A clinical comparison of single-piece and three-piece truncated hydrophobic acrylic intraocular lenses

doi:10.1016/S0002-9394(03)00418-5

American Journal of Ophthalmology

Volume 136, Issue 4, October 2003, Pages 614-619

https://doi.org/10.1016/S0002-9394(03)00418-5 Get rights and content

Abstract

Purpose

To determine the clinical differences between three-piece (3P) and single-piece (SP) truncated hydrophobic acrylic intraocular lenses (IOL).

Design

Retrospective cohort clinical study.

Methods

The setting was an academic clinical practice. The patient population consisted of subjects without confounding comorbidity that could effect central vision with at least 1-year follow-up after uncomplicated surgical placement of 3P or SP IOLs in the capsular bag and at least 20/25 best-corrected postoperative vision documented. Observation procedures were as follows: logarithm of the minimal angle of resolution (LogMAR) visual acuity (uncorrected and best corrected), digital retroillumination photographs to ascertain posterior capsular opacification (PCO), anterior capsular opacification (ACO), IOL centration, and refractive stability by comparing this refraction with the early postoperative refraction. Patients completed a dysphotopsia questionnaire. Main outcome measures were as follows: LogMAR visual acuity (uncorrected and best corrected), PCO, ACO, IOL centration, refractive stability, and dysphotopsia outcomes comparing 3P and SP.

Results

Seventy-five patients were enrolled (36 3P and 39 SP). Corrected and uncorrected visual acuity, refractive stability, and IOL centration were similar. Single piece truncated hydrophobic acrylic intraocular lenses had more PCO (P = .013), less ACO (P = .001), less central flash looking at a peripheral light (P = .044), and less unwanted images to the side of a light source (P = .025).

Conclusions

Although similar in centration and refractive stability, SP has more PCO, less ACO, and less dysphotopsia than 3P.

Section snippets

Setting

Our first SP lenses were inserted in March of 2000. As the first lens available had a 5.5-mm optic, we only examined patients receiving SP from March 1, 2000, to January 31, 2001, and 3P from November 1, 1999, to March 31, 2001, who had 5.5-mm optics (AcrySof MA-30 and SA-30). Because the popularity of the SP at our institution rapidly eclipsed the 3P, to get comparable numbers, we had to extend the patient selection period for 3P. The majority of these patients had surgery before March 2000

Results

Seventy-five patients were enrolled (36 3P and 39 SP). Age and gender were statistically similar; however, as expected, the 3P follow-up time from surgery to examination was on average 37 days longer, and this difference was statistically significant (Table 2).

Looking at refractive stability, the number of patients who had greater than 0.5 and 1.0 diopters of shift and LogMAR visual acuity with and without correction were all statistically similar. Centration results were also similar (Table 3

Discussion

A significant attribute of the 3P lens has been its excellent PCO profile. This has been attributed to both a material effect,10, 11 as well as its truncated edge. Nishi and associates have shown that a truncated edge, when pushed into the posterior capsule, results in a barrier effect to lens epithelial cells and resultant PCO, the effect of which is similar for hydrophobic acrylic, polymethylmethacrylate, and silicone IOLs.4, 5, 12

Our study has shown that SP has roughly twice the PCO of 3P

Acknowledgements

We acknowledge Sarah Hamilton, BS, and Steven C. Alden, PhD (Department of Family and Preventative Medicine, University of Utah), for their statistical consultation and assistance.

