47 R

Postoperative IOL optic opacifications: a mini epi-
demic

Apple DJ
Charleston/USA

The subspecialty of anterior segment surgery has progressed
by leaps and bounds since Sir Harold Ridley's first implant on
November 29, 1949 and in particular during the last decade.
However, during this period of rapid progress, as IOLs have been
improved to near perfection, and kerato-IOL refractive surgery has
dominated the headlines, several complications related to post-
operative opacification of the media have been documented cli-
nically and also in our laboratory. We have documented 8 condi-
tions, especially various types of IOL optic-calcification/opacifica-
tion. The first 7 of these in our list remain sufficient clinical pro-
blems. On a positive note, a quiet, but truly momentous advance-
ment has occurred - almost without notice - namely, the progres-
sion towards eradication of number 8 on the list, namely secon-
dary cataract (posterior capsule opacification, PCO). The implica-
tions are immense financially, for patients, physicians and gover-
nments - as well as surgically, in terms of safety and efficacy. Our
research has shown that, despite attempts at applying various
relatively complex techniques, devices, pharmaceutical agents,
specialized IOLs, etc., this complication can be reduced by the
surgeon's application of 6 relatively simple factors, 3 related to
the IOL and 3 related to the surgical technique. To date the Alcon
AcrySof ® has shown the lowest Nd:YAG laser rate in our series of
ca. 17,500 IOL related specimens (7500 human eyes obtained
postmortem, 1400 foldable lenses) in our Center for Research on
Ocular Therapeutics and Biodevices in Charleston, S.C.



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