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The effect of hypotensive drugs on intraocular lenses clarity

Abstract

Objectives

To assess the effect of hypotensive drugs on light absorbance, discoloration, opacification and precipitate formation of IOLs.

Methods

In this laboratory study, four types of IOLs (two hydrophilic-acrylic—L1 and L2, and two hydrophobic-acrylic—B1 and B2) were soaked in solutions containing Timolol-maleate 0.5%, Dorzolamide 2%, Brimonidine-tartrate 0.2%, Latanoprost 0.005%, Brimonidine-tartrate/Timolol-maleate 0.2%/0.5% and Dorzolamide/Timolol-maleate 2%/0.5%. Non-treated IOLs and IOLs soaked in balanced salt solution (BSS) served as controls. All Treated lenses were sealed in containers and placed in an oven at 82 degrees Celsius for 120 days. Each IOL was examined using four different techniques: light microscopy imaging, light absorbance measurements at 550 nanometers through the optic’s center, assessment of by a scanning electron microscope (SEM), and energy dispersive Xray spectrometry (EDX).

Results

Ninety-eight IOLs were included. All BSS-soaked IOLs appeared clear with no significant discoloration or precipitate-formation. Light absorbance in these lenses was comparable to that of non-soaked, non-heated IOLs. No calcium or phosphate were detected in either of these groups. Light absorbance differed significantly between the four treated IOL types. The drops most affecting light absorbance differed between IOLs. Gross examination revealed brown and yellow discoloration of all IOLs soaked in Dorzolamide and Brimonidine-tartrate solutions, respectively. SEM demonstrated precipitates that differed in size, morphology and distribution, between different IOL-solution combinations. EDX’s demonstrated the presence calcium and phosphor in the majority of precipitates and the presence of sulfur in brown discolored IOLs.

Conclusions

In vitro, interactions between hypotensive drugs and IOLs induce changes in light absorbance, discoloration and precipitate formation.

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Fig. 1: Different phenomena identified by gross inspection.
Fig. 2: Discoloration of IOLs.
Fig. 3: Precipitates.
Fig. 4: Light absorbance.

Data availability

The data that support the findings of this study are not openly available due to the specific condition of the IOL donators. Data are available from the corresponding author upon reasonable request and may be shown under blindness of the IOL manufacture and model.

References

  1. Foster A. Vision 2020: the cataract challenge. Community Eye Health. 2000;13:17–19.

  2. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081–90.

    Article  Google Scholar 

  3. Beiko GHH, Grzybowski A. Intraocular lens implants: do they come with a life time guaranty? Saudi J Ophthalmol. 2015;29:247–8.

  4. Singh K, Shrivastava A. Medical management of glaucoma: principles and practice. Indian J Ophthalmol. 2011;59:S88.

  5. Jiménez-Román J, Prado-Larrea C, Laneri-Pusineri L, Gonzalez-Salinas R. Combined glaucoma and cataract: an overview. In: Difficulties in cataract surgery. Ch. 4. 79–89. InTech; 2018. https://doi.org/10.5772/intechopen.73584.

  6. Choudhry S, Goel N, Mehta A, Mahajan N. Anterior segment optical coherence tomography of intraocular lens opacification. Indian J Ophthalmol. 2018;66:858–60.

    Article  Google Scholar 

  7. Michelson J, Werner L, Ollerton A, Leishman L, Bodnar Z. Light scattering and light transmittance in intraocular lenses explanted because of optic opacification. J Cataract Refractive Surg. 2012;38:1476–85.

    Article  Google Scholar 

  8. Bompastor-Ramos P, Póvoa J, Lobo C, Rodriguez AE, Alió JL, Werner L, et al. Late postoperative opacification of a hydrophilic-hydrophobic acrylic intraocular lens. J Cataract Refract Surg. 2016;42:1324–31.

    Article  Google Scholar 

  9. Barra D, Werner L, Pacini Costa JL, Morris C, Ribeiro T, Ventura BV, et al. Light scattering and light transmittance in a series of calcified single-piece hydrophilic acrylic intraocular lenses of the same design. J Cataract Refractive Surg. 2014;40:121–8.

    Article  Google Scholar 

  10. Neuhann T, Yildirim TM, Son HS, Merz PR, Khoramnia R, Auffarth GU. Reasons for explantation, demographics, and material analysis of 200 intraocular lens explants. J Cataract Refract Surg. 2020;46:20–6.

    Article  Google Scholar 

  11. Goemaere J, Trigaux C, Denissen L, Dragnea D, Hua MT, Tassignon MJ, et al. Fifteen years of IOL exchange: indications, outcomes, and complications. J Cataract Refract Surg. 2020;46:1596–603.

