title: Pathologic comparison of asymmetric or sulcus fixation of 3-piece intraocular lenses with square versus round anterior optic edges.
abstract: OBJECTIVE
  To evaluate the pathologic findings of 3-piece intraocular lenses (IOLs) with asymmetric or sulcus fixation in pseudophakic cadaver eyes, comparing IOLs with square or round edges on the anterior optic surface.
  
  
  METHODS
  Comparative case series with pathology.
  
  
  METHODS
  A total of 661 pseudophakic cadaver eyes, obtained from eye banks within the United States, implanted with different IOLs.
  
  
  METHODS
  Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging followed by gross examination. Selected eyes were processed for complete histopathologic analysis.
  
  
  METHODS
  Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses.
  
  
  RESULTS
  Of 661 pseudophakic cadaver eyes obtained, 13 had 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges, and 14 had 3-piece lenses with anterior round edges (13 silicone lenses and 1 hydrophobic acrylic lens) without symmetric in-the-bag fixation. These 27 selected eyes were processed for complete histopathologic analysis. Gross findings in both groups were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, and iris transillumination defects. Histopathology of the 14 eyes with 3-piece IOLs with round anterior optic edges showed mild focal disruption of the iris pigmented layer and loop protrusion/erosion in the ciliary sulcus. Additional changes observed in the 13 eyes with square anterior optic edge IOLs included iris changes, such as vacuolization, disruption and loss of the pigmented epithelial layers, iris thinning and atrophy, synechiae, and pigmentary dispersion within the trabecular meshwork. One eye also exhibited initial signs of optic nerve disc cupping.
  
  
  CONCLUSIONS
  In this series, pathologic findings were more severe in eyes implanted with 3-piece IOLs with square anterior optic edges, suggesting that IOLs with round anterior edges are more suitable for sulcus fixation.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors.affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ollerton
authors.forename: Liliana
authors.initials: L
authors.lastname: Werner
authors.forename: Susan
authors.initials: S
authors.lastname: Strenk
authors.forename: Lawrence
authors.initials: L
authors.lastname: Strenk
authors.forename: Lisa
authors.initials: L
authors.lastname: Leishman
authors.forename: Zachary
authors.initials: Z
authors.lastname: Bodnar
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kirk
authors.forename: Jennifer
authors.initials: J
authors.lastname: Michelson
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000473:pathology*; D005125:Eye Banks; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007910:Lenses, Intraocular; D008279:Magnetic Resonance Imaging; D033401:Microscopy, Acoustic; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011474:Prosthesis Design; D019591:Pseudophakia / Q000473:pathology*; D014019:Tissue Donors