflex silicone intraocular lens (IOL) [AMO Inc, Santa Ana, California, USA] with that of the double-round edge profile of the SI40 (Phacoflex; AMO Inc, Santa Ana, California, USA) silicone IOL over a period of three years., Design: Prospective, randomized, double-masked, bilateral clinical trial., Methods: The study took place at the Department of Ophthalmology, Medical University of Vienna, Austria. Fifty-two patients with age-related cataracts (104 eyes) were included in the study. Each patient received an SI40 IOL (round edges) in one eye and a Clariflex IOL with OptiEdge (sharp posterior optic edge) in the other eye. Follow-up examinations were at one week, one month, six months, and one, two, and three years. Digital retroillumination images were taken of each eye. The amount of PCO was subjectively assessed with the slit-lamp and objectively assessed by automated image analysis software (the computer program Automated Quantification of After-Cataract [AQUA]; Vienna, Austria) one, two, and three years after surgery., Results: The Clariflex lens showed markedly less PCO at one, two, and three years after surgery. The mean AQUA PCO score was 1.39 for the SI40 and 0.56 for the Clariflex lens after one year, estimated at 1.64 and 0.57 after two years, and at 2.04 and 0.64, respectively, after three years (scale zero to 10; P < .001). The Nd:YAG laser capsulotomy rate was far higher in the SI40 group (Five cases vs one case at three years)., Conclusions: The sharp posterior optic edge profile of the Clariflex silicone IOL led to marked and consistently less PCO than the round-edged SI40 IOL one, two, and three years after surgery.

Capsular fibrosis or fibrotic after-cataract results from transdifferation of anterior lens epithelial cells into myofibroblasts with consequent contraction and collagen deposition. To avoid possible complications, an instrument was designed for efficient and safe polishing of the anterior capsule leaf. The curette features an upward-facing slit with sharp-edged flanks and rounded turning points and an optional bypass hole. It is introduced through 3 equidistant 20-gauge paracentesis openings. In a laboratory test, vacuum rise time and vacuum levels under occlusion and the effect of adding a bypass hole were investigated for various pump settings. In a clinical pilot series, efficiency and safety of various designs were tested and vacuum and flow settings titrated for optimum performance; the clinical effect was determined in prospectively randomized bilateral studies. Optimum pump settings were 5 mL/min and 10 mm Hg with the nonventing curette and 7 to 10 mL/min and 50 mm Hg with the venting curette. A bypass hole delayed the vacuum rise and reduced the mean vacuum level on full occlusion. It also allowed fine-tuning the vacuum at the slit by varying the flow rate with the foot pedal. Anterior capsule polishing significantly decreased capsule fibrosis and is recommended when posterior capsulorhexis and optic buttonholing are combined.

Purpose: To evaluate the long-term effects of anterior capsule polishing on regeneratory posterior capsule opacification (PCO), anterior capsule opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL) with sharp optic edges., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: This prospective bilateral randomized patient- and examiner-masked clinical trial comprised 130 eyes of 65 patients with bilateral age-related cataract. All eyes had implantation of a 3-piece silicone IOL with a truncated, sharp-edged optic (CeeOn Edge 911A, Advanced Medical Optics). In 1 eye, the anterior capsule was extensively polished using an aspiration curette after phacoemulsification and cortex aspiration. Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were graded subjectively 1, 2, 3, and 5 years postoperatively., Results: The mean ACO score was significantly lower in the eyes in which the anterior capsule had been polished (1 year, P<.02; 2 years, P<.03; 3 years, P<.01; 5 years, P<.01). The mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups was not statistically significant., Conclusions: Three years after cataract surgery, eyes in which the anterior capsule had been polished had significantly less ACO. However, polishing did not lower PCO intensity when a sharp-edged CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior capsule polishing may enhance the development of regeneratory PCO, this trend did not reach statistical significance.

