Intraocular PMMA lenses modified with surface-immobilized heparin: evaluation of biocompatibility in vitro and in vivo

doi:10.1016/0142-9612(89)90055-0

Biomaterials

Volume 10, Issue 8, October 1989, Pages 511-516

https://doi.org/10.1016/0142-9612(89)90055-0 Get rights and content

Abstract

Intraocular lenses (IOL) were surface modified with covalently linked heparin. The surface-bound heparin could not be removed by incubation in solutions known to be effective in breaking non-covalent bonds, nor by incubation in a solution of proteinase K and only to a limited extent by incubation with heparinase. In vitro studies demonstrated improved biocompatibility by the heparin surface-modified lens with respect to outgrowth of fibroblasts and macrophages, activation of granulocytes and adhesion of platelets. These results were subsequently verified in vivo in terms of less inflammatory cells on the lens surface and fewer incidences of synechiae after 3 and 6 wk IOL implantation in the rabbit eye.

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These are well-known materials to which the immune system of the living host hardly reacts. In the 1980s, it was determined that coating the surface of a lens with another substance reduced the host's response to apIOLs.19 Furthermore, a soft contact lens made by copolymerizing methacrylate with collagen was commercially available.
To evaluate the in vivo durability of the surface and optical properties of the implantable Collamer lens (ICL).
Retrospective case series.
We included patients who developed cataracts after having undergone ICL implantation from March 2003 to May 2014 and underwent ICL explantation followed by cataract surgery from March 2017 to December 2019 at the Nagoya Eye Clinic. ICL explants were submitted to Chukyo Medical Co, Ltd (Nagoya City, Japan) for laboratory analysis using ultraviolet-visible light spectroscopy, light microscopy (LM), and scanning electron microscopy. Patients' demographic and clinical data were collected and reviewed.
Thirteen eyes from 10 patients were studied. The average age at ICL explantation was 50.5 ± 8.5 years (range, 34.5-66.3 years). The average length of ICL stay in the eye (from implantation to explantation) was 10.5 ± 2.7 years (range, 4.4-13.7 years). No opacification or coloring of the ICL explants was observed by LM. The ICL explants showed almost the same light transmittance as that of unused ICLs. Scanning electron microscopy revealed no irregularities at the surface of the center and periphery of the optic and haptic footplate. The positioning holes did not show any deposition.
The ICLs remained in-eye for >10 years without any deterioration in the surface and optical properties of the ICL, despite their contact with the ciliary body and iris tissues and the continuous interaction with the aqueous humor components. The present study shows long-term in vivo stability of the ICL.
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Tissue engineering (TE) strategies are aimed at the restoration of tissue architecture and functions by the use of cells in combination with supportive scaffolds. The scaffold should act as a temporary matrix for cell proliferation and extracellular matrix deposition, with subsequent tissue ingrowth. Biomaterials play a critical role in the design of scaffolds and, hence, in the realization of a new functional tissue. A variety of synthetic biomaterials have proved to be useful in the reconstruction of tissues, such as bone, cartilage, and nerve, and some of these are currently used in clinical practice. In this chapter, an overview of the different types of synthetic polymers and their properties and TE applications is reported. They can be nonbiodegradable and biodegradable, and able to produce hydrogel matrices. Special attention has been given to addressing polyurethanes that are available as bioresorbable or biostable biomaterials as well as hydrogels.
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Co., Ltd (Changchun, People’s Republic of China). Preparation method of ICG-IOL was similar to that of modifying IOLs with heparin (Larm et al., 1983; Larsson et al., 1989). Briefly, IOLs were first sonicated in a bath of surfactant solution for 15 min, and then in double distilled water for another 15 min.