    Article  Google Scholar 

  12. Stanojcic N, Hull C, O’Brart DP. Clinical and material degradations of intraocular lenses: a review. Eur J Ophthalmol. 2020;30:823–39.

    Article  Google Scholar 

  13. Łabuz G, Yildirim TM, Khoramnia R, Son H-S, Auffarth GU. Optical function of intraocular lenses in different opacification patterns: metrology analysis of 67 explants. J Cataract Refract Surg. 2021;47:1210–17.

  14. Dhaliwal DK, Mamalis N, Olson RJ, Crandall AS, Zimmerman P, Alldredge OC, et al. Visual significance of glistenings seen in the AcrySof intraocular lens. J Cataract Refractive Surg. 1996;22:452–7.

    Article  CAS  Google Scholar 

  15. Werner L. Causes of intraocular lens opacification or discoloration. J Cataract Refractive Surg. 2007;33:713–26.

    Article  Google Scholar 

  16. Gamidov AA, Fedorov AA, Novikov IA, Kas’ianov AA, Siplivyĭ VI. Analyzing causes for opacification of acrylic IOLs. Vestn Oftalmol. 2015;131:64–70.

    Article  CAS  Google Scholar 

  17. Stanojcic N, Hull C, O’Brart DPS. Clinical and material degradations of intraocular lenses: a review. Eur J Ophthalmol. 2020;30:823–39.

  18. Tetz M, Jorgensen MR. New hydrophobic IOL materials and understanding the science of glistenings. Curr Eye Res. 2015;40:969–81.

    Article  Google Scholar 

  19. Durr GM, Ahmed IKK. Intraocular lens complications decentration, uveitis-glaucoma-hyphema syndrome, opacification, and refractive surprises. 2022. https://doi.org/10.1016/j.ophtha.2020.07.004.

  20. Sher JH, Gooi P, Dubinski W, Brownstein S, El-Defrawy S, Nash WA. Comparison of the incidence of opacification of hydroview hydrogel intraocular lenses with the ophthalmic viscosurgical device used during surgery. J Cataract Refractive Surg. 2008;34:459–64.

    Article  Google Scholar 

  21. Maclean KD, Apel A, Wilson J, Werner L. Calcification of hydrophilic acrylic intraocular lenses associated with intracameral air injection following DMEK. J Cataract Refractive Surg. 2015;41:1310–4.

    Article  Google Scholar 

  22. Łabuz G, Yildirim TM, van den Berg TJTP, Khoramnia R, Auffarth GU. Assessment of straylight and the modulation transfer function of intraocular lenses with centrally localized opacification associated with the intraocular injection of gas. J Cataract Refractive Surg. 2018;44:615–22.

    Article  Google Scholar 

  23. Yildirim TM, Auffarth GU, Łabuz G, Bopp S, Son HS, Khoramnia R. Material analysis and optical quality assessment of opacified hydrophilic acrylic intraocular lenses after pars plana vitrectomy. Am J Ophthalmol. 2018;193:10–9.

    Article  Google Scholar 

  24. Neuhann IM, Kleinmann G, Apple DJ. A new classification of calcification of intraocular lenses. 2008.

  25. Arcieri ES, Santana A, Rocha FN, Guapo GL, Costa VP. Blood-aqueous barrier changes after the use of prostaglandin analogues in patients with pseudophakia and aphakia: a 6-month randomized trial. Arch Ophthalmol. 2005;123:186–92.

    Article  CAS  Google Scholar 

  26. Cabrerizo J, Urcola JA, Vecino E. Changes in the lipidomic profile of aqueous humor in open-angle glaucoma. J Glaucoma. 2017;26:349–55.

    Article  Google Scholar 

  27. Kaeslin MA, Killer HE, Fuhrer CA, Zeleny N, Huber AR, Neutzner A. Changes to the aqueous humor proteome during glaucoma. PLoS ONE. 2016;11:e0165314.

  28. Benoist d’Azy C, Pereira B, Chiambaretta F, Dutheil F. Oxidative and anti-oxidative stress markers in chronic glaucoma: a systematic review and meta-analysis. PLoS ONE. 2016;11:e0166915.

  29. Schweitzer C, Orignac I, Praud D, Chatoux O, Colin J. Glistening in glaucomatous eyes: visual performances and risk factors. Acta Ophthalmol. 2014;92:529–34.

    Article  Google Scholar 

  30. Colin J, Orignac I, Touboul D. Glistenings in a large series of hydrophobic acrylic intraocular lenses. J Cataract Refractive Surg. 2009;35:2121–6.