Purpose: To study the efficacy of posterior optic buttonholing (POBH) through a primary posterior capsulorhexis (PPCCC) to preserve full capsular transparency, and its potential as a routine alternative to standard in-the-bag implantation of sharp-edged optic intraocular lenses (IOLs)., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: After standard cataract removal, a PPCCC 4.0 to 5.0 mm in diameter was performed and the optic of a 3-piece IOL buttonholed posteriorly. One third of the eyes additionally had extensive anterior capsule polishing. All surgeries were performed under topical anesthesia., Results: The first 500 consecutive surgeries were evaluated. In 11 eyes, POBH was not performed as planned. In 4 cases, anterior capsulorhexis fixation of the optic was used as an alternative. In the early series, vitreous entanglement was seen in 5 eyes, of which 1 case prompted translimbal anterior vitrectomy. No case of cystoid macula edema was observed. One case of peripheral retinal detachment in a highly-myopic eye 4 months postoperatively appeared to be unrelated to the surgery. All lenses were well-centered without tilt, and both capsule leaves remained clear especially after additional polishing., Conclusion: Posterior optic buttonholing precludes lens epithelial cells from accessing the retrolental space. The sandwiched posterior capsule blocks optic contact and thus fibrosis of the anterior capsule. Posterior optic buttonholing avoids after-cataract independent of optic edge design. Anterior capsule polishing adds to its efficacy by excluding any residual fibrosis. Surgery under topical anesthesia was well-controlled and safe. Posterior optic buttonholing may become a routine alternative to standard in-the-bag IOL implantation when supported by a longer follow-up.

Purpose: To examine the influence of optic material (silicone and hydrophobic acrylic) and haptic design (one-piece and three-piece open loop) of sharp optic edge intraocular lenses (IOL) on anterior capsule opacification (ACO) and capsulorrhexis contraction., Design: Randomized, controlled, double-blind clinical trial with intraindividual comparison., Methods: This study was performed at the Department of Ophthalmology, Medical University of Vienna, Austria, and comprised 210 eyes of 105 patients with bilateral age-related cataract. In group 1 (n = 53 patients), a three-piece acrylic IOL was compared with a three-piece silicone IOL. In group 2 (n = 52 patients), the three-piece acrylic IOL was compared with the one-piece acrylic IOL. One year after the operation, standardized digital slit-lamp images of ACO were taken; 1 week and 1 year after the operation, digital retroillumination images were taken to assess capsulorrhexis size. The intensity of ACO was graded objectively (score, 0% to 100%), and the capsulorrhexis area (square millimeters) was determined objectively., Results: One year after surgery, the mean ACO score was 21% for the acrylic and 20% for the silicone IOL (P = .4) in group 1 and 18% for both the three-piece and one-piece acrylic IOLs (P = .87) in group 2. Concerning the amount of capsulorrhexis contraction, there was no significant difference between the IOL types that were evaluated in this study (after Bonferroni-Holm correction, P > .05)., Conclusion: In the hydrophobic sharp optic edge IOLs that were examined, neither the optic material nor the haptic design had an influence on the amount of ACO or capsulorrhexis contraction.

Purpose: To compare the long-term effect of extensive polishing and nonpolishing of the anterior lens capsule on posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: This prospective randomized bilateral double-masked study included 108 eyes of 54 consecutive patients with age-related cataract. Following phacoemulsification, 3-piece intraocular lenses (IOLs) with round-edged silicone optics were implanted. Patients received an Allergan SI-40 IOL with a truncated, round optic edge or a Domilens Silens6 IOL with a fully round optic edge. Patients were randomly assigned to have extensive anterior capsule polishing with the Menapace aspiration curette or no treatment in the first eye; the second eye received the opposite treatment. Digital retroillumination images were taken at 1 week, 1 year, and 3 years, and Nd:YAG capsulotomy rates were evaluated. Posterior capsule opacification was objectively scored using automated image analysis software (AQUA) or estimated based on clearly defined assumptions if a capsulotomy had been performed., Results: Thirty-nine patients (78 eyes) concluded the study. Three-year PCO scores after polishing did not differ significantly (P>.05). However, 21 polished eyes (53.8%) required Nd:YAG laser capsulotomy compared with 14 nonpolished eyes (35.9%). The mismatch between PCO scores and Nd:YAG rates resulted from a change in PCO morphology that is not detected by scoring methods based on retroillumination photography but is visually disturbing to patients., Conclusions: Polishing the anterior capsule was effective in reducing fibrotic opacification but ineffective in reducing regeneratory opacification. Changes in regeneratory PCO morphology not picked up by retroillumination photography increased the need for Nd:YAG laser capsulotomy.

