Material y plataforma Lentes Intraoculares Multifocales
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Presentación del Oftalmólogo Dr Alvaro Rodríguez-Ratón (IORR Bilbao Getxo) sobre materiales y plataformas de lentes intraoculares multifocales. Estas lentes se introducen en el ojo tras la cirugía de cristalino transparente o la operación de catarata. Proporcionan capacidad de visión de lejos y de cerca compensando defectos como la miopía, hipermetropía, astigmatismo o presbicia. Sin embargo, no todos los materiales con los que se hacen estas lentes son iguales; por ello, en esta presentación se resume la evidencia científica sobre las implicaciones clínicas de los diferentes materiales de fabricación. Se resumen las implicaciones ópticas, biocompatibilidad capsular y uveal, adhesividad y degeneraciones del material como opacificación, glistening, cambio de coloración y surface scattering Presentation of the Ophthalmologist Dr. Alvaro Rodríguez-Ratón (IORR Bilbao Getxo) on materials and platforms of multifocal intraocular lenses. These lenses are introduced into the eye after Refractive Lens Exchange (ReLEx) or cataract surgery. They provide vision capability from far and near by compensating for defects such as myopia, hyperopia, astigmatism or presbyopia. However, not all the materials these lenses are made with are all the same; Therefore, this presentation summarizes the scientific evidence on the clinical implications of the different manufacturing materials. We summarize the optical implications, capsular and uveal biocompatibility, adhesiveness and degenerations of the material such as opacification, glistening, change of coloration and surface scattering
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Material y plataforma Lentes Intraoculares Multifocales
- 1. PLATAFORMAS Y MATERIALES IOLS MF EVIDENCE-BASED Dr. Alvaro Rodríguez-Ratón FacoElche 2018
- 2. Materiales. Polímeros, pureza, fabricación Benz R&D Hidrófilo Hidrófilo+ hidrófobo Benz 25 (Patentado) HEMA + EOEMA Benz 26 (Genérico) HEMA + MMA Hidrófobo HF 1.2 HF2 alvaro.rodriguez-raton@rodriguez-raton.com
- 3. Materiales. Hidrófilo Vs Hidrófobo alvaro.rodriguez-raton@rodriguez-raton.com
- 4. Materiales. Hidrófilo Vs Hidrófobo JCRS 2012. Assessment of new-generation glistening-free hydrophobic acrylic intraocular lens material <90º HIDROFILO >90º HIDROFOBO >150º SUPERHIDROFOBO alvaro.rodriguez-raton@rodriguez-raton.com
- 5. Materiales. Guía MF más implantadas 2018 Casa Lente Comportamiento (Agua) Polímero Plataforma Fabricación IR / Abbe Alcon Panoptix Hidrófobo (0.4%) 2 Phenyl Ethyl Acrylate 2 Phenyl Ethyl Metacrylate C loop Molde 1.55 / 37 Johnson Tecnis Hidrófobo (0.99%) EtilMetacrilate- 2,2,2trifluoroetilmetacrilate C loop torneado 1.47 / 55 PhysIOL FineVision GF Hidrófobo (4.9%) Patentado (en salino) Doble C loop torneado 1.52 / 42 PhysIOL FineVision Micro F Hidrófilo (25%) Benz 25 4 asa cerrada torneado 1.46 / 58 PhysIOL FineVision Pod F Hidrófilo (26%) Benz 26 Doble C loop torneado 1.46 / 58 Medicontur Bi Flex M Hidrófilo (25%) Benz 25 C loop doble torneado 1.46 / 58 Zeiss LISA Tri/LARA Hidrófilo (25%) Benz 25 Plato torneado 1.46 / 58 Opthec,B&L (VSY) Versario, Precizon… Hidrófilo (25%) Benz 25 … torneado 1.46 / 58 alvaro.rodriguez-raton@rodriguez-raton.com
- 6. Hidrófilo Hidrófobo Óptica Biocompatibilidad uveal Biocompatibilidad capsular Bioadhesividad Complicación característica Materiales. Implicaciones clínicas alvaro.rodriguez-raton@rodriguez-raton.com
- 7. Materiales. Implicación óptica • Straylight (metaanálisis) • Dispersión de luz en torno a luz brillante • Medida de Disability Glare JCRS 2016. Comparison of ocular straylight after implantation of multifocal intraocular lenses alvaro.rodriguez-raton@rodriguez-raton.com
- 8. Materiales. Implicación óptica 1JCRS 2016. Comparison of ocular straylight after implantation of multifocal intraocular lenses 2JCRS 2015. Ocular straylight in the normal pseudophakic eye 3 AJO 2010. Posterior capsule opacification assessment and factors that influence visual quality after posterior capsulotomy = - 1 linea de AV LogMAR1 = dos décadas de envejecimiento2 Hidrófoba mayor Straylight2,3 • Partícula pequeña-Rayleigh • Partícula grande-Forward alvaro.rodriguez-raton@rodriguez-raton.com
