Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses

Purpose: To compare the incidence of re-orientating surgery to improve misalignment of three models of acrylic toric intraocular lenses: AcrySof toric intraocular lens (Alcon Laboratories, Inc.), TECNIS toric intraocular lens (Johnson & Johnson Vision, Inc.) and HOYA 355 toric intraocular lens (HOYA). Methods: In this retrospective, multicenter case series, medical charts were reviewed for collecting data on realignment surgery of toric intraocular lenses at 10 ophthalmic surgical sites in Japan. Results: Over all, intraocular lens repositioning surgery was conducted in 89 of 9430 eyes (0.944%) at an average of 10.5 ± 9.7 days after the initial cataract surgery. The incidence was 0.213% (11/5155), 1.797% (62/3451) and 1.942% (16/824) with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively. The incidence was significantly lower with AcrySof than with other two brands of toric intraocular lenses ( p < 0.0001). In those eyes which underwent reorientation surgery, the amount of misalignment was 26.4 ± 21.9°, 29.7 ± 15.4° and 28.1 ± 20.7° with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively; there was no significant difference among groups ( p = 0.821). The repositioning surgery significantly reduced misalignment in all three groups. Conclusion: The rotational stability was considerably different among toric intraocular lenses of different manufacturers. The incidence of repositioning surgery was significantly lower with AcrySof than with TECNIS and HOYA toric intraocular lenses.

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Prediction accuracy of standard and total keratometry by swept-source optical biometer for multifocal intraocular lens power calculation

Scientific Reports ◽

10.1038/s41598-021-84238-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hun Lee ◽

Jae Lim Chung ◽

Young Jun Kim ◽

Jae Yong Kim ◽

Hungwon Tchah

Keyword(s):

Cataract Surgery ◽

Case Series ◽

Intraocular Lenses ◽

Power Calculation ◽

Neutral Position ◽

Swept Source ◽

Refractive Outcomes ◽

Case Series Study ◽

Significant Difference ◽

Optical Biometer

AbstractWe aimed to compare the refractive outcomes of cataract surgery with diffractive multifocal intraocular lenses (IOLs) using standard keratometry (K) and total keratometry (TK). In this retrospective observational case series study, a total of 302 patients who underwent cataract surgery with multifocal IOL implantation were included. Predicted refractive outcomes were calculated based on the current standard formulas and a new formula developed for TK using K and TK, which were obtained from a swept-source optical biometer. At 2-month postoperatively, median absolute prediction errors (MedAEs) and proportion of eyes within ± 0.50 diopters (D) of predicted postoperative spherical equivalent (SE) refraction were analyzed. There was no significant difference between MedAEs or proportion of eyes within ± 0.50D of predicted refraction from K and TK in each formula. In TFNT00 and 839MP IOL cases, there was no difference between MedAEs from K and TK using any formula. In 829MP IOL cases, MedAE from TK was significantly larger than that from K in Barrett Universal II/Barrett TK Universal II (P = 0.033). In 677MY IOL cases, MedAE from TK was significantly larger than that from K in Haigis (P = 0.020) and Holladay 2 (P = 0.006) formulas. In the subgroup analysis for IOL, there was no difference between the proportion of eyes within ± 0.50 D of predicted refraction from K and TK using any formula. TFNT00 and 839MP IOLs were favorable with TK, with 677MY IOL with K and 829MP IOL being in a neutral position, which necessitates the study that investigates the accuracy of the new TK technology.

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Comparison of Astigmatism Correction in Cataract Surgery Between Simultaneous Femtosecond Laser-Assisted Intrastromal Arcuate Keratotomy and Toric Intraocular Lens Implantation

10.21203/rs.3.rs-58747/v1 ◽

2020 ◽

Author(s):