Purpose: To compare the posterior capsule opacification (PCO) inhibiting effect of a 3-piece polymethyl methacrylate (PMMA) intraocular lens (IOL) with a sharp optic edge design with that of the round-edged version of the same IOL during a 5-year period., Design: Randomized patient- and examiner-masked clinical trial with intraindividual comparison., Participants: Thirty-two patients with bilateral age-related cataract (64 eyes)., Methods: Each study patient had phacoemulsification cataract surgery in both eyes and received a sharp optic edge PMMA IOL in one eye and a round optic edge PMMA IOL in the fellow eye (both by Dr Schmidt in Germany). Follow-up examinations were at 1 week, 1 month, 1 year, 3 years, and 5 years. Digital retroillumination images were taken from each eye. The amount of posterior capsule opacification was assessed objectively by means of automated image analysis software (Automated Quantification of After-Cataract) at 1 year, 3 years, and 5 years after surgery., Main Outcome Measure: Posterior capsule opacification score: 0-10., Results: The sharp optic edge IOL showed significantly less regeneratory and fibrotic PCO at 1 year, 3 years, and 5 years after surgery. The mean AQUA PCO score was 5.12 for the round-edge and 2.49 for the sharp-edge IOL (scale, 0-10; P<0.001) at 5 years. The mean difference among patients for the PCO score in the eye implanted with the sharp optic edge versus the score in the eye with the round optic edge was 2.83 at 5 years (95% confidence interval, 1.66-4.00). Due to the large number of neodymium:yttrium-aluminum-garnet laser capsulotomies that were performed (12 in the round-edge group and 4 in the sharp-edge group), there was no significant difference in visual acuity between both groups at any time point., Conclusions: Compared with the round-edge version, the sharp optic edge design of a 3-piece PMMA IOL led to significantly less PCO at 1 year, 3 years, and 5 years after surgery. However, the sharp optic edge did not lead to complete PCO prevention during this follow-up period. This finding has implications for the design of PMMA IOLs used for cataract surgery, especially in the developing world.

Purpose: To classify the morphologic appearance of posterior capsule opacification (PCO) and to observe and document the changes over longer periods of time., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: Eighty-one pseudophakic eyes of 53 patients with PCO of varying degrees were included in this prospective study. Digital retroillumination images of the posterior capsule were taken in a standardized fashion 1, 2, and 3 years after cataract surgery. The PCO morphology was classified, and changes among the 3 follow-up images were analyzed., Results: At 1, 2, and 3 years, pearls occurred in 16 (20%), 41 (51%), and 57 (63%) eyes. Pearls increased in size and number. Cases with thin layers of PCO decreased from 53 to 33 to 16 eyes. Conversely, cases with thick layers increased from 18 to 45 and 64 eyes. "Cheese holes" appeared most frequently as the predominant structure (range 47% to 51%), followed by plates (range 28% to 31%), islands (range 15% to 20%), and traces of PCO (range 1% to 5%). Changes in expansion of the PCO area were observed in 61 eyes (75%) during period 1 (1 to 2 years) and period 2 (2 to 3 years). Regions of expansion and regression in the same eye occurred in periods 1 and 2 in 11 eyes (14%) and 9 eyes (11%), respectively. The phenomenon of thinning bridges, a regression of syncytial extensions of PCO, occurred in 22 eyes (27%) and 32 eyes (40%), respectively. An overlapping growth of 2 layers was observed in 18 eyes (22%)., Conclusions: The morphology of PCO is multifaceted. Apart from the Elschnig pearls, categories such as cheese holes, plates, islands, and traces of PCO were distinguished. Over the years, pearls increased in frequency, size, and number. Expansion and regression occurred simultaneously in some cases. Two or more layers grew on top of each other in some eyes.