References (20)

E.J. Hollick et al.
Biocompatibility of poly (methylmethacrylate), silicone and AcrySof intraocular lensesrandomized comparison of the cellular reaction on the anterior lens surface
J Cataract Refract Surg
(1998)
E.J. Hollick et al.
The effect of polymethylmethacrylate, silicone and polyacrylic intraocular lenses on posterior capsule opacification three years after cataract surgery
Ophthalmology
(1999)
K. Hayashi et al.
Changes in posterior capsule opacification after poly (methylmethacrylate), silicone, and acrylic intraocular lens implantation
J Cataract Refract Surg
(2001)
O. Nishi et al.
Preventing posterior capsule opacification by creating a discontinuous sharp bend in the capsule
J Cataract Refract Surg
(1999)
O. Nishi et al.
Effect of round-edged acrylic intraocular lenses on preventing posterior capsule opacification
J Cataract Refract Surg
(2001)
J.T. Holladay et al.
Analysis of edge glare phenomena in intraocular lens edge designs
J Cataract Refract Surg
(1999)
M.A. Farbowitz et al.
Visual complaints of patients with AcrySof acrylic intraocular lenses
J Cataract Refract Surg
(2000)
R. Tester et al.
Dysphotopsia in phakic and pseudophakic patients—incidence and relation to intraocular lens types
J Cataract Refract Surg
(2000)
M.R. Tetz et al.
Photographic image analysis system of posterior capsule opacification
J Cataract Refract Surg
(1997)
R.J. Linnola
Sandwich theorybioactivity-based explanation for posterior capsule opacification
J Cataract Refract Surg
(1997)

There are more references available in the full text version of this article.

Cited by (61)

