Abstract
Intraocular lens (IOL) implantation has no doubt been one of the most satisfying advances of medicine. Millions of individuals with visual disability or frank blindness from cataracts had and continue to have benefit from this procedure. It has been reported by ophthalmologists that the modern cataract-intraocular lens (IOL) surgery is safe and complication-free most of the time. This makes the watchword for any cataract surgeon to be ‘implantation,’ ‘implantation,’ ‘implantation.’ In the mid-1980s, as IOLs were evolving rapidly, the watchword of the implant surgeon was ‘fixation,’ ‘fixation,’ ‘fixation.’ Most techniques, lenses and surgical adjuncts now allow us to achieve the basic requirement for successful IOL implantation, namely long-term stable IOL fixation in the capsular bag. However despite this advancement some items ‘slipped through cracks.’ In this article, we would like to alert the reader to a new watchword, namely ‘opacification,’ ‘opacification,’ ‘opacification.’ Here we will be talking about the good, the bad, and the ugly. Examples of the ‘good’ include the recent successes now being achieved in reducing the incidence of posterior capsule opacification. Examples of the ‘bad’ include various proliferations of anterior capsule cells, problems caused by silicone oil adherence to IOLs and problems with piggyback IOLs. The ‘ugly’ include the sometimes striking and often visually disabling opacifications occurring on and within IOL optics, both on some modern foldable IOLs as well as a poly(methyl methacrylate) (PMMA) optic degradation occurring with some models a decade or more after implantation.
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Acknowledgements
The authors have no financial or proprietary interest in any product mentioned in this review article.
Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, NY, USA.
We acknowledge the help of our colleagues Stella Arthur, MD, Marcela Escobar-Gomez, MD, Liwei Ma, MD, Tamer A Macky, MD, Qun Peng, MD, Josef M Schmidbauer, MD, Luis G Vargas, MD and Mark P Wimberly, BS for their assistance. Special thanks to the eye banks nationwide and to all the surgeons for submitting the explanted IOLs and supporting this effort.
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Presented in part at the Oxford Ophthalmologic Congress, 2001.
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Trivedi, R., Werner, L., Apple, D. et al. Post cataract-intraocular lens (IOL) surgery opacification. Eye 16, 217–241 (2002). https://doi.org/10.1038/sj.eye.6700066
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DOI: https://doi.org/10.1038/sj.eye.6700066
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