- 9. Materiales. Implicación óptica • Hidrófilas • Mejor memoria1 • Mayor Índice de Abbe (58) • Menor IR • Menor dispersión cromática 1JCRS 2013. Biomechanical and optical properties of 2 new hydrophobic platforms for intraocular lenses alvaro.rodriguez-raton@rodriguez-raton.com
- 10. Materiales. Biocompatibilidad uveal • Uveal. Ruptura BHA -> cc. gigantes, macrófagos y epitelioides • Reacción de cuerpo extraño (corto plazo) • Menor en hidrófila1,2 -> menor flare y depósito celular 1JCRS 2002. Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses 2 JCRS 2011. Biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and siliconeintraocular lenses in eyes with uveitis having cataract surgery: Long-term follow-up Depósito cc redondas Incidencia OCP Ojos con Uveitis2 alvaro.rodriguez-raton@rodriguez-raton.com
- 11. Materiales. Biocompatibilidad capsular • Capsular. Lens Epithelial Cells • PCO • cc.ecuatoriales migran • Perlas de Elschnig • ACO • Metaplasia miofibroblastos – fimosis • cc.subcapsulares, no migran2 • Hidrófoba • menor migración 2-5 • menor metaplasia (in vitro)6 2JCRS 2016. Lens epithelial cell growth on the anterior optic of 2 hydrophobic intraocular lens models 3JCRS 2002. Results of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in uveitic eyes with cataract: comparison to a control group. 4JCRS 2002. Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses. 5JCRS 2002. Uveal and capsular biocompatibility of 2 foldable acrylic intraocular lenses in patients with uveitis or pseudoexfoliation syndrome: comparison to a control group. 6Curr Eye Res 2017. In Vitro Evaluation of the Effects of Intraocular Lens Material on Lens Epithelial Cell Proliferation, Migration, and Transformation. alvaro.rodriguez-raton@rodriguez-raton.com
- 12. Materiales. Opacificación capsular posterior • 3 META ANÁLISIS • 11 estudios (100% RCT)1 • 899 ojos • 9 estudios2 • 861 ojos • Riesgo YAG x 7 a 2 años (p<0.05) • 66 estudios3 • Findl 11 Hidrófoba Hidrófila MENOR YAG MENOR PCO subj MENOR PCO obj MENOR AV 1Medicine 2017. Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery 2PLoS One 2013. ffect of hydrophobic acrylic versus hydrophilic acrylic intraocular lens on posterior capsule opacification:meta-analysis 3Cochrane 2010.Interventions for preventing posterior capsule opacification alvaro.rodriguez-raton@rodriguez-raton.com
- 13. Plataformas. Opacificación capsular posterior • Borde cuadrado • reduce OCP1 • Randomizado2 • PMMA redondo • PMMA cuadrado • Hidrófoba cuadrado • Difícil en hidrófila (% agua)3 1 Cochrane 2012. Interventions for preventing posterior capsule opacification 2 Ophthalmology 2017. Long-term Posterior Capsule Opacification Reduction with Square-Edge Polymethylmethacrylate Intraocular Lens: Randomized Controlled Study 3 JCRS 2011. Hydrophobic versus double-square-edged hydrophilic foldable acrylic intraocular lens: effect on posterior capsule opacification alvaro.rodriguez-raton@rodriguez-raton.com
- 14. Materiales. Opacificación capsular posterior • Diferente polímero dentro de material hidrófobo monobloque Prospectivo, randomizado (Acta Opht. 2016) 4 años (n= 50) Acrysof Tecnis YAG 2 6 Glistening +++ + Fibrosis anterior +++ + EtilMetacrilate- 2,2,2trifluoroetilmetacrilate 2 Phenyl Ethyl Acrylate 2 Phenyl Ethyl Metacrylate alvaro.rodriguez-raton@rodriguez-raton.com
- 15. Plataformas. Opacificación capsular posterior 33-44 meses FineVision (micro) LISA TRI n 3387 1743 YAG 9% 23% (p<0.001) 1JRS 2016. Nd:YAG Capsulotomy Rates With Two Trifocal Intraocular Lenses 2JCRS 2013. Posterior capsule opacification and neodymium:YAG rateswith 2 single-piece hydrophobic acrylic intraocular lenses:three-year results. 3AJO 2013. Posterior capsule opacification with the iMics1 NY-60 and AcrySofSN60WF 1-piece hydrophobic acrylic intraocular lenses: 3-year results of a randomized trial Comparable a 4 años (15%) - 26.1% Tecnis ZCB002 - 16.7% SN60WF3 alvaro.rodriguez-raton@rodriguez-raton.com • Diferente unión háptico-óptica • Retrospectivo, multicéntrico. 1 año seguimiento1