Purpose: To assess and classify capsular bend configuration at the optic rim and its association with posterior capsule (PCO) and anterior capsule opacification (ACO) and capsulorhexis contraction with various intraocular lenses (IOLs)., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: A total of 659 post-cataract surgery eyes of 370 patients from different prospective randomized studies were evaluated. All eyes had standardized phacoemulsification surgery with implantation of an IOL in the capsular bag. The IOLs had a sharp or round optic edge design and were made of silicone, acrylic, or poly(methyl methacrylate) optic materials. One year postoperatively, the configuration of the capsular bend at the optic rim was assessed at the slitlamp, and standardized slitlamp images of ACO and fibrotic PCO were taken. One week, 1 year, and 3 years postoperatively, digital retroillumination images were taken for objective quantification of regeneratory PCO and the capsulorhexis area. The outcome measures were the type of capsular bend configuration, ACO score (0% to 100%), regeneratory PCO score (0 to 10), fibrotic PCO score (0 to 3), and amount of capsulorhexis contraction (mm(2))., Results: Four main types of capsular bend configuration were classified: parallel, "Y," right angle, and wrapping. The right-angle type was observed in the most cases (52%). Eyes with a wrapping capsular bend configuration had significantly less PCO, more capsulorhexis contraction, and more ACO than eyes with the other configurations. Wrapping capsule configuration was seen most often (55%) in round-edged silicone IOLs that had a thin optic rim., Conclusion: The design and material of IOLs influenced the long-term capsular bend configuration at the optic rim. The right-angle type was the most common capsular bend configuration. Intraocular lenses with silicone optic material and a thin optic rim caused a wrapping capsule configuration and resulted in more capsulorhexis contraction and ACO, but less PCO.

Purpose: To compare the posterior capsule opacification (PCO) inhibiting effect of the sharp posterior optic edge design of the Sensar OptiEdge AR40e intraocular lens (IOL) with that of the double-round edge design of the Sensar AR40 IOL over a period of 3 years., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: Fifty-three patients with bilateral age-related cataract (106 eyes) were included in this randomized prospective bilateral patient- and examiner-masked clinical trial with intraindividual comparison. Each study patient had cataract surgery in both eyes and received a Sensar AR40 IOL (anterior and posterior round optic edges) in 1 eye and a Sensar OptiEdge AR40e IOL (round anterior and sharp posterior optic edge) in the other eye. Follow-up examinations were at 1 week, 1 and 6 months, and 1, 2, and 3 years. Digital retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software (AQUA) 1, 2, and 3 years after surgery., Results: The sharp-edged AR40e lens showed significantly less regeneratory and fibrotic PCO 1, 2, and 3 years after surgery. The mean AQUA PCO score was 2.18 for the AR40 and 1.00 for the AR40e lens after 1 year; 2.94 and 1.56 after 2 years, and estimated at 3.13 and 1.77, respectively, after 3 years (scale 0 to 10; P<.001). The neodymium:YAG laser capsulotomy rate was significantly higher in the AR40 group. The AR40e lens also led to less peripheral fibrotic PCO. There was no significant difference in complaints concerning edge glare between the groups., Conclusion: Compared with the AR40 IOL, the sharp posterior optic edge design of the Sensar OptiEdge AR40e IOL led to significantly less PCO 1, 2, and 3 years postoperatively. In contrast with most past studies on PCO-preventative factors, this study varied only 1 parameter, namely the optic edge design, and the main outcome measure (PCO) was assessed with an objective image-analysis system.