    Article  Google Scholar 

  31. Nemet AY, Vinker S. Associated morbidity of nasolacrimal duct obstruction—a large community based case-control study. Graefe’s Arch Clin Exp Ophthalmol. 2014;252:125–30.

    Article  Google Scholar 

  32. Seider N, Miller B, Beiran I. Topical glaucoma therapy as a risk factor for nasolacrimal duct obstruction. Am J Ophthalmol. 2008;145:120–3.e1.

    Article  CAS  Google Scholar 

  33. Kawai K, Hayakawa K, Suzuki T. Simulation of 20-year deterioration of acrylic IOLs using severe accelerated deterioration tests. 2012.

  34. Michler GH, Lebek W. Electron Microscopy of Polymers. In Polymer Morphology, Guo Q. (ed.). 2016. https://doi.org/10.1002/9781118892756.ch3.

  35. Gartaganis SP, Prahs P, Lazari ED, Gartaganis PS, Helbig H, Koutsoukos PG. Calcification of hydrophilic acrylic intraocular lenses with a hydrophobic surface: laboratory analysis of 6 cases. 2016.

  36. Izak AM, Werner L, Pandey SK, Apple DJ. Calcification of modern foldable hydrogel intraocular lens designs. Eye. 2003;17:393–406.

  37. Tandogan T, Khoramnia R, Choi CY, Scheuerle A, Wenzel M, Hugger P, et al. Optical and material analysis of opacified hydrophilic intraocular lenses after explantation: a laboratory study. BMC Ophthalmol. 2015;15:170.

    Article  Google Scholar 

  38. Pei XT, Bao YZ. Lens implant opacification. Ophthalmology. 2011;118:426–.e1.

  39. Werner L, Apple DJ, Escobar-Gomez M, Ohrström A, Crayford BB, Bianchi R, et al. Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens. Ophthalmology. 2000;107:2179–85.

    Article  CAS  Google Scholar 

  40. BSS® Sterile Irrigating Solution (balanced salt solution) [Internet]. 2021. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=4bd4d59c-eb3b-4a5e-9eb7-ae95b0a92bea&type=display.

  41. Goel M. Aqueous humor dynamics: a review. Open Ophthalmol J. 2010;4:52–9.

  42. Oshika T, Ando H, Inoue Y, Eguchi S, Sato Y, Sugita T, et al. Influence of surface light scattering and glistenings of intraocular lenses on visual function 15 to 20 years after surgery. J Cataract Refractive Surg. 2018;44:219–25.

    Article  Google Scholar 

  43. van der Mooren M, van den Berg T, Coppens J, Piers P. Combining in vitro test methods for measuring light scatter in intraocular lenses. Biomed Opt Express. 2011;2:505.

    Article  Google Scholar 

  44. Kang JY, Song JH, Lee SJ. Changes in opacification of hydrophobic acrylic intraocular lenses according to temperature and hydration. Clin Ophthalmol. 2020;14:3343–9.

    Article  Google Scholar 

  45. Mamalis N. Intraocular lens glistenings. J Cataract Refract Surg. 2012;38:1119–20.

    Article  Google Scholar 

  46. Patel A. Ocular drug delivery systems: an overview. World J Pharmacol. 2013;2:47.

    Article  CAS  Google Scholar 

  47. Leung EW, Medeiros FA, Weinreb RN. Prevalence of ocular surface disease in glaucoma patients. J Glaucoma. 2008;17:350–5.

    Article  Google Scholar 

  48. Sehi M, Zhang X, Greenfield DS, Chung Y, Wollstein G, Francis BA, et al. Retinal nerve fiber layer atrophy is associated with visual field loss over time in glaucoma suspect and glaucomatous eyes. Am J Ophthalmol. 2013;155:73–82.e1.

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge Professor Graham Trope for his inspiration and for his support of this project.

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Authors

Contributions

TS conceived and directed the project and wrote the manuscript. LNBH collected data, performed statistical analysis and critically revised the manuscript. NR, DK and AK collected data, YT, ALE and EIA contributed to the discussion and critically revised the manuscript. AB conceived the project, wrote the manuscript and directed the project.

Corresponding author

Correspondence to Tal Sharon.

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The authors declare no competing interests.

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This study was exempted by the Institutional Review Board (IRB) at Meir Medical Center, since no use of human data was used.

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Sharon, T., Naftali Ben Haim, L., Rabinowicz, N. et al. The effect of hypotensive drugs on intraocular lenses clarity. Eye (2022). https://doi.org/10.1038/s41433-022-02225-w

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