Process mining as support to simulation modeling: A hospital-based case study
2020, Simulation Modelling Practice and Theory
The purpose of this paper is to show how the knowledge of Process Mining techniques can provide a robust premise to build a Discrete Event Simulation (DES) model of a healthcare process. In order to analyze some specific processes of an ophthalmology ward of a large Italian hospital, ProM6 framework was implemented, which supports process mining techniques in form of plug-ins; the plug-ins process data, in form of Event Log, in order to extract information about the process. The DES model based on such information was run via a commercial tool, Simul8, which allows building sophisticated process models. A timely algorithm was then deployed to adapt the ProM6 information to the DES model. Following, a conformance analysis was conducted by comparing the original Event Log, and the Simulation tool data, taking into account the main case-related model attributes (routing probabilities profile, time perspective, and resources perspective). The paper aims at developing the line of inquiry for what concerns the deployment of approaches to set forth the link between Process mining and Simulation modeling.
Long-term outcome of cataract surgery: 20-year results from a population-based prospective study
2019, Journal of Cataract and Refractive Surgery
To report the longitudinal visual functional outcome after cataract surgery over 20 years.
Eye clinic, Norrlands University Hospital, Sweden.
Prospective population-based cohort study.
One hundred fourteen patients (86% of survivors) who had cataract surgery during a 1-year period (1997 to 1998) answered the same Visual Function Index-14 questionnaire (VF-14) preoperatively, 2 to 4 months postoperatively, and at 5, 10, 15, and 20 years after surgery. Most patients (100 [88%] of 114; 75% of survivors) also had a routine ocular examination, including corrected distance visual acuity (CDVA).
The mean age of the114 patients in the study was 60.6 years (range 36 to 80 years) at the time of surgery. Twenty years after surgery, the median CDVA in the operated eye had deteriorated from Snellen acuity 20/20 (logarithm of the minimum angle of resolution [logMAR] 0.0) postoperatively to 20/23 (logMAR 0.07) (P = .001). Patients aged 70 years or older at surgery had the largest loss of CDVA at 20 years compared with younger patients. At 20 years, 63 (55%) of the 114 patients had no deterioration in subjective visual function and most patients (82 [72%]) had 10 points decline or less. Patients who were older at surgery had a more pronounced decline in VF-14 total score over 20 years (P = .002). Fifty-six (58%) of 96 patients had never been treated for posterior capsule opacification.
This prospective 20-year follow-up study provided estimates of longitudinal visual results. Cataract surgery also offered excellent long-term visual rehabilitation for the majority, especially younger patients, after 20 years, with a low requirement for Nd:YAG laser capsulotomy. The results in this study are of value for counseling younger patients with cataract and patients considering refractive lens surgery.
Five-Year Cumulative Incidence and Risk Factors of Nd:YAG Capsulotomy in 10 044 Hydrophobic Acrylic 1-Piece and 3-Piece Intraocular Lenses
2019, American Journal of Ophthalmology
To evaluate the 5-year cumulative incidence and risk factors of Nd:YAG capsulotomy between hydrophobic acrylic intraocular lenses (IOLs).
A retrospective cohort study.
A review of the registry of operations between the years 2007 and 2016 was carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland. A total of 10 044 eyes having cataract surgery and in-the-bag implantation of ZCB00 (Abbott Medical Optics Johnson & Johnson Vision, Inc, Abbott Park, Illinois, USA), SN60WF (Alcon Laboratories, Inc, Fort Worth, Texas, USA), or ZA9003 (Abbott Medical Optics Johnson & Johnson Vision, Inc) IOLs were included in the study. The cumulative incidence of Nd:YAG capsulotomy was estimated with competing risks methodology. Competing risks regression modeling was used to evaluate potential risk factors, including the patient's age, sex, type of IOL, dioptric power of IOL, and operating surgeon's seniority.
The 5-year cumulative incidence of Nd:YAG capsulotomy after cataract surgery was 13.2% (95% confidence interval [CI] 12.5%-14.0%) for all eyes and 18.1% (16.5%-20.0%), 11.5% (10.5%-12.6%), and 9.6% (8.2%-11.4%) for ZCB00, SN60WF, and ZA9003 IOLs, respectively. Implantation of SN60WF and ZA9003 IOLs was associated with a 38% and 47% subhazard reduction (SHR), respectively, compared to ZCB00, after accounting for other predictors (SHR = 0.62; 95% CI 0.54-0.71; P < .001 and SHR = 0.53; 95% CI 0.43-0.64; P < .001). Increased risk of Nd:YAG capsulotomy was associated with eyes of patients aged younger than 60 years, female sex, and eyes implanted with an IOL of <22.5 diopters power.
Real-world evidence suggests that the cumulative incidence of Nd:YAG capsulotomy is significantly lower in eyes receiving SN60WF or ZA9003 IOLs compared to ZCB00.
Refractive predictability of a 3-piece intraocular lens platform versus its 1-piece counterpart
2017, Canadian Journal of Ophthalmology
Citation Excerpt :
Previous studies comparing the ZA9003 and ZCB00 lenses found similar rates of decentration and tilt, but the ZA9003 had a tendency to shift anteriorly postoperatively, resulting in a shallower postoperative ACD and myopia compared with the ZCB00.7,9,10 These findings are similar to those of previous work comparing other 3-piece and single-piece lenses.2–4,6,11 This anterior shift could be caused by decay of the PMMA haptic compression force in the intraocular environment during the first 2 weeks of the postoperative period and by reduced haptic memory with time.1,12,13
To compare the refractive outcomes of a 3-piece acrylic intraocular lens (IOL) with its 1-piece counterpart after phacoemulsification with in-the-bag implantation.
Retrospective chart review.
One-hundred twenty-six eyes of 95 patients were analyzed in the study, including 60 eyes of 43 patients receiving a 3-piece IOL and 66 eyes of 52 patients receiving a 1-piece IOL.