- 16. Materiales. Adhesión • Material hidrófobo mayor por Fibronectina1-3 • Dominio de adhesión funcional a colágeno/LEC • Efecto sobre rotación (prospectivo randomizado. Findl 2017) • Adhesión bacteriana4 • No relación con mayor endoftalmitis (sí PMMA)5-6 1JCRS 2003.Adhesion of soluble fibronectin, vitronectin, and collagen type IV to intraocular lens materials 2JCRS 2000. Adhesion of fibronectin, vitronectin, laminin, and collagen type IV to intraocular lens materials in pseudophakic human autopsy eyes. Part 1: histological sections 3JCRS 2000. Adhesion of fibronectin, vitronectin, laminin, and collagen type IV to intraocular lens materials in pseudophakic human autopsy eyes. Part 2: explanted intraocular lenses 4J Fr Ophtalmol 2009. Intraocular lens and cataract surgery: comparison between bacterial adhesion and risk of postoperative endophthalmitis according to intraocular lens biomaterial 5Biomed Mater Eng. 2004. Intraocular lenses, bacterial adhesion and endophthalmitis prevention: a review. 6Eye 2008. Influence of intraocular lens material on the development of acute endophthalmitis after cataract surgery? N= 40 Vs 40 Hidrófila Hidrófoba p 1h -> 3m 2.4 ±1.85° 1.6 ±1.61° 0.016 1a -> 2a 2.3 ±1.3° 1.8 ±1.0° 0.09 alvaro.rodriguez-raton@rodriguez-raton.com
- 17. Materiales. Adhesión 0.6% 51% 36% 75% alvaro.rodriguez-raton@rodriguez-raton.com
- 18. Materiales. Degeneraciones del implante • Glistening • Whitening • Opacificación • Opalescencia • Otros1 • Alt. reológicas • Alt. Adhesividad • coloración 1Colloids Surf B Biointerfaces 2018. Restructuration kinetics of amphiphilic intraocular lenses during aging. alvaro.rodriguez-raton@rodriguez-raton.com
- 19. Materiales. Glistening 1JCRS 2010. Glistenings and surface light scattering in intraocular lenses alvaro.rodriguez-raton@rodriguez-raton.com
- 20. Materiales. Glistening Surface scattering1 agua separación fase/biofilm Glistening (vacuolas 1-20 micras) Relación variación temperatura y humedad1 Medicación glaucoma(Prospectivo)2 1JCRS 2010. Glistenings and surface light scattering in intraocular lenses 2Acta Ophthalmol 2014. Glistening in glaucomatous eyes: visual performances and risk factors. alvaro.rodriguez-raton@rodriguez-raton.com
- 21. Materiales. Glistening H2O + 60O 48H DESHIDRATACIÓN 1JCRS 2012. Assessment of new-generation glistening-free hydrophobic acrylic intraocular lens material alvaro.rodriguez-raton@rodriguez-raton.com
- 22. Materiales. Glistening Característica de hidrófoba RCT 9 años1 Más frecuente en “cast molded” Vs “lathe-milling” 1JCRS 2015. Glistenings 9 years after phacoemulsification in hydrophobic and hydrophilic acrylic intraocular lenses 2JCRS 2017. Straylight from glistenings in intraocular lenses: In vitro study alvaro.rodriguez-raton@rodriguez-raton.com
- 23. Materiales. Glistening. Efecto sobre calidad Sin glare Con glare Estudio de caso control. N=35x3. Hidrófobo/PMMA/silicona1 1AJO 2012. Long-Term Effect of Surface Light Scattering and Glistenings of Intraocular Lenses on Visual Function alvaro.rodriguez-raton@rodriguez-raton.com
- 24. Materiales. Glistening. Efecto sobre AV 8 años 5 años 1JCRS 2016. Light scattering, straylight, and optical quality in hydrophobic acrylic intraocularlenses with subsurface nanoglistenings 2JCRS 2011. Incidence of glistenings with the latest generation of yellow-tinted hydrophobic acrylic intraocular lenses alvaro.rodriguez-raton@rodriguez-raton.com
- 25. Materiales. Glistening en MF • Simulación modelo matemático Ray Tracing1 20/20 – umbral de contraste para reconocer objeto 0.05 1JCRS 2016. Evaluation of loss in optical quality of multifocal intraocular lenses with glistenings alvaro.rodriguez-raton@rodriguez-raton.com
- 26. Materiales. Glistening en MF • Retrospective comparative case series (n= 10 vs 8; 75 años; 6 años p.o.)1 1JCRS 2013. Surface light scattering and visual function of diffractive multifocal hydrophobic acrylic intraocular lenses 6 years after implantation 2Klin Monbl Augenheilkd. 2016.[Explantation of Multifocal Intraoular Lenses - Frequency, Causes and Course]. 3Eur J Ophthalmol. 2007. A survey of intraocular lens explantation: a retrospective analysis of 23 IOLs explanted during 2005 *Dos descripciones de explante2,3 alvaro.rodriguez-raton@rodriguez-raton.com
