Secondary intraocular lenses in eyes with aphakia or dislocated IOL: impact of suture fixation on early and late complications

BACKGROUND: Secondary intraocular lens (IOL) implantation is exposed to an increased risk of complications, including endophthalmitis and retinal detachment. The present analysis compares the outcomes and complications experienced in our own series of patients. PATIENTS AND METHODS: We retrospectively reviewed a consecutive series of secondary posterior chamber IOL implantations performed in a single centre, two surgeon setting over a period of 8 years and with a follow up-time of at least 4 months. RESULTS: Between 1997 and 2005, 75 patients received a sulcus-supported secondary IOL without suture fixation, whereas suture fixation was required in 137 instances. Visual acuity improved in both groups (group 1: from 0.36 +/- 0.39 (0.01-1.2) to 0.73 +/- 0.33 (0.02-1.0; p = 0.18); group 2: from 0.33 +/- 0.34 (0.02-1.0) to 0.46 +/- 0.33 (0.01-1.0; p = 0.006), but more pronounced in eyes not requiring suture fixation (p = 0.012). IOL placement was more likely to be combined with endophacoemulsification in the not suture-fixed IOLs (12.7 vs. 5.3 %). In contrast, retinal tears (10.6 vs. 8.6 %, respectively) and retinal detachment (5.3 vs. 2.2 %, respectively) were equally distributed. In the early postoperative phase, IOP was lower in suture-fixed eyes, which showed a higher incidence of minor intraocular haemorrhages and cystoid macular edema (5.3 vs. 8.0 %); late complications up to 5 years postoperatively were equally distributed. CONCLUSION: A preoperatively less complicated anterior segment situation and a lower incidence of postoperative macular edema may account for a better visual outcome after placement of a sulcus supported IOLs without suturing. If required, suture fixation may be performed without exposing the eye to an increased risk of late postoperative complications.

Late postoperative opacification of hydrogel intraocular lenses: analysis of 13 explanted lenses

PURPOSE: We report the clinical, morphological, and ultrastructural findings of 13 consecutively explanted opacified Hydroview(R) (hydrogel) intraocular lenses (IOLs). Our purpose was to provide a comprehensive account on the possible factors involved in late postoperative opacification of these IOLs. PATIENTS AND METHODS: Thirteen consecutive opacified hydrogel IOLs (Hydroview H 60 M, Bausch ; Lomb) were explanted due to the significant visual impairment they caused. The IOLs underwent macroscopical examination, transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and electrophoresis for protein detection. Three unused control Hydroview IOLs served for comparison. RESULTS: Macroscopical examination showed a diffuse or localized grey-whitish opacification within the IOL optic. TEM confirmed the presence of lesions inside the optic in all the explanted IOLs and revealed 3 patterns of deep deposits: a) diffuse, thick, granular, electron-dense ones; b) small, thin, lattice-like ones, with prominent electron-lucent areas; and c) elongated electron-dense formations surrounded by electron-lucent halos. SEM showed surface deposits on four IOLs. EDS revealed oxygen and carbon in all IOLs and documented calcium, phosphorus, silicon and/or iron in the deposits. Two of the patients with iron in their IOLs had eye surgery prior to their phacoemulsification. Iron correlated well with the second TEM pattern of deep lesions, whereas calcium with the third TEM pattern. No protein bands were detected on electrophoresis. Control lenses did not show any ultrastructural or chemical abnormality. CONCLUSIONS: The present study supports the presence of chemical alterations inside the polymer of the optic in late postoperative opacification of Hydroview IOLs. This opacification does not follow a unique pathway but may present under different ultrastructular patterns depending on the responsible factors. Mechanical stress during surgery may initiate a sequence of events where ions such as calcium, phosphorus, silicon, and/or iron, participate in a biochemical cascade that leads to gradual alteration of the polymer network. Intraocular inflammation due to previous operation may be a factor inducing opacification through increase of iron-binding capacity in the aqueous humour. Calcification accounts only partially for the opacification noted in this type of IOL.