Purpose: To compare the intensity of capsule opacification with the sharp and the round optic edge variant of an open-loop hydrophobic silicone intraocular lens (IOL)., Design: Randomized, controlled, double-blind clinical trial with intraindividual comparison., Methods: Fifty-one patients with bilateral age-related cataract were included (102 eyes). Each patient had had cataract surgery in both eyes and received a Microsil IOL with a sharp optic edge design (model S) in one eye and a Microsil IOL with a round optic edge design (model R) in the fellow eye. Both IOLs had an identical haptic design (nonangulated polymethylmethacrylate) and silicone optic material. The patients were examined at the slit lamp, best-corrected visual acuity was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken 5 years after surgery. The intensity of regeneratory posterior capsule opacification (rPCO), fibrotic PCO (fPCO), and anterior capsule opacification (ACO) was assessed subjectively at the slit lamp, and of rPCO, objectively using automated image analysis software (AQUA). The need for an Nd:YAG laser capsulotomy (Nd:YAG-LCT) was noted., Results: The mean AQUA PCO score was 1.2 for the model S and 2.4 for the model R lens (P = .001). The model S lens also led to less peripheral fPCO (P = .003). Concerning ACO, there was no significant difference between both IOL groups (P = .72). Whereas no capsulotomy was required with the model S, four cases (16%) had been performed in the model R group., Conclusion: Five years postoperatively, the sharp-edged silicone IOL showed less rPCO and fPCO than the round-edged IOL. However, regarding ACO, there was no significant difference between both IOL styles.

Purpose: Comparison of the intensity of posterior capsule opacification (PCO) between a silicone intraocular lens (IOL) and a hydrophobic acrylic IOL, both of them 3-piece and open-loop and having truncated optics with sharp edges., Design: Randomized, controlled, patient- and examiner-masked trial with intrapatient comparison., Participants and Controls: One hundred six eyes of 53 patients with age-related bilateral cataract., Methods: Each patient had cataract surgery in both eyes and received a silicone IOL in one eye and a hydrophobic acrylic IOL in the fellow eye. Follow-up examinations were at 1 and 3 years after surgery. The patients were examined at the slit lamp, visual acuity (VA) was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken. The amount of PCO was assessed subjectively at the slit lamp and objectively using automated image analysis software. Data of 56 eyes of 28 patients, who were examined at each follow-up, were analyzed., Main Outcome Measure: Posterior capsule opacification intensity at 3 years as measured with automated image analysis., Results: At 1 and 3 years after surgery, PCO did not differ between the silicone (1.6 and 1.9 [image analysis scores, 0-10 scale], respectively) and acrylic IOLs (1.7 and 2.2) (P > 0.24). Furthermore, there was no significant difference in best-corrected VA, rhexis/IOL overlap, capsular folds, and amount of anterior capsule opacification during the follow-up period. In each group, one neodymium:yttrium-aluminum-garnet (YAG) laser capsulotomy was performed during the entire study duration., Conclusion: Silicone and hydrophobic acrylic are similarly effective in inducing the PCO-inhibiting effect of a rectangular, sharp optic edge. Three years after surgery, the PCO intensity and the YAG rate were low with both IOL models.

Purpose: To evaluate the long-term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO)., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: This randomized double-blind study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients received round-edged intraocular lenses (IOLs); 26 received an SI-40 IOL (Advanced Medical Optics Inc.) in both eyes, and 26 received a Silens6 IOL (Domilens) in both eyes. Both IOLs consist of different silicone material and have different haptic angulation. The SI-40 IOL has 13.0 mm open-loop poly(methyl methacrylate) (PMMA) haptics angulated by 10 degrees. The Silens6 IOL has 12.5 mm open-loop PMMA haptics with no angulation. In 1 eye, the anterior capsule was extensively polished. The anterior capsule was left unpolished in the contralateral eye, which acted as a control. Digital slitlamp photographs of the ACO and fibrotic PCO were taken with a standardized technique for 3 years postoperatively. The intensity of ACO was measured objectively (score 0% to 100%) using Adobe Photoshop software. Fibrotic PCO was graded subjectively (score 0 to 4)., Results: The mean ACO was 17% in the polished eyes and 26% in the control eyes (P = .0001). The mean fibrotic PCO score was 0.5 and 1.0, respectively (P = .0007). The mean ACO was 15% in the polished SI-40 eyes and 26% in the control SI-40 eyes (P = .01). It was 19% in the polished Silens6 eyes and 26% in the control Silens6 eyes (P = .003). The mean fibrotic PCO score was 0.4 in the polished SI-40 eyes and 1.1 in the control SI-40 eyes (P = .0006). It was 0.6 in the polished Silens6 eyes and 0.9 in the control Silens6 eyes (P = .08)., Conclusions: Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round-edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.

