Quantification of straylight induced by silicone oil adherence and calcification in Artisan Aphakia and Carlevale intraocular lenses.

PURPOSE: In lack of capsular support, two commonly used secondary intraocular lens (IOL) fixation strategies include retropupillary iris-claw fixation using the hydrophobic Artisan Aphakia and scleral fixation of the hydrophilic Carlevale IOL. Both models may come into direct contact with endotamponades frequently implanted in the same surgical procedure. The purpose of this laboratory study was to compare the interaction of both IOL models with endotamponades, specifically silicone oil adhesion and calcification, which is more prevalent after exposure to gas endotamponades. METHODS: Laboratory study using Artisan Aphakia (Ophtec, Groningen, Netherlands), Carlevale IOL (Soleko IOL Division, Pontecorvo, Italy) and CT Spheris (Carls Zeiss Meditec, Jena, Germany) as a control. Straylight measurements were carried out with C-Quant straylight meter and used to quantify the effects of both, adherent silicone oil and calcifications in the polymer. Siluron 2000 was used to test silicone oil adhesion. Electrophoresis was used to induce IOL calcification. Calcification was quantified using thermogravimetric analysis and plasma optical emission spectroscopy. Light loss was evaluated using a power meter combined with an optical bench system. The reversibility of silicone oil adhesion was evaluated after usage of F4H5 as a cleansing solution. RESULTS: The Artisan Aphakia was more prone to increased silicone oil adhesion causing a clinically relevant increase in straylight (baseline vs. silicone oil adherence: 3.0 vs. 140.7 deg2/sr; p = 0.0001), not fully reversible by using F4H5 as a wash-out (baseline vs. F4H5 washout: 3.0 vs. 15.3 deg2/sr; p = 0.0029). In contrast, the Carlevale IOL demonstrated a higher susceptibility to calcification (baseline vs. calcification: 2.75 vs. 12.59 deg2/sr). CONCLUSION: In addition to clinical aspects, such as iris and ciliary body anatomy, choice of endotamponade in trauma cases can influence the postoperative long-term optical quality of intraocular lenses. Differences between hydrophilic and hydrophobic materials are magnified secondary IOL fixation due to the direct contact to the used endotamponade and may be considered in clinical decision making.