Hye Ji Kwon ◽

Hun Lee ◽

Jin Ah Lee ◽

Jae Yong Kim ◽

Hungwon Tchah

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Intraocular Lens ◽

Tertiary Care ◽

Corneal Astigmatism ◽

Toric Intraocular Lens ◽

Toric Iol ◽

Iol Implantation ◽

Tertiary Care Medical Center ◽

Significant Difference

Abstract Objectives To compare the efficacy of astigmatic correction between simultaneous femtosecond laser-assisted intrastromal arcuate keratotomy (AK) combined with femtosecond laser-assisted cataract surgery (FLACS) and toric intraocular lens (IOL) implantation during cataract surgery in moderate astigmatism. Design: Retrospective observational study, tertiary care medical center Methods We retrospectively reviewed medical records of patients who underwent astigmatic correction via femtosecond laser-assisted intrastromal AK (AK group; 27 eyes of 27 patients) with FLACS or toric IOL implantation (toric IOL group; 21 eyes of 21 patients). All patients had senile cataracts with corneal astigmatism ranging from + 1.00 to + 2.00 diopters (D) before cataract surgery. We measured visual acuity, intraocular pressure, automated keratometry, manifest refraction and topography preoperatively and at 1-day, 1-month, 3-month, and 6-month postoperatively. Results Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. There was significant difference in corneal astigmatism from topography and automated keratometer between the two groups at 6-month postoperatively (0.94 ± 0.40 vs 1.53 ± 0.46 D, P = 0.018 for topography and 0.98 ± 0.69 vs 1.37 ± 0.41 D, P = 0.032 for automated keratometer). Conclusions Femtosecond laser-assisted intrastromal AK in FLACS could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.

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Clinical Evaluation of Toric Intraocular Lens Implantation Based on iTrace Wavefront Keratometric Astigmatism

10.21203/rs.2.24137/v2 ◽

2020 ◽

Author(s):

Zhe Zhang ◽

Hui Li ◽

Jing Zhou ◽

Yaqin Zhang ◽

Suhua Zhang

Keyword(s):

Intraocular Lens ◽

Case Series ◽

Standard Technique ◽

Rotational Stability ◽

Toric Intraocular Lens ◽

Vector Method ◽

Toric Iol ◽

Iol Implantation ◽

Wavefront Aberrometry ◽

Prospective Case Series

Abstract Background: There was no standard technique for measuring corneal astigmatism. The iTrace wavefront aberrometry of cornea calculated steep power and axis based on the best Zernike mathematical fit from all topo data within 4 mm circle. It was supposed to be more accurate than iTrace simulated keratometry which was calculated based on only 4 points on the circle of 3 mm. This study evaluated visual outcomes, rotational stability after performing toric intraocular lens (IOL) implantation planning based on the wavefront aberrometry of the cornea with iTrace. Setting: Single site in China, Shanxi Eye Hospital, Shanxi, China.Design: Prospective case series.Methods: The study included 85 eyes of 63 patients undergoing phacoemulsification and toric IOL implantation. The IOL power and cylinders were chosen with the help of the iTrace toric planning program using wavefront keratometric astigmatism. Over a 3-month follow-up period, astigmatic changes were assessed using the Alpins vector method. Results: Preoperative mean corneal topographic astigmatism was 1.91 diopters (D) ± 0.69 (standard deviation). Postoperative mean refractive astigmatism decreased significantly to 0.48 D ± 0.34. Surgical induced astigmatism was 1.73 D ± 0.77 and the mean correction index was 0.89 ± 0.22, showing a slight undercorrection. The proportion of astigmatism ≤ 0.50 D increased from 0 to 71.8% postoperatively.Conclusions: This is the first study evaluating the clinical outcomes of using iTrace wavefront keratometric readings to plan a toric IOL implantation. The findings show that the iTrace built-in toric calculator with wavefront keratometric astigmatism for toric IOL planning is safe and effective.Trial registration: Current Controlled Trials ISRCTN94956424, Retrospectively registered (Date of registration: 05 February 2020). http://www.isrctn.com/ISRCTN94956424.

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Astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus Toric intraocular Lens Impantation with conventional phacoemulsification

BMC Ophthalmology ◽

10.1186/s12886-021-02059-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hye Ji Kwon ◽