Purpose: To compare intensity of posterior capsule opacification (PCO) between the 1-piece and 3-piece haptic designs of an open-loop hydrophobic acrylic intraocular lens (IOL)., Design: A randomized, patient- and examiner-masked clinical trial with intraindividual comparison., Participants: Fifty-two patients with bilateral age-related cataract (104 eyes)., Methods: Each patient had cataract surgery in both eyes and received a 1-piece Acrysof IOL in one eye and a 3-piece Acrysof IOL in the fellow eye. Follow-up examinations were at 1 week, 1 month, 6 months, 1 year, and 2 years. Patients were examined at the slit lamp, visual acuity (VA) was determined, and standardized high-resolution digital retroillumination images of the posterior capsule were taken. The intensity of PCO was assessed subjectively at the slit lamp and objectively using automated image analysis software., Main Outcome Measure: Posterior capsule opacification score (scale, 0-10)., Results: There was no significant difference between IOL styles in best-corrected VA, rhexis/IOL overlap, capsular folds, and amount of anterior capsule opacification during the follow-up period. One year postoperatively, the amount of regeneratory PCO was higher for the 1-piece Acrysof eyes (image analysis software score: 1.3) than for the 3-piece Acrysof eyes (score: 0.9; P = 0.002). However, 2 years postoperatively, there was no significant difference between the 2 IOL styles (1-piece: 1.5; 3-piece: 1.3; P = 0.3). Neodymium:yttrium-aluminum-garnet capsulotomy was not performed in the study., Conclusion: One year postoperatively, the 1-piece Acrysof showed slightly more regeneratory PCO than the 3-piece Acrysof. However, 2 years postoperatively, the barrier effect of the 1-piece design was comparable to that of the 3-piece haptic design, with low PCO intensity.

Purpose: To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: This randomized controlled patient- and examiner-masked study comprised 210 eyes of 105 patients with bilateral age-related cataract. In Group 1 (n = 53), the Sensar OptiEdge AR40e hydrophobic acrylic IOL with a sharp posterior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex OptiEdge silicone IOL with a sharp posterior optic edge was compared with the PhacoFlex SI-40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digital slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillumination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm(2)) was determined objectively., Results: One year after surgery, the mean ACO score was 32% in eyes with the sharp-edged acrylic IOL and 29% in eyes with the round-edged acrylic IOL (P<.05). In the silicone group, the mean was 31% and 26%, respectively (P<.05). The mean fibrotic PCO score was lower in eyes with a sharp-edged acrylic IOL than in eyes with a round-edged acrylic IOL (0.26 and 0.93, respectively; P<.05) and in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (0.24 and 0.82, respectively; P<.001). At 1 year, the mean capsulorhexis area was statistically significantly smaller in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (P<.05)., Conclusions: Acrylic and silicone IOLs with the sharp OptiEdge design led to significantly less fibrotic PCO but more ACO than round-edged acrylic and silicone IOLs. The sharp-edged silicone IOL caused significantly more capsulorhexis contraction than the round-edged silicone IOL and both acrylic IOLs.

Purpose: To compare the inhibiting effect on posterior capsule opacification (PCO) of a silicone intraocular lens (IOL) with a sharp posterior optic edge (ClariFlex OptiEdge, Advanced Medical Optics) and a silicone IOL with a round optic edge (PhacoFlex SI-40, Advanced Medical Optics)., Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria., Methods: This prospective randomized patient- and examiner-masked study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients had cataract surgery in both eyes and received a sharp-edged IOL in 1 eye and a round-edged IOL in the other eye. Postoperative examinations were at 1 week, 1 and 6 months, and 1 year. Digital slitlamp and retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using Automated Quantification of After-Cataract (AQUA) automated-image analysis software., Results: The sharp-edged IOL group had significantly less regeneratory and fibrotic PCO 1 month, 6 months, and 1 year after surgery. The mean AQUA PCO score (scale 0 to 10) was 0.71 in the sharp-edged IOL group and 1.40 in the round-edged IOL group (P<.001). The sharp-edged IOL group had less peripheral fibrotic PCO. There was no significant difference between the 2 IOL groups in patient reports of edge glare., Conclusion: The sharp-edged design of the ClariFlex OptiEdge silicone IOL led to significantly less PCO than the round-edged PhacoFlex SI-40 IOL 1 year postoperatively.

