Study finds CeeOn IOLs differ significantly in PCO rates

Sharp versus round optic edges appear to make the difference.

ByBob Kronemyer

VIENNA — After 2 years postoperatively, there is a significant difference in posterior capsular opacification (PCO) between the CeeOn Edge (model 911A, Pharmacia & Upjohn AB, Uppsala, Sweden) IOL and its sister lens, the rounded-edge CeeOn 920.

“In all ‘sharp-edge’ cases, the posterior capsule remained clear,” said investigators Michael Amon, MD, and Andreas J. Kruger, MD, general ophthalmologists at the University Hospital of Vienna, who took part in the multicenter study. However, “two of the 25 patients implanted with the ‘round-edge’ lens had to be treated with the YAG laser because of dense central posterior fibrosis.” Furthermore, 50% of the remaining round-edge cases showed a first-degree central fibrotic PCO, and nearly all the round-edge cases had a peripheral mixed, fibrotic and Elschnig PCO.

The comparative study consisted of 50 patients. Half of the patients were implanted with the CeeOn Edge (model 911A) — a high refractive silicone lens with sharp optic edges — and the other one-half with the CeeOn 920 — a silicone lens with round optic edges. All lenses were implanted in a horizontal in-the-bag position.

Excellent biocompatibility

---Andreas J. Kruger, MD

At 2 years, both silicone lenses demonstrated “excellent uveal biocompatibility,” Dr. Amon reported at the annual meeting of the European Society of Cataract and Refractive Surgeons. “No foreign-body giant cells or epitheloid cells on the anterior capsule-free surface of the IOLs could be detected with specular microscopy.” However, in two instances, “we found small round cells in the sharp-edge group,” compared with five cases in the round-edge group.

In addition, “the centration properties of both IOLs were comparable, with no severe optic decentration in either group,” Dr. Kruger said. In the sharp-edge group, 25% showed minimal centration, and in the round-edge group, 40%.

Anterior capsular opacification also was similar for both lens groups. “As we have learned from our experience with other silicone lenses, the anterior capsule shows a dense whitening of the capsulorrhexis rim area and also a whitening of the anterior capsule where it comes in contact with the IOL,” Dr. Kruger explained. “This helps to minimize edge glare phenomena, even in the sharp optic edge lenses.” Edge glare is a patient complaint of acrylic lenses, he noted. “But the CeeOn has no edge glare.”

Good visual acuity

Dr. Amon implanted all 50 lenses. In a separate presentation at the conference, he shared 2-year results of the sharp-edge CeeOn lens. Regarding visual acuity, 91% of these same 25 patients were at least seeing 0.6, and only 9% were less than 0.6 (due to age-related macular edema). “These results were expected,” Dr. Amon said. In addition, “I feel this sharp-edge barrier effect is of benefit because none of the 25 patients had central PCO. This finding is similar to the AcrySof [Alcon, Fort Worth, U.S.A.], which also has the sharp edge.”

Dr. Kruger emphasized, though, that fibrotic transformation can be initiated with either lens “if the rhexis slips off the IOL and comes into contact with the anterior and posterior capsule. But this is not edge-design dependent.” Therefore, “it is necessary to have a well-centered rhexis opening of about 4 to 5 mm.”

In conclusion, Dr. Kruger recommends the CeeOn sharp-edge lens over its round-edge counterpart in all situations “because of the PCO reduction.”

Formation of PCO, ACO, Elschnig pearls

photograph
Good centered rhexis of 4.5 mm, anterior capsule opacification (ACO) grade 1, no posterior capsular opacification (PCO), Elschnig pearl formation up to optic edge.

Higher magnification of the same case.	Higher magnification of the same case.
Anterior capsular fibrosis (rim, grade 2; capsule/optic, grade 1), central Elschnig proliferates and peripheral mixed PCO.	Good centered rhexis of 4.9 mm, central Elschnig proliferates and peripheral mixed fibrotic PCO (10 o’clock).

For Your Information:

Andreas J. Kruger, MD can be reached at Vienna General Hospital, Department of Ophthalmology, Wahringer Gurtel 18-20, A-1090 Vienna, Austria; +(43) 140-400-79; fax: +(43) 140-400-7932; e-mail: andreas.kruger@akh-wien.ac.at. Dr. Kruger has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Michael Amon, MD, can be reached at Vienna General Hospital, Department of Ophthalmology, Wahringer Gurtel 18-20, A-1090 Vienna, Austria; +(43) 140-400-79; fax: +(43) 140-400-7932. Dr. Amon has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Pharmacia & Upjohn AB can be reached at SE 75182, Uppsala, Sweden; +(46) 18-16-30-00; fax: +(46) 18-16-64-08.