Hun Lee ◽

Jin Ah. Lee ◽

Jae Yong Kim ◽

Hungwon Tchah

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Intraocular Lens ◽

Retrospective Chart Review ◽

Corneal Astigmatism ◽

Vector Analysis ◽

Toric Intraocular Lens ◽

Toric Iol ◽

Iol Implantation ◽

Significant Difference

Abstract Background To compare the efficacies in astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus toric intraocular lens (IOL) implantation with conventional phacoemulsification in moderate astigmatism. Methods A retrospective chart review was conducted for patients who had undergone cataract surgery by one surgeon. We identified patients with preoperative corneal astigmatism from + 0.75 to + 2.00 diopters (D) who had undergone astigmatic correction with FLACS with ISAK or toric IOL implantation with conventional phacoemulsification. We measured the visual acuity, intraocular pressure, automated keratometer, manifest refraction, and topography preoperatively and 1-day, 1-month, 3-month, and 6-month postoperatively. The vector analysis of refractive astigmatism was performed. Results Of a total of 48 eyes of 48 patients, 27 eyes of 27 patients had FLACS with ISAK (AK group), and 21 eyes of 21 patients had conventional cataract surgery with toric IOL implantation (toric IOL group). Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. Corneal astigmatism from topography and the automated keratometer were significantly lower in the AK group 6-month postoperatively compared to toric IOL group (0.94 ± 0.40 vs. 1.53 ± 0.46 D, P = 0.018 for topography; and 0.98 ± 0.69 vs. 1.37 ± 0.41 D, P = 0.032 for the automated keratometer). Conclusions FLACS with ISAK could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.

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Clinical Evaluation of Toric Intraocular Lens Implantation Based on iTrace Wavefront Keratometric Astigmatism

10.21203/rs.2.24137/v1 ◽

2020 ◽

Author(s):

Zhe Zhang ◽

Hui Li ◽

Jing Zhou ◽

Yaqin Zhang ◽

Suhua Zhang

Keyword(s):

Intraocular Lens ◽

Case Series ◽

Standard Technique ◽

Rotational Stability ◽

Toric Intraocular Lens ◽

Vector Method ◽

Toric Iol ◽

Iol Implantation ◽

Wavefront Aberrometry ◽

Prospective Case Series

Abstract Background: There was no standard technique for measuring corneal astigmatism. The iTrace wavefront aberrometry of cornea calculated steep power and axis based on the best Zernike mathematical fit from all topo data within 4 mm circle. It was supposed to be more accurate than iTrace simulated keratometry which was calculated based on only 4 points on the circle of 3 mm. This study evaluated visual outcomes, rotational stability after performing toric intraocular lens (IOL) implantation planning based on the wavefront aberrometry of the cornea with iTrace. Setting: Single site in China, Shanxi Eye Hospital, Shanxi, China. Design: Prospective case series. Methods ： The study included 85 eyes of 63 patients undergoing phacoemulsification and toric IOL implantation. The IOL power and cylinders were chosen with the help of the iTrace toric planning program using wavefront keratometric astigmatism. Over a 3-month follow-up period, astigmatic changes were assessed using the Alpins vector method. Results ： Preoperative mean corneal topographic astigmatism was 1.91 diopters (D) ± 0.69 (standard deviation). Postoperative mean refractive astigmatism decreased significantly to 0.48 D ± 0.34. Surgical induced astigmatism was 1.73 D ± 0.77 and the mean correction index was 0.89 ± 0.22, showing a slight undercorrection. The proportion of astigmatism ≤ 0.50 D increased from 0 to 71.8% postoperatively. Conclusions ： This is the first study evaluating the clinical outcomes of using iTrace wavefront keratometric readings to plan a toric IOL implantation. The findings show that the iTrace built-in toric calculator with wavefront keratometric astigmatism for toric IOL planning is safe and effective.

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Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery

European Journal of Ophthalmology ◽

10.1177/11206721211046496 ◽

2021 ◽

pp. 112067212110464

Author(s):

Oya Donmez ◽

Bilgehan Sezgin Asena ◽

Yonca Aydin Akova

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Clinical Outcomes ◽

Intraocular Lens ◽

Rotational Stability ◽

Toric Intraocular Lens ◽

Low Contrast ◽

Patient Reported ◽

The Mean

Purpose: To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). Methods: This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. Results: The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group ( p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and −1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. Conclusions: This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients’ satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

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Clinical evaluation of toric intraocular lens implantation based on iTrace wavefront keratometric astigmatism

BMC Ophthalmology ◽

10.1186/s12886-020-01726-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhe Zhang ◽

Hui Li ◽

Jing Zhou ◽

Yaqin Zhang ◽

Suhua Zhang

Keyword(s):

