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Hydrophilic acrylic IOLs deserve consideration, surgeon says

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Douglas Koch, MD, suggested North American ophthalmologists consider using hydrophilic acrylic IOLs.

OTTAWA — North American ophthalmologists should not disregard the potential of hydrophilic acrylic IOLs, according to a surgeon speaking here.

The European experience with modern hydrophilic acrylic IOLs runs counter to earlier experiences that soured many North American ophthalmologists on these materials, said Douglas Koch, MD, here at the Sally Letson symposium on cataract surgery and IOLs.

“A lot of surgeons (in North America) have had very negative experiences with these lenses and are not interested in re-evaluating them or looking at other hydrophilic acrylic materials,” Dr. Koch told Ocular Surgery News. “My point is that there are a wide range of materials that are available, and lumping them into a category of hydrophilic acrylic is probably not appropriate.”

Adverse events that have been seen in the past with hydrophilic acrylic IOLs include calcification of the lens, optic opacification and anterior capsular opacification. These problems were seen in the past with hydrophilic acrylic IOLs including the HydroView from Bausch & Lomb, the Aqua-Sense from Ophthalmic Innovations International and the MemoryLens from CIBA Vision.

(The CIBA Vision MemoryLens was renamed the CV232 SRE. That IOL was sold to the French company IOLTECH.). Blue discoloration has also been seen with the Acqua lens from Mediphacos.

Dr. Koch said side effects such as calcification have been traced to impurities in the lens materials or the lens packaging. He said that he is “unaware” of any new reports of adverse events since the HydroView and other lens and packaging designs have been modified and their manufacturing processes improved.

“Europeans love these lenses and have used certain models for many years with great success and no material-related complications,” Dr. Koch said.

He added that several reports presented at the European Society of Cataract and Refractive Surgeons meeting last month demonstrated that posterior capsular opacification rates with hydrophilic acrylic IOLs are comparable to those with hydrophobic acrylic and silicone IOLs.

“The point to remember is every IOL has some limitations, whether those limitations are stiffening of the material or greater chance of internal reflection or not being acceptable for patients who might require vitrectomy,” Dr. Koch said. “It’s reasonable to look at these materials again.”

He cited an Austrian study from 2002 that investigated inflammation after implantation of hydrophilic acrylic, hydrophobic acrylic and silicone IOLs in eyes with cataract and uveitis. The study found no difference in the postoperative degree of flare and cell among the IOL groups, and no significant differences in inflammation after implantation of foldable IOLs in uveitic eyes.

Dr. Koch added that one of the possible advantages of hydrophilic acrylic IOLs is that the low refractive index of the materials may lead to fewer internal reflections.