Purpose: To evaluate the role of posterior optic edge design and the effect of anterior capsule polishing on peripheral fibrotic posterior capsule opacification (PCO)., Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria., Methods: This randomized prospective study comprised 144 eyes of 72 patients with bilateral age-related cataract. Each patient had standardized cataract surgery in both eyes by the same surgeon. Group 1 (46 patients) received a round-edged hydrophobic acrylic IOL (AMO Sensar AR40) in 1 eye and a sharp-edged hydrophobic acrylic IOL (AMO Sensar OptiEdge AR40e) in the other eye. Group 2 (26 patients) received a silicone IOL (Pharmacia CeeOn 911A) with a truncated optic in both eyes. In this group, the anterior capsule was extensively polished in 1 eye and was left unpolished in the other eye. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for fibrotic PCO. The intensity of PCO was subjectively graded (score 0 to 4) by 2 masked examiners., Results: Subjective PCO scores correlated well between the 2 examiners (r = 0.88). In Group 1, the mean PCO score was 0.26 for the OptiEdge AR40e IOL and 0.90 for the AR40 IOL (P<.01). In Group 2, the mean PCO score was 0.24 in eyes with a polished capsule and 0.17 in eyes in which the capsule was not polished (P =.31)., Conclusions: The sharp-edged OptiEdge AR40e IOL led to significantly less peripheral fibrotic PCO 1 year postoperatively than the round-edged AR40 IOL. In eyes with the sharp-edged silicone 911A IOL, anterior capsule polishing caused no significant difference in fibrotic PCO.

Purpose: To evaluate the influence of a neodymium:YAG (Nd:YAG) laser capsulotomy on the morphology and development of regeneratory opacification of the remaining surrounding posterior capsule., Setting: Department of Ophthalmology, Medical School, University of Vienna, Vienna, Austria., Methods: Standardized digital retroillumination photographs were taken immediately before and after Nd:YAG laser capsulotomy and at 1 week, 6 months, and 1 to 3 years in 38 eyes of consecutive patients. Changes in regeneratory posterior capsule opacification (PCO) and opacification around the capsulotomy opening were evaluated. The influence of the type of intraocular lens (IOL) material and design (acrylic, n = 8; hydrogel, n = 8; silicone open loop, n = 11; silicone plate haptic, n = 6; poly(methyl methacrylate) [PMMA], n = 5) was assessed. The state of the anterior vitreous surface was examined at the slitlamp in all eyes., Results: In 8 of 17 eyes with a silicone IOL, reduced regeneratory PCO was observed. Massive pearl formation on the margin of the Nd:YAG capsulotomy was typical with silicone IOLs (8 eyes) but also occurred with PMMA IOLs. Eyes with acrylic IOLs had no change in regeneratory PCO after the capsulotomy. Three of 8 eyes with hydrogel IOLs had complete closure of the posterior capsulotomy opening., Conclusions: Neodymium:YAG laser capsulotomy induced changes in the development and morphology of regeneratory PCO. Silicone and PMMA IOLs led to significant pearl formation on the capsulotomy margin, often combined with a reduction of peripheral regeneratory PCO (silicone). Hydrogel IOLs led to a higher incidence of reclosure of the Nd:YAG capsulotomy opening.

