The Binkhorst Medal Lecture Biologic relationship between poly(methyl methacrylate) intraocular lenses and uveal tissue

Abstract

Implantation of a poly(methyl methacrylate) (PMMA) intraocular lens (IOL) after cataract surgery is associated with breakdown of the blood-ocular barrier and a foreign body inflammatory response. Although the material is biocompatible, it is not inert. The history of PMMA IOL implantation has reflected mechanical, chemical, and immunological interactions between the IOL and ocular tissues. The common link in these events is instability of the blood-ocular barrier. In this lecture, I discuss the nature of these interactions and present evidence that currently investigated methods of surface modification and capsular bag IOL implantation are effective in stabilizing the blood-ocular barrier.

Long-term results of cataract extraction with intraocular lens implantation in patients with uveitis

“…33,34 Using stringent perioperative control of inflammation, short-term viability has been good. In this series these trends have been reinforced; no IOL required removal or exchange after a minimum of 5 years; none has been significantly decentred; and the number compromised by adherent inflammatory cells has been small.…”

“…In this series these trends have been reinforced; no IOL required removal or exchange after a minimum of 5 years; none has been significantly decentred; and the number compromised by adherent inflammatory cells has been small. The optimal IOL material is the continued subject of debate, 31,[34][35][36] and long-term follow-up studies such as this cannot address such issues (being intrinsically out of date with developments in materials). Nevertheless, the high degree of long-term intraocular tolerance of PMMA IOLs, with or without HSM, is further encouragement to the almost universal use of IOLs in patients with uveitis.…”

Inhibition of lens epithelial cell proliferation by substituted PMMA intraocular lenses

“…Implantation of a PC-IOL leads to an inflammatory reaction which triggers cellular proliferation [9]. Cellular migration and proliferation is based on interaction between extracellular matrix protein (ECM) components and cellular receptors of the integrin family that transmit signals from outside to inside the cells [15].…”

Long-term follow-up of obsolete design: Iris-clip glass intraocular lens

“…6 Corneal decompensation was probably caused by a combination of both mechanisms: intermittent contact between the edges of the IOL optic-haptics and the corneal endothelium, as well as long-term disruption of the blood-aqueous barrier caused by anterior and posterior iris chafing. 8 As expected with such an iris-clip design, there were different signs of pigment dispersion within the eye and probably a pigmentary component in the glaucoma history of the patient.…”