Randomized chart review of all patients who underwent uncomplicated phacoemulsification with in-the-bag IOL implantation with either a 3-piece hydrophobic acrylic IOL (Tecnis ZA9003) or a 1-piece hydrophobic acrylic IOL (Tecnis ZCB00) between 2006 and 2014 in a tertiary ophthalmology care centre in Mississauga, Ontario. Preoperative visual acuity and refraction, anterior chamber depth, axial length, IOL design and power, predicted refraction, postoperative visual acuity, and refraction were recorded.
Mean absolute error was 0.40 ± 0.27 in the ZA9003 group and 0.39 ± 0.35 in the ZCB00 group, with no statistically significant difference between the 2 IOLs (p = 0.86). Mean arithmetic error was 0.11 ± 0.47 D in the ZA9003 group and 0.01 ± 0.47 D in the ZCB00 group (p = 0.019). In the ZA9003 group, 23 (38%), 42 (70%), and 52 (87%) of 60 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction. In the ZCB00 group, 32 (48%), 46 (70%), and 56 (85%) of 66 eyes were within 0.25, 0.50, and 0.75 D, respectively, of predicted postoperative refraction (p = 0.2836, p = 1.00, p = 0.8044).
The ZA9003 and the ZCB00 have similar mean absolute error and thus appear to have similar refractive predictability.
Comparer les résultats réfractifs obtenus avec une lentille intraoculaire (LIO) en acrylique 3 pièces et une LIO monobloc après phacoémulsification avec implantation dans le sac capsulaire.
Examen rétrospectif de dossiers médicaux
L’étude portait sur 126 yeux (95 patients); on a implanté une LIO 3 pièces dans 60 yeux (43 patients) et une LIO monobloc dans 66 yeux (52 patients).
Examen aléatoire des dossiers de tous les patients ayant subi une phacoémulsification sans complications avec implantation dans le sac capsulaire d’une LIO 3 pièces en acrylique hydrophobe (Tecnis ZA9003) ou d’une LIO monobloc en acrylique hydrophobe (Tecnis ZCB00) entre 2006 et 2014 dans un centre de soins ophtalmologiques tertiaires de Mississauga (Ontario, Canada). On a consigné les paramètres suivants: acuité visuelle et réfraction préopératoires, profondeur de la chambre antérieure, longueur axiale, conception et puissance de la LIO, réfraction prévue, et acuité visuelle et réfraction postopératoires.
Erreur absolue moyenne (EAM), erreur arithmétique moyenne (EArM)
L’EAM était de 0,40 ± 0,27 dans le groupe ZA9003 et de 0,39 ± 0,35 dans le groupe ZCB00; l’écart entre les deux LIO n’était pas statistiquement significatif (p = 0,86). L’EArM était de 0,11 ± 0,47 D dans le groupe ZA9003 et de 0,01 ± 0,47 D dans le groupe ZCB00 (p = 0,019). Dans le groupe ZA9003, 23 (38 %), 42 (70 %) et 52 (87 %) des 60 yeux étaient à ≤ 0,25 D, à ≤ 0,50 D et à ≤ 0,75 D, respectivement de la réfraction postopératoire prévue. Dans le groupe ZCB00, 32 (48 %), 46 (70 %) et 56 (85 %) des 66 yeux étaient à ≤ 0,25 D, à ≤ 0,50 D et à ≤ 0,75 D, respectivement de la réfraction postopératoire prévue (p = 0,2836, p = 1,00 et p = 0,8044).
Les LIO ZA9003 et ZCB00 sont assorties d’une EMA comparable; elles semblent donc avoir une prévisibilité de réfraction semblable.
Intraindividual comparison of capsule behavior of 2 hydrophobic acrylic intraocular lenses during a 5-year follow-up
2017, Journal of Cataract and Refractive Surgery
To evaluate and compare the 5-year postoperative anterior (ACO) and posterior capsule opacification (PCO), the occurrence of glistenings, and the level of anterior capsule retraction after implantation of 2 designs of 1-piece hydrophobic acrylic IOLs.
Hospital St. John, Vienna, Austria.
Randomized controlled prospective case series.
Patients had an Acrysof SA60AT IOL (Group A) implanted in 1 eye and a Tecnis ZCB00 IOL (Group B) implanted in the fellow eye. At 1, 3, and 5 years, the PCO level was evaluated with the Evaluation of Posterior Capsule Opacification software. The level of ACO and capsule retraction was graded subjectively. Glistenings were scored as present or not present.
Fifty eyes of 25 patients were evaluated after 5 years. No significant differences in PCO scores were found between the 2 groups at all follow-up visits (1 year: 0.06 ± 0.12 [SD] versus 0.07 ± 0.13, P = .35; 3 years: 0.23 ± 0.36 versus 0.22 ± 0.32, P = .66; 5 years: 0.36 ± 0.41 versus 0.36 ± 0.54, P = .98). A significant increase in PCO score was found between 3 and 5 years (P < .01). Anterior capsule opacification was present in Group A and Group B in 18.0% and 2.7% of eyes (P = .03), in 92.0% and 24.0% of eyes, and in 100% and 52% of eyes (P < .01) at 1, 3, and 5 years, respectively. Glistenings (5 years 100%) were observed in Group A.
Both IOLs had a comparable PCO rate 5 years after surgery, although more ACO and retraction as well as glistenings were observed in Group A.
The effect of single-piece hydrophobic acrylic intraocular lenses on the development of posterior capsule opacification
2015, American Journal of Ophthalmology
To evaluate the long-term effect of a single-piece hydrophobic acrylic intraocular lens (IOL), AcrySof SN60AT (Alcon Laboratories, Fort Worth, Texas, USA), on the development of posterior capsule opacification (PCO) 5 years postoperatively.
Prospective, observational, consecutive, case series.
setting: Iladevi Cataract and IOL Research Center, Ahmedabad, India. study population: Three hundred and ninety eyes with uncomplicated age-related cataract were included. Patients with diabetes mellitus, glaucoma, high myopia, pseudoexfoliation, traumatic cataract, subluxated cataract, previous ocular surgeries, and allergy to dilating drops were excluded. intervention procedures: Digital retroillumination photographic documentation was performed and analyzed for PCO using Evaluation of Posterior Capsule Opacification software. The scores and areas were calculated. main outcome measures: PCO development and the influence of the anterior capsule cover (total on and part on) on the IOL optic was studied within the capsulorrhexis margin and the central 3.0 mm optic area.
There was a significant increase in PCO up to 3 years. No significant change in PCO was observed between 3 and 5 years within the capsulorrhexis margin and central 3.0 mm optic area. In the total on group, within the capsulorrhexis margin, significantly lower scores and areas were observed when compared with part-on scores and areas.
The increase in PCO up to 3 years was significant. Stabilization in PCO was observed between 3 and 5 years with no difference at 5 years. There was a low incidence of PCO in eyes with total anterior capsule cover over the IOL optic.