- 27. Materiales. Opacificación • Cristalización fosfato de calcio1 • Saturación local tras difusión • Relación con pureza polímeros • Silicona como nido2 1. JOVS 2009. Intraocular Lens Calcification;a Clinicopathologic Report 2. AMO 2003. Proposed pathogenesis for the delayed postoperative opacification of the hydroview hydrogel intraocular lens. alvaro.rodriguez-raton@rodriguez-raton.com
- 28. Materiales. Opacificación 7.6% de causas de explante1 1Klin Monbl Augenheilkd. 2012. Reasons for exchange and explantation of intraocular lenses alvaro.rodriguez-raton@rodriguez-raton.com
- 29. Materiales. Opacificación espontánea • Espontánea (series de casos 3m-2a) • Lentis LS-502-1 “Hydrosmart”1,2 • Hydroview3 • SC60B-OUV (12-24m) 4,5 • DM5 • Vitrectomía6 • Inyección gas en C.A.7 1. JCRS 2016. Late postoperative opacification of a hydrophilic–hydrophobic acrylic intraocular lens 2. AMO 2016. Calcification of Hydrophilic Acrylic Intraocular Lenses With a Hydrophobic Surface: Laboratory Analysis of 6 Cases 3. Klin Monbl Augenheilkd. 2009. Late postoperative opacification of hydrogel intraocular lenses: analysis of 13 explanted lenses 4. JCRS 2001. Dense opacification of the optical component of a hydrophilic acrylic intraocular lens: a clinicopathological analysis of 9 explanted lenses. 5. Ophthalmology 2002. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: bilateral case report and clinicopathologic correlation. 6. BMC 2016. Akreos Adapt AO Intraocular lens opacification after vitrectomy in a diabetic patient: a case report and review of the literature. 7. AJO 2017. Intraocular Lens Calcifications After (Triple-)Descemet Membrane Endothelial Keratoplasty alizarin red Akreos Adapt AO alvaro.rodriguez-raton@rodriguez-raton.com
- 30. Materiales. Opacificación tras DMEK • Tras Faco-DMEK 1AJO 2017. Intraocular Lens Calcifications After (Triple-)Descemet Membrane Endothelial Keratoplasty IMPLANTADAS OPACIFICADAS Hidrófila 88.2% 78.56% Hidrófoba 10.6% 14.29% PMMA 1.2% 0.00% alvaro.rodriguez-raton@rodriguez-raton.com
- 31. Materiales. Conclusiones Hidrófilo Hidrófobo Óptica + - Biocompatibilidad uveal + - Biocompatibilidad capsular - + Bioadhesividad - + Complicación característica Opacificación Glistening alvaro.rodriguez-raton@rodriguez-raton.com
- 32. Muchas gracias! *ppt disponible en www.alvarorodriguezraton.com
Editor's Notes
- 25 lleva 25.5 agua . 99.99 (log· pureza respecto 99.5 de otros) . No ácidos, no ionización; hará que no deposite fosfato de calcio 26 lleva 26 HF lleva <5%
- Polar – No Polar
- Ambi-fílicas
- Diferenciación (Ep->Mes)
- Un ojo cada lente
- contrast threshold function of the eye. At 100 lp/mm (spatial frequency equivalent of 20/20 visual acuity), the contrast threshold is roughly 0.05 contrast. Despite a large drop in the MTF (eg, w 0.42), the MTF of the pseudo- phakic eye remains at roughly 0.13, which exceeds the contrast threshold making object of 100 lp/mm reasonable to the eye. This might help explain why despite relatively higher levels of intraocular scatter in IOLs with glistenings and whitening, pseudophakic patients are still able to maintain high visual acuities with relatively few complaints.
- At 100 lp/mm (spatial frequency equivalent of 20/20 visual acuity), the contrast threshold is roughly 0.05 contrast. Despite a large drop in the MTF (eg, w 0.42), the MTF of the pseudo- phakic eye remains at roughly 0.13, which exceeds the contrast threshold making object of 100 lp/mm reasonable to the eye. This might help explain why despite relatively higher levels of intraocular scatter in IOLs with glistenings and whitening, pseudophakic patients are still able to maintain high visual acuities with relatively few complaints.
- It is suggested that the surface hydroxyl groups of the polyacrylic polymeric components of the IOLs are capable of inducing surface nucleation and crystal growth of calcium phosphates. However, most important is the finding that the calcification of IOLs is initiated from their interior through the development of sufficiently high local supersaturation, realized through the diffusion of calcium and phosphate ions.