Prismatine and Ferrohogbomite-2N2S in Granulite-Facies Fe-Oxide Lenses in the Eastern Ghats Belt at Venugopalapuram, Vizianagaram District, Andhra Pradesh, India: Do Such Lenses Have a Tourmaline-Enriched Lateritic Precursor?

Fluorine-rich prismatine, (square,Fe,Mg)(Mg,Al,Fe)(5)Al-4(Si,B,Al)(5)O-21(OH,F), with F/(OH+F) = 0.36-0.40 and hercynite are major constituents of a Fe-Al-B-rich lens in ultrahigh-temperature granulite-facies quartz-sillimanite-hypersthene-cordierite gneisses of the Eastern Ghats belt, Andhra Pradesh, India. Hemo-ilmenite. sapphirine, magnetite, biotite and sillimanite are subordinate. Lithium, Be and B are concentrated in prismatine (140 ppm Li, 170 ppm Be, and 2.8-3.0 wt.% B2O3). Another Fe-rich lens is dominantly magnetite, which encloses fine-grained zincian ferrohogbomite-2N2S, (Fe2+ Mg,Zn,Al)(6) (Al,Fe3+,Ti)(16)O-30(OH)(2), containing minor Ga2O3 (0.30-0.92 wt.%). Fe-Al-B-rich lenses with prismatine (or kornerupine) constitute a distinctive type of B-enrichment in granulite-facies rocks and have been reported from four other localities worldwide. A scenario involving a tourmaline-enriched lateritic precursor affected by dehydration melting is our preferred explanation for the origin of the Fe-Al-B-rich lenses at the five localities. Whole-rock analyses and field relationships at another of these localities, Bok se Puts, Namaqualand, South Africa, are consistent with this scenario. Under granulite-facies conditions, tourmaline would have broken down to give korner-upine-prismatine ( other borosilicates) plus a sodic melt containing H2O and B. Removal of this melt depleted the rock in Na and B, but the formation of ferromagnesian borosilicate phases in the restite prevented total loss of B.

Prevention of increased abnormal fundus autofluorescence with blue light-filtering intraocular lenses

PURPOSE To observe changes in fundus autofluorescence 2 years after implantation of blue light-filtering (yellow-tinted) and ultraviolet light-filtering (colorless) intraocular lenses (IOLs). SETTING Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, and the Department of Ophthalmology, University of Bern, Bern, Switzerland. DESIGN Prospective comparative observational study. METHODS Patients were enrolled who had cataract surgery with implantation of a yellow-tinted or colorless IOL and for whom images were obtained on which the fundus autofluorescence was measurable using the Heidelberg Retina Angiogram 2 postoperatively. The fundus autofluorescence in the images was classified into 8 abnormal patterns based on the classification of the International Fundus Autofluorescence Classification Group, The presence of normal fundus autofluorescence, geographic atrophy, and wet age-related macular degeneration (AMD) also was recorded. The fundus findings at baseline and 2 years postoperatively were compared. RESULTS Fifty-two eyes with a yellow-tinted IOL and 79 eyes with a colorless IOL were included. Abnormal fundus autofluorescence did not develop or increase in the yellow-tinted IOL group; however, progressive abnormal fundus autofluorescence developed or increased in 12 eyes (15.2%) in the colorless IOL group (P = .0016). New drusen, geographic atrophy, and choroidal neovascularization were observed mainly in the colorless IOL group. The incidence of AMD was statistically significantly higher in the colorless IOL group (P = .042). CONCLUSIONS Two years after cataract surgery, significant differences were seen in the progression of abnormal fundus autofluorescence between the 2 groups. The incidence of AMD was lower in eyes with a yellow-tinted IOL. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

(Table 2) Observations of anticyclonic lenses of Mediterranean water in the Central North Atlantic