View all citing articles on Scopus

^☆

InternetAdvance publication at ajo.com April 22, 2003.

This study was supported in part by a grant from Research to Prevent Blindness, Inc., New York, New York, to the Department of Ophthalmology and Visual Sciences, University of Utah. Dr. Olson is a consultant for Advanced Medical Optics.

View full text

Original articleA clinical comparison of single-piece and three-piece truncated hydrophobic acrylic intraocular lenses☆

Abstract

Purpose

Design

Methods

Results

Conclusions

Section snippets

Setting

Results

Discussion

Acknowledgements

Biocompatibility of poly (methylmethacrylate), silicone and AcrySof intraocular lensesrandomized comparison of the cellular reaction on the anterior lens surface

J Cataract Refract Surg

The effect of polymethylmethacrylate, silicone and polyacrylic intraocular lenses on posterior capsule opacification three years after cataract surgery

Ophthalmology

Changes in posterior capsule opacification after poly (methylmethacrylate), silicone, and acrylic intraocular lens implantation

J Cataract Refract Surg

Preventing posterior capsule opacification by creating a discontinuous sharp bend in the capsule

J Cataract Refract Surg

Effect of round-edged acrylic intraocular lenses on preventing posterior capsule opacification

J Cataract Refract Surg

Analysis of edge glare phenomena in intraocular lens edge designs

J Cataract Refract Surg

Visual complaints of patients with AcrySof acrylic intraocular lenses

J Cataract Refract Surg

Dysphotopsia in phakic and pseudophakic patients—incidence and relation to intraocular lens types

J Cataract Refract Surg

Photographic image analysis system of posterior capsule opacification

J Cataract Refract Surg

Sandwich theorybioactivity-based explanation for posterior capsule opacification

J Cataract Refract Surg

Original article
A clinical comparison of single-piece and three-piece truncated hydrophobic acrylic intraocular lenses☆