Construction Solutions to Prevent Development of Secondary Cataract After Intraocular Lenses Implantation
Background. The development of secondary cataract after implantation of an intraocular lens (IOL) as a result of migration and reproduction of residual epithelial cells after phacoemulsification occurs in 45–78% of patients. The currently used IOL models do not adequately protect the posterior part of the lens capsule and the front surface of the lens from the deposition of epithelial cells on them.
Objective. The aims of the paper are as follows: (1) modeling the process of development of secondary cataract due to proliferation, migration and metaplasia of residual epithelial cells (E-LEC); (2) evaluation of existing technical solutions to combat clouding of the lens capsule (CLC), secondary cataract, after implantation of IOL; (3) development of original technical approach to solving the problem of CLC with next modeling; (4) conducting an experiment to study the movement of a dye solution in an extracted pig's eye lens, implanted with a "Support OP" lens based on the data obtained during simulation.
Methods. To model the migration of epithelial cells, the COMSOL Multiphysics 5.4 software environment and the Fluid flow library were used. For computer analysis, IOL of our own design and the lens of an American company were taken. During the simulation, it was taken into account that cells of a polygonal or oval shape have sizes from 48 to 142 μm and a constant propagation velocity of 10-4 m/s. The main attention was paid to the spread of epithelial cells not only towards the posterior wall of the lens capsule, but also to the front surface of the lens itself. After carrying out computer modeling, the results of which have been repeatedly confirmed, an experiment was carried out in which a capsule bag of a pig's eye lens was implanted with an implanted IOL of its own design. An aqueous dye solution, applied under a pressure not exceeding the penetration strength of the lens capsule, imitated the movement of epithelial cells. The study was conducted in compliance with the ARRIVE guidelines.
Results. The simulation showed that the use of the IOL sharp edge design just partially protects the back wall of the capsule from the growth of epithelial cells (E-cells) on it, despite the fact that the lens is made of hydrophobic acrylic. This IOL doesn’t tightly contact with the back wall of the capsule and therefore the migration of lens epithelial cells in this direction is possible. The front of the lens also remains vulnerable to fibrous hyperplasia, which leads not only to visual impairment, but also to its complete loss. The proposed volume-replacing IOL of its own design, which has a sharp edge, which provides close contact with the lens capsule, a groove-trap for migrating cells, and in the front of the elements for suture fixation.
Conclusions. The study revealed a number of factors that need to be addressed to prevent the development of secondary cataract. The intraocular lens must be made of biocompatible material, for the full tension of lens capsule, it is necessary that the haptic is angulated, the optical part should include at least one of the elements (a sharp edge or a special side). Based on this, the proposed approach takes into account the problems described in the article and includes the above elements and a special groove-trap for epithelial cells. Modeling and experimental testing of the proposed option confirmed its effectiveness.
Full Text:PDF (Українська)
Brian G, Taylor H. Cataract blindness – challenges for the 21 century. Bulletin of the World Health Organization. 2001;79(3):249-56.
Cataracts, symptoms, causes, classification, diagnosis [Internet]. Vizio.com.ua. 2019 [cited 2019 Dec 11]. Available from: http://vizio.com.ua/knigi/52-oftal-mologija-bezkorovajna/348-katarakta-simptomi-prichini-klasifikatsiya-diagnostika.html
Trubilin V. Analysis of cataract progression in Russia taking into account the data of natural mortality of the population. Practical Medicine. 2016;1(2):70-3.
Neroev V. Clinical and social aspects of cataract treatment in Russia. Cataract and Refractive Surgery. 2016;16(1):4-14.
Ostrovskaya M. Frequency-contrast characteristics of the eye. Optical-Mechanical Industry. 1969;2:45-54.
Aznabaev B. Clinical results of ultrasonic phacoemulsification based on three-dimensional oscillations. Modern Technologies in Ophthalmology. 2015;2:11-4.
Malyugin B. Modern standards of cataract surgery with implantation of an intraocular lens. Refractive Surgery and Ophthalmology. 2010;10(3):4-10.
Slade D. Ab externo sclera fixation of intraocular lens. Cataract Refract Surg. 2012;38(10):1316-21.
Razvina Y, Hadzhikeeva A. The history of the lens implantation. Bulletin of Medical Internet Conferences. 2017;7(6):1197.
Bellan L. The most common eye procedure in older adults. The Evolution of Cataract Surgery. 2008;11(6):328-32.
Bikbov M, Bikbulatova A. On the question of the optimal technique for conducting primary back capsulorexis. In: Modern technologies of cataract and refractive surgery. Moscow; 2008. p. 21-6.
Veshchikova V. Elastic "reverse" IOL in cataract surgery for high myopia [PhD thesis]. Moscow; S.Fedorov NMRC "MNTK "Eye microsurgery"; 2014. 27 p.
Margieva O. Analysis of the incidence of retinal detachment after laser and surgical treatment of secondary cataracts. In: Modern technologies of treatment of vitreoretinal pathology. Moscow; 2012. p. 126-8.