Analyses of spatial structure of hydrophysical fields and its vertical evolution in the Northeast Atlantic in a layer from the surface down to 2-2.5 km are carried out based on results of measurements in a testing area (31°-36°N, 20°-26°W) southeast of the Azores in autumn 1993. A description of an anti-cyclonic lens (ACL) of Mediterranean water (MW), which was found in the eastern part of the testing area from data of sets of sequential surveys, is presented. Analysis of CTD and XBT measurements in an area west of the lens allows to conclude that despite some contraction of width of the Azores Current directed eastward (from 60-80 km to 50-60 km) its total eastward volume transport for a period of time from October to November does not vary much. It is shown that intermediate salinity maxima in the northern part of the testing area formed by advection of MW and meddy destruction weakens while intersecting the Azores frontal zone (AFZ) from north to south, displacing itself to larger depth, and increases in thickness. Analysis of data shows that the number of lenses observed within the selected area north of the AFZ is two times more than that observed south of it. North of the AFZ observed salinity maximum and local temperature maxima may be associated with accumulation of heat and salt because of the fact that the AFZ is not only a southern boundary of penetration of MW into the North Atlantic, but also is a "semitransparent" boundary for Mediterranean lenses.

(Table 3) Observations of Mediterranean water lenses in the Eastern North Atlantic

Spreading pattern and mesoscale structure of Mediterranean water outflow in the eastern North Atlantic are studied on the basis of historical hydrographical records. Effect of bottom topography on Mediterranean water distribution is revealed. It is shown that the Mediterranean water outflow is divided into two streams after leaving the Gulf of Cadiz. These are northwestern and southwestern ones; the former is more intensive and spreads in more regular and continuous way. West of the Tejo (Tagus) Plateau it splits into three branches; the most intense of them keeps continuity up to 14°W. The less intensive southwestern stream passes south of the Gettysburg Bank and splits into two branches immediately after the Gulf of Cadiz. From 11°W, this stream has lenticular, intermittent character. West of 14°-15°W all Mediterranean water branches are represented mainly by isolated salty patches. As a result of historical data analysis in the 32°-44°N, 8°-22°W area, 30 Mediterranean water lenses have been found; 12 of them had not been previously mentioned in publications. A table of main parameters of Mediterranean water lenses is presented. It includes data of 108 observations from 1911 to 1993.

Silica final lenses under HiPER laser fusion reactor operation conditions

We have studied the thermo-mechanical response and atomistic degradation of final lenses in HiPER project. Final silica lenses are squares of 75 × 75 cm2 with a thickness of 5 cm. There are two scenarios where lenses are located at 8 m from the centre: •HiPER 4a, bunches of 100 shots (maximum 5 DT shots <48 MJ at ≈0.1 Hz). No blanket in chamber geometry. •HiPER 4b, continuous mode with shots ≈50 MJ at 10 Hz to generate 0.5 GW. Liquid metal blanket in chamber design.

Lifetime of silica final lenses subject to HiPER irradiation conditions

The goal of the European laser fusion project, is to build an engineering facility for repetitive laser operation (HiPER 4a) and later a fusion reactor (HiPER 4b). A key aspect for laser fusion energy is the final optics. At the moment, it is based on silica transmission lenses located 8 m away from the chamber center. Lens lifetime depends on the irradiation conditions. We have used a 48 MJ shock ignition target for calculations. We have studied the thermo-mechanical effects of ions and X-rays on the lenses. Ions lead to lens melting and must therefore be mitigated. On the other hand, X-rays (~1% of the energy) does not produce either a significant temperature rise or detrimental stresses. Finally, we calculated the neutron flux and gamma dose rate on the lenses. Next, based on a simple model we studied the formation of color centers in the sample, which lead to optical absorption. Calculations show that simultaneous neutron and gamma irradiation does not significantly increase the optical absorption during the expected lifetime of the HiPER 4a facility. Under severe conditions (HiPER 4b), operation above 800 K or lens refreshing by thermal annealing treatments seem to assure adequate behavior.

