Glistenings in Modern IOL Materials - A Summary of the Peer-Reviewed Literature
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Glistenings in Modern IOL Materials A Summary of the Peer-Reviewed Literature
Literature Review
Glistenings in IOL Materials
Abstract
Glistenings, or microvacuoles, have been observed with most modern IOL materials. Glistenings are tiny inclusions of
water present within the matrix of the IOL material that may be seen after implantation.
While glistenings can be identified by the eye care professional at the slit lamp, they are cosmetic in nature, and are
not generally observed by the patient.
A large body of peer-reviewed literature demonstrates that glistenings do not adversely affect visual function, as
measured using best-corrected visual acuity, contrast sensitivity, glare testing or wavefront measurements in human
eyes. Glistenings also appear to have no measurable effect on lens optics when measured in a laboratory setting.
Glistenings - Definition observed with a thin slit beam at a 45° angle. They are
Glistenings, or microvacuoles, are reflections of light usually more difficult to observe with retro illumination.
that occur from migrations of water within the matrix
of hydrated IOL material.1,2 Glistenings typically are 1 Formation of Glistenings
to 20 μm in size3,4,32,35 and present from 1 to 6 months Microvacuoles result from water absorption and
postoperatively.3,5-7,9,32 Some studies suggest they are subsequent condensation (phase separation) within the
stable over time,3,7,8,32 while others suggest they may be matrix of the IOL material.1,2,32 Their formation appears to
progressive.5,9-11,32 be influenced by temperature,1,3,4,29 inflammation21 and
aqueous composition.30-32
Glistenings in Different Intraocular Lens Materials
Glistenings have been observed in most modern IOL Microvacuoles are not visible when an IOL is in a dry state.
materials including polymethylmethacrylate When an IOL is implanted, a certain amount of water is
(PMMA),12-14,32 silicone,9,13,15-17,32 hydrophilic acrylic9,18,19,32 absorbed. About 1 to 6 months postoperatively, phase
and hydrophobic acrylic.1-11,13,17,18,20-28,32 separation may occur within the matrix of the IOL material,
allowing minute water particles to condense and form
Glistenings are visible due to differences in refractive microvacuoles.32
indices between the IOL material and water within the
IOL material. The larger the difference between these 2 All IOL materials have a limited uptake of water, thus,
refractive indices, the more apparent the microvacuoles. the self-limiting factor in glistening formation is the
IOL material refractive indices are as follows: achievement of a state of equilibrium in water content
within the IOL. For example, hydrophilic acrylic IOLs reach
• PMMA (1.49) a state of equilibrium at 18% to 33% water content, and
• silicone (1.43-1.46) hydrophobic acrylic IOLs at 0.3% to 1.5%.32
• hydrophilic acrylic (1.47)
• hydrophobic acrylic (1.47 to 1.55) A change in temperature is the most commonly-used
method of generating glistenings in vitro.4,9,29,33 The
Water has a lower refractive index [1.33] than any IOL glistenings formed in this manner are generally similar
material, which means that glistenings will be most to those that form in vivo; however, the density of in
apparent in those IOL materials with the highest vitro glistenings can sometimes exceed those that would
refractive index. If the index of refraction were equal, be expected in a clinical setting.34 While not directly
for instance, glistenings would be unnoticeable, since comparable, glistenings created in vitro will have optical
the deviation of any light at the interface is a function of properties and effects consistent with those in-vivo, when
the angle of incidence and the difference between the they are formed at clinically-relevant densities.
refractive indices of the materials on either side of the
interface.
The observance of microvacuoles changes as the angle
of the slit beam changes. Microvacuoles are usually bestLiterature Review
Methodology settings“.34 They found “the optical quality of the acrylic
The US National Library of Medicine has an on-line medical foldable intraocular lens is not significantly affected by the
publication search engine (pubmed.com) and database. level of glistenings usually seen in the clinical setting“.34
This on-line database was searched using a wide range of (See Figure 1) In a separate study, Miura et al created
terms designed to capture all potential articles related to glistenings by immersing IOLs in in normal saline solution
glistenings. at 50°C for 2 hours and then at 35°C for 3 days. They
examined possible polarization effects from glistenings
The search term below was used to identify all potential and found no significant effect.35
articles:
(glistening* IOL) or (refractile IOL) or (vacuole* iol) or
(discolor* iol) or (deposit* IOL) or (glistening* intraocular
lens) or (refractile intraocular lens) or (vacuole* intraocular
lens) or (discolor* intraocular lens) or
(deposit* intraocular lens)
The intent was to ensure that miscategorized articles
(those that referenced internal deposits, for instance)
would not be missed. The expectation was that a high
number of unrelated articles would be returned, in order
to capture these few potentially miscategorized articles. A
total of 472 articles were identified.
