[Heparin Surface-Modified Poly(methylmethacrylate) and Foldable Hydrophobic Acrylic Intraocular Lenses in Cataract Patients with Acquired Immune Deficiency Syndrome and CMV-Retinitis].
BACKGROUND
In HIV-positive patients with necrotising retinitis, well-tolerated lens material as well as minimal invasive surgery to avoid postoperative complications are imperative. Heparin surface-modified PMMA-IOLs as well as acrylic IOLs are associated with less postoperative inflammation than conventional intraocular lenses.


METHODS
In this randomised prospective clinical trial 18 patients received 7 HSM-IOLs through a self-sealing scleral tunnel and 11 foldable Acrysof-IOLs through a self-sealing limbal tunnel incision by the same surgeon. 7 of the 18 eyes were silicone oil-filled before cataract surgery, one eye received oil after the IOL implantation. Visual acuity, intraocular pressure, contrast sensitivity, intraocular inflammation and posterior capsule opacification were assessed. The follow-up period was 1 year.


RESULTS
Eyes with Acrysof-IOLs were associated with lower, but not statistically significant, laser flare photometry values (photon counts/ms) than those with HSM-IOLs pre- (90.18 +/- 54.7 vs. 73.92 +/- 6.44) and 3 months post-surgery (69.06 +/- 8.27 vs. 55.03 +/- 7.75). 6 of the 7 eyes with HSM-IOL and 3 eyes of the Acrysof-group developed a dense posterior capsule opacification (PCO), 2 eyes had no and 6 eyes only a distinct PCO. YAG capsulotomy did not improve visual acuity in any case but retinal examination was again possible. Eyes with Acryl-IOL showed pre- and postoperatively a better visual acuity than eyes with HSM-IOL ("hand movement" - 0.4 vs. "no light perception" - 0.1 pre- and 0.05 - 0.6 vs. "no light perception" - 0.1 3 months postoperatively. Contrast sensitivity testing (Vistech method) could be performed in the PMMA-group preoperatively only in 1 eye (A1), in the Acryl-group in 2 eyes (A4, B4, C2, D2) and revealed postoperatively "no contrast vision" - A1, B2, C1 vs. "no contrast vision" - A2, B2, C3, D1, E1. The intraocular pressure was preoperatively 13.86 mm Hg (PMMA) vs. 14.82 mm Hg (Acrysof) and 14.4 mm Hg vs. 12.89 mm Hg 3 months post surgery.


CONCLUSIONS
In the parameters we observed there was no statistical significant difference between heparin-surface modified (Pharmacia 811 C) and hydrophobic acrylic IOLs (Alcon Acrysof MA60BM) in patients with AIDS. As foldable Acrysof-IOLs can be implanted through a self-sealing bloodless tunnel incision and are associated with less posterior capsule opacification we prefer this IOL type in cataract surgery of AIDS patients.
Krieglsteiner
Susanne
S
Johann-Wolfgang-Goethe-Universität, Zentrum für Augenheilkunde, Frankfurt am Main. Kohnen@em.uni-frankfurt.de
Gümbel
Herrmann O C
HO
Kohnen
Thomas
T
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000179:Acrylates; D000328:Adult; D020099:Coated Materials, Biocompatible; D017726:Cytomegalovirus Retinitis / Q000150:complications*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D057927:Hydrophobic and Hydrophilic Interactions; D016849:Keratitis, Herpetic / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011474:Prosthesis Design; D012086:Reoperation; D012163:Retinal Detachment / Q000601:surgery; D015882:Retinal Necrosis Syndrome, Acute / Q000150:complications*; D012307:Risk Factors; D012827:Silicone Oils / Q000008:administration & dosage / Q000009:adverse effects
D000179:Acrylates; D020099:Coated Materials, Biocompatible; D012827:Silicone Oils; D019904:Polymethyl Methacrylate