Intraocular Lens ◽

Case Series ◽

Standard Technique ◽

Corneal Astigmatism ◽

Rotational Stability ◽

Toric Intraocular Lens ◽

Vector Method ◽

Toric Iol ◽

Iol Implantation ◽

Wavefront Aberrometry

Abstract Background Currently, there is no standard technique for determining corneal astigmatism. The iTrace wavefront aberrometry of cornea calculated steep power and axis based on the best Zernike mathematical fit from all topo data within 4 mm circle. It was supposed to be more accurate than iTrace simulated keratometry which was calculated based on only 4 points on the circle of 3 mm. This aim of this study was to evaluate visual outcomes and rotational stability after toric intraocular lens (IOL) implantation using the wavefront aberrometry of the cornea with iTrace. Setting: Single site in China, Shanxi Eye Hospital, Shanxi, China. Design: Prospective case series. Methods The study included 85 eyes of 63 patients undergoing phacoemulsification and toric IOL implantation. The IOL power and cylinders were chosen with the help of the iTrace toric planning program using wavefront keratometric astigmatism. Astigmatic changes were assessed using Alpins vector method over a 3-month follow-up period. Results Preoperative mean corneal topographic astigmatism was 1.91 diopters (D) ± 0.69 (standard deviation). Postoperative mean refractive astigmatism decreased significantly to 0.48 D ± 0.34. Surgical induced astigmatism was 1.73 D ± 0.77 and the mean correction index was 0.89 ± 0.22, showing a slight undercorrection. The proportion of astigmatism ≤0.50 D increased from 0 to 71.8% postoperatively. Conclusions This is the first study on evaluation of clinical outcomes of toric IOL implantation in corneal astigmatism patients using iTrace wavefront keratometric readings. The findings show that use of iTrace built-in toric calculator is safe and effective for planning toric IOL surgery for wavefront keratometric astigmatism. Trial registration Current Controlled Trials ISRCTN94956424, Retrospectively registered (Date of registration: 05 February 2020).

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Prediction of postoperative refractive astigmatism before toric intraocular lens implantation

BMC Ophthalmology ◽

10.1186/s12886-021-01959-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Atsushi Kawahara

Keyword(s):

Regression Model ◽

Cataract Surgery ◽

Intraocular Lens ◽

Corneal Thickness ◽

Anterior Chamber Depth ◽

Corneal Astigmatism ◽

Toric Intraocular Lens ◽

Toric Iol ◽

Significant Difference ◽

Rms Errors

Abstract Background To determine the preoperative factors influencing refractive astigmatism after cataract surgery for astigmatism correction by toric intraocular lens (IOL) implantation and to evaluate the prediction model using these factors. Methods Prospective, observational case series. The right eyes of forty consecutive patients with preoperative corneal astigmatism of the total cornea of 1.5 diopters (D) or more in magnitude and scheduled for implantation of a non-toric IOL during cataract surgery with a 2.4-mm temporal clear corneal incision were examined prospectively. The vertical/horizontal astigmatism component (J0) and oblique astigmatism component (J45) of refractive and corneal astigmatism were converted using power vector analysis. Multivariate regression analysis was performed with refractive astigmatism at three months postoperatively as the dependent variable, and preoperative parameters including age, sex, refractive astigmatism, corneal astigmatism, sphere, spherical equivalent, intraocular pressure, corneal thickness, anterior chamber depth, lens thickness, lens positions (tilt and decentration), axial length, and corneal higher order aberrations as independent variables. The root mean square (RMS) errors were calculated to express the regression model fit. Results The regression model for the J0 component was $$ Postoperative\kern0.34em refractive\kern0.2em J0=1.05\times Coneal\kern0.2em J0-0.14 $$ P o s t o p e r a t i v e r e f r a c t i v e J 0 = 1.05 × C o n e a l J 0 − 0.14 (R2 = 0.96, P < 0.001). The model for the J45 component was $$ Postoperative\kern0.34em refractive\kern0.2em J45=0.68\times Coneal\kern0.2em J45+0.19\times Preoperative\kern0.34em refractive\kern0.2em J45-0.06 $$ P o s t o p e r a t i v e r e f r a c t i v e J 45 = 0.68 × C o n e a l J 45 + 0.19 × P r e o p e r a t i v e r e f r a c t i v e J 45 − 0.06 (R2 = 0.72, P < 0.001). The mean RMS errors for preoperative corneal astigmatism alone and the multivariate model were 0.58 D and 0.46 D, respectively. There was a statistically significant difference between them (P = 0.02). Conclusions Refractive astigmatism after implantation of a toric IOL can be predicted by the regression model more accurately than by corneal astigmatism alone. However, the prediction of oblique astigmatism remains a challenge.