Ronkina T. The nature and timing of opacification of the posterior lens capsule after phacoemulsification with IOL implantation. Мoscow; 2006. 24 p.
Tereshchenko Y, Sorokin E, Belonozhenko I. Clarification of the relationship between implantable intraocular lenses from various materials and variants of the formation of opacities of the posterior lens capsule after phacoemulsification of age-related cataracts. Ophthalmosurgery. 2014;4:30-4.
Zubareva L, Khvatov V, Vilyianskaya O. Clouding of the posterior lens capsule and its treatment in children with aphakia and artifactia. Ophthalmological Journal. 1993;2:98-101.
Chuprov AD, Shcherbakov MA, Demakova LV. Laser posterior capsulotomy in case of the 1st degree of posterior capsular opacity of the lens in pseudophakic eyes. The Fyodorov Journal of Ophthalmic Surgery. 2015;1:6-11.
Polischuk O, Kozyar V. Comparative characteristic of existing aphakic intraocular lenses. Sci Res Develop. 2018;12:34-6.
Apple DJ, Peng Q, Visessook N, Werner L, Pandey SK, Escobar-Gomez M, et al. Surgical prevention of posterior capsule opacification. Part 1: Progress in eliminating this complication of cataract surgery. J Cataract Refractive Surgery. 2000;26(2):180-7. DOI: 10.1016/s0886-3350(99)00353-3
Gaponko O, Kuroyedov A, Gorodnichy V, Ogorodnikova V, Zakharova M, Kuznetsov K, et al. New morphometric diagnostic markers of glaucoma. RMJ Clinical ophthalmol. 2016;1:1-6.
Suzana M. What do eye‐surgeons expect from IOLs for the future? In: Proceedings of the 45th EFCLIN Congress and Exhibition; 2018 Apr 26–28; Dubrovnik.
Lane N. Pioneers of the past and the present examine the permissible limits of innovation [Internet]. EuroTimes. 2006 [cited 2019 Dec 15]. Available from: https://issuu.com/eurotimes/docs
Ramazanova A. Complex system of prevention and treatment of opacification of the posterior lens capsule after phacoemulsification with IOL implantation. Moscow; 2006. 25 p.
Abela-Formanek C, Amon M, Schauersberger J, Kruger A, Nepp J, Schild G. Results of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in uveitic eyes with cataract: comparison to a control group. J Cataract Refract Surg. 2002 Jul;28(7):1141-52. DOI: 10.1016/s0886-3350(02)01425-6
Polischuk OS, Kozyar VV, inventors; Polischuk OS, assignee. Flexible monoblock multifocal intraocular “Support OP” lens. Ukraine patent 137306. 2019 Oct 10.
Ioshin I, Egorova E, Tolchinskaya A. Intracapsule ring in the prevention of complicated cataract surgery. In: Proceedings of the Conference on Questions of Ophthalmology; 2001; Krasnoyarsk.
Hara T, Yamada Y. "Equator ring" for maintenance of the completely circular contour of the capsular bag equator after cataract removal. Ophthalmic Surg. 1991 Jun;22(6):358-9.
Egorova E, Ioshin I, Tolchinskaya A, Sobolev N. The choice of the IOL fixation method for traumatic damage to the lens. Modern Technologies of Cataract Surgery. 2000;32-9.
Nagamoto T, Bissen-Miyajima H. A ring to support the capsular bag after continuous curvilinear capsulorhexis. J Cataract Refract Surg. 1994 Jul;20(4):417-20. DOI: 10.1016/s0886-3350(13)80177-0
Apple DJ, Peng Q, Visessook N, Werner L, Pandey SK, Escobar-Gomez M, et al. Eradication of posterior capsule opacification: documentation of a marked decrease in Nd:YAG laser posterior capsulotomy rates noted in an analysis of 5416 pseudophakic human eyes obtained postmortem. Ophthalmology. 2001 Mar;108(3):505-18. DOI: 10.1016/s0161-6420(00)00589-3
Findl O, Buehl W, Menapace R, Georgopoulos M, Rainer G, Siegl H, et al. Comparison of 4 methods for quantifying posterior capsule opacification. J Cataract Refract Surg. 2003 Jan;29(1):106-11. DOI: 10.1016/s0886-3350(02)01509-2
Nishi O, Nishi K, Mano C, Ichihara M, Honda T. The inhibition of lens epithelial cell migration by a discontinuous capsular bend created by a band-shaped circular loop or a capsule-bending ring. Ophthalmic Surg Lasers. 1998 Feb;29(2):119-25.
Bobrova N., Tassignon M., Romanova T., Kovalchuk A. The state of the capsular ring in the dynamics of observations during implantation of the IOL "BIL" (bag-in-lens) in children. In: Modern Technologies of Cataract and Refractive Surgery. Moscow; 2012. p. 41-5.
Assia EI, Legler UF, Apple DJ. The capsular bag after short- and long-term fixation of intraocular lenses. Ophthalmology. 1995 Aug;102(8):1151-7. DOI: 10.1016/s0161-6420(95)30897-4
GOST Style Citations
Copyright (c) 2020 The Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.