Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes

Abstract

Purpose Management of refractive errors after cataract surgery includes spectacles or contact lens, secondary laser vision correction, intraocular lens (IOL) exchange, or piggyback lens implantation. We evaluated for the first time a single-piece hydrophilic acrylic IOL designed for supplementary sulcus fixation in postmortem pseudophakic human eyes. Methods Pseudophakic human cadaver eyes were imaged by anterior segment optical coherence tomography (AS-OCT) to assess position of the primary IOL. Eyes were prepared as per the Miyake-Apple technique. The supplementary IOL (Medicontur A4 Addon IOL family) was then inserted into the ciliary sulcus. AS-OCT and photographs from anterior and posterior views were used to assess IOL centration, tilt, and interlenticular distance from the primary IOL. Results Data were obtained from 12 eyes having primary IOLs of varying materials and designs in the bag and representing different sizes of eyes and severity of Soemmering's ring formation. The A4 Addon IOL was successfully inserted into the ciliary sulcus and was well centered in all cases. Four cases of tilt were observed on AS-OCT: three with mild tilt due to pre-existing zonular dehiscence, and one due to a localized area of Soemmering's ring formation. Interlenticular distance ranged from 0.34 to 1.24 mm and was not dependent on severity of Soemmering's ring or type of primary IOL. Conclusions The A4 Addon IOL was designed for sulcus fixation as a supplementary lens, with a large diameter, a square-shaped optic, four smooth loop haptics, and a convex-concave optical surface. It exhibited appropriate centration and interlenticular distance with different primary in-the-bag IOLs.

<p>Spectacle Independence for Pseudophakic Patients – Experience with a Trifocal Supplementary Add-on Intraocular Lens</p>

“…No complications were observed during surgery or in the postoperative period, which is a finding similar to previous studies involving the same ciliary sulcus lens family. 10,11,14,15,24 The design of the tested lenses supports the integrity and physiologic function of the anterior segment of the eye. Intraocular pressure remained practically unchanged in these studies.…”

“…7,9 Unlike historical approaches, when inserting the secondary IOL into the capsular bag (piggybacking) used to be the general practice in the implantation of supplementary IOLs, the most advanced additional lenses are specifically designed for implantation into the ciliary sulcus, meaning sufficient space remains between the two lenses, and the development of interlenticular opacification is minimal. 10 Furthermore, manufacturers are making great efforts to design lenses that efficiently eliminate all complications that may arise from polypseudophakia or from the ciliary sulcus being the implantation site, such as iris chafing, pigment dispersion syndrome, pupillary block, angle-closure and secondary glaucoma. 7,[10][11][12][13] The aim of this study was to present the initial results obtained in connection with the implantation of the 1stQ AddOn ® diffractive supplementary IOL produced by Medicontur Medical Engineering Ltd (Zsámbék, Hungary) in pseudophakic patients who had previously had various monofocal capsular bag IOLs implanted.…”

“…10 Furthermore, manufacturers are making great efforts to design lenses that efficiently eliminate all complications that may arise from polypseudophakia or from the ciliary sulcus being the implantation site, such as iris chafing, pigment dispersion syndrome, pupillary block, angle-closure and secondary glaucoma. 7,[10][11][12][13] The aim of this study was to present the initial results obtained in connection with the implantation of the 1stQ AddOn ® diffractive supplementary IOL produced by Medicontur Medical Engineering Ltd (Zsámbék, Hungary) in pseudophakic patients who had previously had various monofocal capsular bag IOLs implanted. The patients in this study wished to become completely independent of spectacle correction.…”

“…Our choice of this supplementary add-on IOL family was justified by that, unlike similar lenses on the market, this platform has been reported to be safe in terms of stable positioning in various eyes, leaving an adequate interlenticular space between the lens and the primary IOL, and involving hardly any complications related to either the surgery or the postoperative course. 10,11,14,15 According to the manufacturer, the 1stQ AddOn diffractive supplementary IOL has an optic similar to the Medicontur Liberty ® 677MY capsular bag IOL, with clinical trifocal performance and spectacle independence of patients being confirmed in related studies. [16][17][18]…”

A review of results after implantation of a secondary intraocular lens to correct residual refractive error after cataract surgery

“…The only peer-reviewed study discussing this new secondary IOL (that we are aware of) was a study performed on postmortem pseudophakic human eyes 14. The results of the study suggested that the distance between the primary in-the-bag lens and the AddOn secondary lens was sufficient and predictable.…”