Electrooptic characterization of tunable cylindrical liquid crystal lenses

In this work, one-dimensional arrays of cylindrical adaptive liquid crystal lenses were manufactured and characterized; and test devices were filled with nematic liquid crystal. Comb interdigitated electrodes were designed as a mask pattern for the control electrode on the top glass substrates. A radial graded refractive index along each microsized lens was achieved by fabricating a layer of high resistance sheet deposited as a control electrode. These tunable lenses were switched by applying amplitude and frequency optimized waveforms on the control electrode. Phase profiles generated by the radial electric field distribution on each lens were measured by a convectional interferometric technique.

Thermal effects and other interesting issues with CPV lenses

The Photovoltaic (PV) Module Reliability Workshop was held in Golden, Colorado, on Feb. 28?March 1, 2012. The objective was to share information to improve PV module reliability because such improvements reduce the cost of solar electricity and give investors confidence in the technology. NREL led the workshop, which was sponsored by the U.S. Department of Energy (DOE) Solar Energy Technologies Program (Solar Program).

Design of spherical symmetric gradient index lenses

Spherical symmetric refractive index distributions also known as Gradient Index lenses such as the Maxwell-Fish-Eye (MFE), the Luneburg or the Eaton lenses have always played an important role in Optics. The recent development of the technique called Transformation Optics has renewed the interest in these gradient index lenses. For instance, Perfect Imaging within the Wave Optics framework has recently been proved using the MFE distribution. We review here the design problem of these lenses, classify them in two groups (Luneburg moveable-limits and fixed-limits type), and establish a new design techniques for each type of problem.

On the design of spherical gradient index lenses

Classical spherical gradient index (GRIN) lenses (such as Maxwell Fish Eye lens, Eaton lens, Luneburg lens, etc.) design procedure using the Abel integral equation is reviewed and reorganized. Each lens is fully defined by a function called the angle of flight which describes the ray deflection through the lens. The radial refractive index distribution is obtained by applying a linear integral transformation to the angle of flight. The interest of this formulation is in the linearity of the integral transformation which allows us to derive new solutions from linear combinations of known lenses. Beside the review of the classical GRIN designs, we present a numerical method for GRIN lenses defined by the Abel integral equation with fixed limits, which is an ill-posed problem.

Performance of UV-enhanced PMMA fresnel lenses and impact on LCOE

Tiny increases in the transmittance of optical materials within a CPV module can have an important impact on the economy of a plant. This is certainly true in systems comprising multi-junction solar cells, whose high performance, based on a balanced photocurrent generation among the series-connected junctions, is very sensitive to spectrum variations. Every efficiency point gained causes not only an increase in the kilowatts hour produced, but a higher benefit on it, since the difference between electricity tariff and Levelized Cost of Electricity (LCOE) rises. This work studies the impact on the LCOE of a plant based on modules comprising PMMA lenses of two different types, standard UV blocking grade which is normally used for outdoor applications at high DNI climate and a specialty stabilized UV-enhanced transmittance acrylic (see Figure 1). Energy production will be compared for these two systems throughout the year at different sites to analyze when (season, time of the day) and where the usage of the enhanced PMMA is justified.

Methodology of quantifying curvature of Fresnel lenses and its effect on CPV module performance

Fresnel lenses used as primary optics in concentrating photovoltaic modules may show warping produced by lens manufacturing or module assembly (e.g., stress during molding or weight load) or due to stress during operation (e.g., mismatch of thermal expansion between different materials). To quantify this problem, a simple method called “checkerboard method” is presented. The proposed method identifies shape errors on the front surface of primary lenses by analyzing the Fresnel reflections. This paper also deals with the quantification of the effects these curvatures have on their optical performance and on the electrical performance of concentrating modules incorporating them. This method can be used to perform quality control of Fresnel lenses in scenarios of high volume production.