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Three-Random-Point Marking Method for Toric Intraocular Lens Alignment Using the iTrace Aberrometer

Journal of Ophthalmology ◽

10.1155/2021/6695454 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Yongyi Niu ◽

Hongliang Lin ◽

Yongjie Qin ◽

Cheng Yang ◽

Yanlei Chen ◽

...

Keyword(s):

Cataract Surgery ◽

Intraocular Lens ◽

Comparative Trial ◽

Corneal Astigmatism ◽

Random Point ◽

Horizontal Meridian ◽

Toric Intraocular Lens ◽

Preoperative Marking ◽

Department Of Ophthalmology ◽

Significant Difference

Purpose. To evaluate the clinical outcome of the three-random-point (TRP) marking method for toric intraocular lens (IOL) alignment using the iTrace aberrometer (Tracey Technologies Corp., Houston, TX). Setting. Department of Ophthalmology, Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People’s Hospital, Guangzhou, China. Design. Prospective, randomized comparative trial. Method. Thirty eyes of 30 patients undergoing cataract surgery with coexisting corneal astigmatism of over 1.0 D were included in this study. All patients were prospectively randomized into the TRP marking group or slit-lamp horizontal meridian (SHM) marking group. TRP marking involved marking three points randomly in the corneal limbus of the patients and accurately marking the horizontal meridian was not required. The follow-up duration was 3 months after cataract surgery. Results. Fifteen eyes of 15 patients were in the TRP marking group and 15 eyes of 15 patients in the SHM marking group. There was no statistically significant difference in BCVA, UDVA, preexisting corneal astigmatism, or residual astigmatism between the groups before or after surgery P > 0.05 . The mean toric IOL misalignment was lesser but without significance in the TRP marking group than in the SHM marking group after 3 postoperative months (2.66° ± 1.42° versus 3.29° ± 1.67°; P = 0.295 ). Conclusion. The TRP marking method using the iTrace aberrometer is simple and accurate for preoperative marking of toric IOLs. It can eliminate the potential systematic errors resulting from varying head positions during the preoperative keratometry measurement and from manual marking.

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Comparing capsular bag performance of a hydrophilic and a hydrophobic intraocular lens: A randomised two-centre study

European Journal of Ophthalmology ◽

10.1177/1120672117752133 ◽

2018 ◽

Vol 28 (6) ◽

pp. 639-644 ◽

Cited By ~ 1

Author(s):

John Koshy ◽

Nino Hirnschall ◽

Ashok Kumar V Vyas ◽

R Narendran ◽

Alja Crnej ◽

...

Keyword(s):

Cataract Surgery ◽

Intraocular Lens ◽

Posterior Capsule Opacification ◽

Intraocular Lenses ◽

Posterior Capsule ◽

Fort Worth ◽

Slit Lamp ◽

Significant Difference ◽

Capsular Bag

Purpose: To evaluate the capsular bag performance and posterior capsule opacification development of two intraocular lenses differing in material and design. Methods: This study included patients who were scheduled for cataract surgery and compared a hydrophilic intraocular lens (Super flex® intraocular lens; Rayner Surgical, Worthing, UK) with a hydrophobic intraocular lens (AcrySof® SA60AT; Alcon, Fort Worth, TX, USA). Follow-ups were performed 1 month and 2 years after cataract surgery, including a slit lamp examination and retroillumination images. Results: In total, 80 eyes of 80 patients were recruited. At the 1-month follow-up, 6 of 39 cases had a gap between the posterior lens capsule and intraocular lens (1 case in the hydrophilic intraocular lens group and 5 cases in the hydrophobic intraocular lens group; p = 0.348). Objective and subjective posterior capsule opacification scoring showed no statistically significant difference between both groups (p = 0.123). Conclusion: Both intraocular lens showed a good capsular bag performance and a relatively low posterior capsule opacification development within the first 2 years after surgery.

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