Posterior capsule opacification (PCO) is one of the main reasons for loss of vision again after cataract surgery. In this study, intraocular lenses were modified with indocyanine green (ICG) and sealed up with PLGA to form long-term intraocular implants (ICG-IOL). When triggered by laser, ICG-IOL would induce photodynamic therapy (PDT). In-vitro cell viability assay and scratch wound healing assay demonstrated that ICG-IOL could effectively inhibit HLEpiC proliferation and migration without causing damage to the cells far away from it. Laser attenuation test indicated that ICG-IOL could be applied in vivo. In-vivo pharmacodynamics and safety study showed that ICG-IOL could significantly prevent the occurrence of PCO and was safe for intraocular normal tissue. All these results suggested that ICG-IOL would be a very promising candidate for PCO prevention.
Effect of heparin coating of a foldable intraocular lens on inflammation and capsular bag performance after cataract surgery
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In this study, heparin-coated foldable acrylic IOLs did not show any benefit over the same IOL without heparin coating in terms of postoperative inflammation in high-risk patients. This finding is contrary to results in older studies in which HSM PMMA IOLs were used and found to effectively reduce postoperative inflammation2,3,6,23–28 because of the anticoagulant and antiinflammatory effects of heparin.20–22 But, when HSM PMMA IOLs were compared with uncoated foldable acrylic IOLs, no significant differences in flare were found.36–38
To evaluate the effect of a heparin-coated foldable intraocular lens (IOL) on postoperative flare in high-risk patients.
Vienna Institute for Research in Ocular Surgery, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria.
Randomized clinical trial.
This study included patients with diabetes mellitus (DM), pseudoexfoliation syndrome (PXF), or both scheduled for cataract surgery in both eyes. One eye received a coated IOL (Polylens EC-1YH PAL) and the other eye, an uncoated control IOL (Polylens EC-1Y PAL). Aqueous flare measurements were taken using a laser flare meter (FM-600, Kowa) preoperatively and 1 hour, 1 day, 3 weeks, and 3 months postoperatively. Visual acuity and anterior (ACO) and posterior (PCO) capsule opacification were assessed, and IOL centration and tilt were measured with a Purkinje meter.
Eighty eyes of 40 patients were included in the study; 64 eyes of 32 patients completed the study. The mean flare values (photons/ms) preoperatively and 1 hour, 1 day, 3 weeks, and 3 months postoperatively were 6.98 ± 3.71 (SD), 19.14 ± 18.90, 16.62 ± 25.33, 10.33 ± 9.70, 8.74 ± 4.64, respectively, with the coated IOL and 8.65 ± 5.73, 22.08 ± 16.23, 13.44 ± 13.71, 7.50 ± 4.11, and 7.03 ± 3.70, respectively, with the control IOL. No significant differences were found in flare, visual acuity, ACO, PCO, tilt, or centration between the coated IOL and the control IOL at any timepoint.
No significant differences in flare or capsule performance were found between the coated IOL and control IOL.
No author has a financial or proprietary interest in any material or method mentioned.
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The life span of PMMA prostheses will also increase by the DLC coating. Extensive research has been carried out on the biocompatible study of PMMA and DLC coatings, separately [2–5,12,13,18–20]. There are very few reports on the detailed study of biocompatibility of DLC coated PMMA [8,9].
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In another part of the review, modification techniques concerning optimization of the bulk properties of the polymer lens are also discussed and synthetic approaches such as copolymerization and nanocomposite formation are considered. A perspective aspect of this discussion concerns improvement of the performance of the main polymer by the incorporation of in situ formed or preformed nanoparticles.
The most attractive perspectives concerning the improvement of the IOL properties by chemical modification approaches are described.

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PaperIntraocular PMMA lenses modified with surface-immobilized heparin: evaluation of biocompatibility in vitro and in vivo

Abstract

Am. J. Ophthalmol.

Am. Intra-Ocular Lens Implant Soc. J.

Surv. Ophthalmol.

Ophthalmology

Dev. Brain Res.

Thromb. Res.

Paper
Intraocular PMMA lenses modified with surface-immobilized heparin: evaluation of biocompatibility in vitro and in vivo