Purpose: To evaluate the potential of primary posterior continuous curvilinear capsulorhexis (PCCC) to prevent after-cataract 2 years after surgery and perform a bilateral comparison of 2 intraocular lens (IOL) materials, silicone and hydrogel., Setting: Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria., Methods: In this randomized patient- and examiner-masked study, 37 patients (74 eyes) with age-related cataract had bilateral small-incision cataract surgery with PCCC. Randomly, 1 eye received a hydrogel IOL and the contralateral eye, a silicone IOL. Both IOLs had open-loop haptics and a round-edged optic. Standardized digital retroillumination photographs were taken 1 day and 1, 6, 12, and 24 months after surgery to evaluate development of after-cataract on the anterior and posterior capsules by subjective grading. Opacification of the PCCC area was also objectively evaluated using new software., Results: Twenty-nine patients (58 eyes) completed the 2-year follow-up. Partial closure with ongrowth at the edge of the PCCC was found in 55% in the hydrogel group and 28% in the silicone group. Total closure of the PCCC was observed in 3 eyes, 2 in the hydrogel group and 1 in the silicone group., Conclusion: Ongrowth onto the PCCC area was dependent on IOL material. Because of less ongrowth and more fibrotic after-cataract with silicone IOLs, the efficacy of the PCCC was higher in this group.

Purpose: To compare the posterior capsule opacification (PCO) inhibiting effect of the sharp posterior optic edge design of the Sensar OptiEdge AR40e intraocular lens (IOL) (Allergan Surgical) with that of the round-edged design of the Sensar AR40 IOL. Setting Department of Ophthalmology, University of Vienna, Vienna, Austria., Methods: This prospective randomized patient- and examiner-masked study comprised 106 eyes of 53 patients with bilateral age-related cataract. Each patient had cataract surgery in both eyes and received an AR40 IOL in 1 eye and an AR40e IOL in the other eye. Postoperative examinations were at 1 week, 2 and 6 months, and 1 year. Digital slitlamp and digital retroillumination images of each eye were taken. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software., Results: The AR40e group had significantly less regeneratory and fibrotic PCO 1 year after surgery. The mean automated image-analysis software PCO score (scale 0 to 10) was 2.19 in the AR40 group and 1.10 in the AR40e group (P <.001). The AR40e group had less peripheral fibrotic PCO. There was no significant difference in patient-reported edge glare between the 2 IOL groups., Conclusions: The sharp-edged design of the Sensar OptiEdge AR40e IOL led to significantly less PCO than the round-edged AR40 IOL 1 year postoperatively.

Purpose: To determine the short-term reproducibility of standardized digital retroillumination images of regeneratory posterior capsule opacification (PCO) using the photographic setup at 1 institution., Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria., Methods: In this prospective study, 60 retroillumination images of 30 eyes with varying degrees of PCO and different types of intraocular lenses were acquired with a standardized digital coaxial retroillumination system. Two images were taken per eye with a 1-minute interval between images. Ten other eyes were photographed in the same way but with a 5-day interval between the 2 images. All images were evaluated with a fully automated, objective PCO analysis software in which the PCO score was from 0 to 100. The 2 results (A, B) in each eye were compared, and the differences were calculated., Results: There was a high correlation between the A and B results (r = 0.99). The mean absolute difference was 3.7%. The repeatability coefficient was 8.8%., Conclusion: Digital coaxial retroillumination photography provided quick acquisition of regeneratory PCO images. It provided excellent image quality and high reproducibility. The technique forms a good basis for automated quantification of PCO with new software systems.

Purpose: To develop and evaluate a standardized slitlamp photographic technique to document and quantify anterior capsule opacification (ACO) in the pseudophakic eye., Setting: University of Vienna, Medical School, Department of Ophthalmology, Vienna, Austria., Methods: In this prospective study, slitlamp photographs were taken in 29 eyes of 19 patients with ACO of varying degrees and intraocular lenses of different materials. Digital slitlamp photographs were taken by 2 examiners using a standardized protocol. The intensity of anterior fibrosis was evaluated using subjective grading by 2 masked examiners and by image analysis., Results: A standardized protocol was developed for documentation of ACO. The intraexaminer (or short-term) reproducibility (r = 0.96, P < .01) and interexaminer reproducibility (r = 0.93, P < .01) were excellent. The results of image analysis used to objectively quantify ACO correlated with the subjective grading (r = 0.95, P < .01)., Conclusion: This standardized technique of slitlamp photography and image analysis provided reproducible documentation and can therefore serve as a basis for the quantification of ACO.