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Philip I. Murray, Ramesh R. Sivaraj, Saaeha Rauz, Paul J. Tomlins; Long Term Visual Outcome and Biocompatibility of a Hydrophilic Acrylic Lens in Patients with Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4288.
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To evaluate the long-term visual outcome and biocompatibility of an injectable, single piece, posterior chamber hydrophilic acrylic intraocular lens (IOL) in patients with uveitis.
Retrospective case note review of patients with uveitis who underwent phakoemulsification and implantation of a hydrophilic acrylic IOL (Rayner 574H, 570H, 574H, 620H, 920H, 970C) by a single surgeon. All patients were free of active inflammation for 2-3 months before surgery. Intraoperative procedures, such as division of posterior synechiae (PS), iris sphincterotomies, pupil stretching and the use of iris retractors were documented. Capsular biocompatibility was assessed by anterior capsular phimosis, visually significant posterior capsular opacification (PCO) and the need for a Nd:YAG laser posterior capsulotomy. Uveal biocompatibility was assessed by the formation of PS and any deposits on the IOL including a fibrinous membrane.
In total 191 operations were performed on 140 patients. Case notes could not be located for 20 eyes. Follow-up was 7 months to 10 years (mean 3.8 years), with a mean age of 53 years and 93/140 (66.4%) patients were female. 93 patients had panuveitis, 34 anterior uveitis, 8 intermediate uveitis and 5 posterior uveitis (SUN classification). In 113/171 (66%) eyes an intravenous pulse of methylprednisolone was given just prior to surgery. At final visit 131/171 (76.6%) of eyes had maintained a 3 logMAR line (15 letter) improvement in vision (rate of failure to maintain 3 line improvement of 6%/eye-year). 103/171 (60%) of eyes were seeing 0.3 or better (rate of visual loss below 0.3 of 10%/eye-year). Of the 68 eyes that failed to reach 0.3 or better, 44 had visually significant preoperative ocular comorbidity. Signs of capsular bioincompatibility were found in 47/171 (27.4%) eyes occurring at a rate of 7%/eye-year, with 42/171 (24.6%) eyes developing visually significant PCO during follow up (6%/eye-year). 31/171 (18.1%) eyes required a Nd:YAG laser capsulotomy (5%/eye-year). Only 22/171 (12.8%) eyes showed signs of uveal bioincompatibility during follow up (3%/eye-year). Chi-squared analysis found no significant association between any of the adverse outcome measures and anatomical classification, number of intraoperative procedures, aetiology of uveitis, gender, age or ethnicity.
The long-term safety profile of the Rayner hydrophilic acrylic IOL appears excellent in patients with uveitis. They are associated with good postoperative visual outcome and a low rate of uveal and capsular complications.
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