BackgroundLaboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK).MethodsThirteen opacified IOLs after posterior lamellar keratoplasty, 8 after descemet stripping automated endothelial keratoplasty (DSAEK), 3 after descemet membrane endothelial keratoplasty (DMEK) and 2 after both DSAEK and DMEK were analysed in our laboratory. Analyses included optical bench assessment for optical quality, light microscopy, scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS).ResultsIn all IOLs the opacification was caused by a thin layer of calciumphosphate that had accumulated underneath the anterior optical surface of the IOLs in the area spared by the pupil/anterior capsulorhexis. The calcifications lead to a significant deterioration of the modulation transfer function across all spatial frequencies of the affected IOLs.ConclusionsThe instillation of exogenous material such as air or gas into the anterior chamber increases the risk for opacification of hydrophilic IOLs irrespective of the manufacturer or the exact composition of the hydrophilic lens material. It is recommended to avoid the use of hydrophilic acrylic IOLs in patients with endothelial dystrophy that will likely require procedures involving the intracameral instillation of air or gas, such as DMEK or DS(A)EK.

BackgroundTo analyse objective optical properties of the spherical and aspheric design of the same intraocular lens (IOL) model using optical bench analysis.MethodsThis study entailed a comparative analysis of 10 spherical C-flex 570 C and 10 aspheric C-flex 970 C IOLs (Rayner Intraocular Lenses Ltd., Hove, UK) of 26 diopters [D] using an optical bench (OptiSpheric, Trioptics, Germany). In all lenses, we evaluated the modulation transfer function (MTF) at 50 lp/mm and 100 lp/mm and the Strehl Ratio using a 3-mm (photopic) and 4.5-mm (mesopic) aperture.ResultsAt 50 lp/mm, the MTF values were 0.713/0.805 (C-flex 570 C/C-flex 970 C) for a 3-mm aperture and 0.294/0.591 for a 4.5-mm aperture. At 100 lp/mm, the MTF values were 0.524/0.634 for a 3-mm aperture and 0.198/0.344 for a 4.5-mm aperture. The Strehl Ratio was 0.806/0.925 and 0.237/0.479 for a 3-mm and 4.5-mm aperture respectively. A Mann–Whitney U test revealed all intergroup differences to be statistically significant (p < 0.01).ConclusionThe aspheric IOL design achieved higher MTF values than the spherical design of the same IOL for both apertures. Moreover, the differences between the two designs of the IOL were more prominent for larger apertures. This suggests that the evaluated IOL provides enhanced optical quality to patients with larger pupils or working under mesopic conditions.

BackgroundWith recent advances in technology and introduction of new intraocular lens (IOL) models, surgeons today have the opportunity to choose from various optical designs, which can influence the postoperative quality of vision. In our laboratory study, we compared the optical quality of three different IOLs that use the identical platform and are produced by the same manufacturer. The study included two diffractive multifocal IOLs, a bifocal and a trifocal one, as well as a monofocal IOL.MethodsThree IOL models: monofocal CT ASPHINA 409 M, diffractive bifocal AT LISA 809 M, and diffractive trifocal AT LISA Tri 839MP (Carl Zeiss Meditec AG, Germany) were assessed for optical quality by measuring modulation transfer function (MTF) and Strehl Ratio (SR) values at pupil sizes of 3.0 and 4.5 mm on the OptiSpheric® IOL PRO (Trioptics GmbH, Germany). The United States Air Force (USAF) Target images were also recorded to comfirm the optical performance qualitatively.ResultsFor far focus at 50 lp/mm and 3.0 mm pupil size, MTF value of the monofocal lens (MTF = 0.798) was 1.8-fold and 2.1-fold better than the bifocal (MTF = 0.446) and the trifocal (MTF = 0.382) IOLs, respectively. For near focus, bifocal IOL (MTF = 0.265) was 1.4-fold better than trifocal IOL (MTF = 0.187), while for intermediate focus, the trifocal IOL (MTF = 0.148) was 1.7-fold better than the bifocal IOL (MTF = 0.086). For the same pupil size, total sum of light loss amounted to 5.2% for the monofocal, 16.0% for the bifocal and 6.0% for the trifocal IOL. For a larger pupil, the amount of light loss increased significantly for the multifocal IOLs.ConclusionsThe monofocal IOL performed the best for far, the bifocal IOL for near and the trifocal IOL for intermediate focus. While the monofocal IOL created the least amount of light loss for both pupil sizes, the trifocal IOL created less than half the amount of light loss than the bifocal IOL for small pupil. For large pupil, however, less light scatter was observed for the bifocal than the trifocal IOL.