Posterior capsular opacification and intraocular lens surface micro-roughness characteristics: an atomic force microscopy study.

OBJECTIVE Surface roughness parameters of various intraocular lenses (IOLs) biomaterials using atomic force microscopy (AFM) are compared. Variation, if any, in the micro-roughness properties of different IOLs made up of the same biomaterial is also explored. Retrospective analysis of posterior capsular opacification (PCO) incidence has been followed up for a period of four years post IOL implantation to evaluate the correlation of PCO formation with surface roughness of IOLs. DESIGN Experimental materials study. MATERIALS AND PARTICIPANTS: Surface characteristics of 20 different IOL models were assessed using AFM. These IOL models were made up of PMMA or HEMA or acrylic hydrophobic or acrylic hydrophilic or silicone. Retrospective analysis of PCO incidence in 3629 eyes of 2656 patients implanted with the same IOL models was performed. METHODS Topological characteristics of 20 different IOLs made up of 5 different biomaterials including (i) PMMA, (ii) HEMA, (iii) acrylic hydrophobic, (iv) acrylic hydrophilic and (v) silicone were evaluated using AFM in the tapping mode. Images were acquired with a resolution of 256 × 256 data points per scan at a scan rate of 0.5 Hz per line and a scan size of 10 × 10μm. Rate of PCO formation in 3629 eyes of 2656 patients implanted with the five different IOL biomaterials was retrospectively analyzed. RESULTS AFM images of IOL optic surfaces showed a collection of pores, grooves, ridges and surface irregularities. Surface roughness parameters of the IOL optics were significantly different on comparing lenses of different materials. Acrylic hydrophobic IOLs had minimum surface roughness while acrylic hydrophilic IOLs showed the highest surface roughness. Different IOL models of the same biomaterial showed varied topological roughness characteristics. Retrospective analyses of PCO formation rate after IOL implantation was carried out, which revealed that rate of PCO incidence, was directly proportional to the increase in surface micro-roughness of IOLs. CONCLUSIONS AFM is a powerful technique for the topological characterization of IOLs. Acrylic hydrophobic IOLs showed minimum surface roughness properties as well as minimum PCO incidence over a period of four years post implantation. It is, therefore, tempting to consider acrylic hydrophobic IOLs over other IOL biomaterials as the ideal biocompatible material for lowering PCO incidence. These results suggest an urgent need for manufacturers to optimize the various steps involved in the fabrication of IOLs.