Each abstract was reviewed and the article was classified
as related or unrelated to glistenings. Where there was any Figure 1
FROM OSHIKA et al. [Figure 1.] In-vitro glistenings and optical quality.
doubt, the article was classified as related to glistenings. A
more detailed review of the text of each article potentially
related to glistenings was then conducted, and the article Impact on Vision
retained or discarded as the detailed review indicated. In Seventeen studies, each with a minimum enrollment of 20
this manner 428 articles were eliminated and 44 articles eyes, report on glistenings and their association with vision
were retained. Of the retained articles, one was an editorial loss. A total of 1,843 eyes are included. .
with no new information, one described a general Three of the studies in question include patient evaluations
technique for measuring glistenings, one concerned 8 years or more after implantation, and account for 278
lens opacification but mentioned glistenings as a related eyes (15% of the total).14,39,40 Monestam et al examined 103
phenomenon and one was a single case report in a French eyes of 103 patients and graded the intensity of glistenings
journal and was not translated.The final 40 articles are according to the photographic classification of Dhaliwal et
referenced in this paper. al.26 They found that most patients had “severe glistenings“,
but that “no detectable impact on BCVA, LCVA 10% and
Impact on Optical Quality, Measured In Vitro 2.5% was found.“39 Hayashi et al studied 35 eyes more than
Of 18 in vitro studies of glistenings, the majority were 10 years after implantation, grading glistenings according
concerned with their formation and characteristics. to the method of Miyata et al.3 They found “At more than
Only 2 studies measured optical quality as well. 10 years postoperatively, visual function, including contrast
sensitivity, and ocular HOAs were comparable among eyes
Oshika et al measured spectral transmittance, forward that received acrylic, silicone, and PMMA IOLs. Glistenings
scatter, the modulation transfer function and resolving with the acrylic IOLs were not significantly correlated
power at various contrasts with and without a glare with visual function and optical aberrations.“40 The only
source. Several degrees of glistenings in the optic were significant differences found between lenses were higher
experimentally created by immersing lenses in water at light scatter and better corrected visual acuity in the
37°C for 48 hours and then at 25°C for 24 hours. Glistenings acrylic group. Wilkins et. al. examined patients an average
were graded by inspection according to a visual scale of 8 years postoperatively with a PMMA lens and found a
provided in the article, with Grade 1 being minimal similar result; they saw significant glistenings but “did not
density. Grade 4+ glistening density was characterized document any clinical impact.“14
as “extremely intense and… beyond the range of clinicalLiterature Review
Table 1 shows a summary of the 17 studies in question IN SUMMARY:
and the differences that were noted with regard to • Glistenings are an observable phenomenon, using
glistenings and visual performance. The bulk of the a slit lamp with an off-axis beam, in a wide array of
evidence points to the fact that glistenings, even when intraocular lens materials, more evident in those
severe, have an insignificant impact on visual acuity materials with a high index of refraction.
and other measures of visual function such as contrast • Glistenings have been extensively investigated both in
sensitivity. In less frequent severe cases, glistenings did vitro (artificially created) and in vivo.
not have a significant impact on high and low contrast • In vitro testing has shown no effect of clinically-
visual acuity and other common measures of visual relevant levels of glistenings on image quality or the
function such as contrast sensitivity. modulation transfer function of intraocular lenses.
• In vivo clinical testing has included almost 2,000 eyes
In addition, three case studies suggested an effect on (some control eyes) reported in 17 different clinical
visual function. In one case where glistenings were studies.
suspected as the cause of reduced visual acuity, a repeat - Long term studies, which included a significant
YAG capsulotomy was performed that restored visual percentage of eyes with severe glistenings, have
acuity.36 In the second case, the effects from glistenings shown no effect on best corrected visual acuity,
could not be separated from the lens tilt and the low contrast visual acuity or higher order
progressive hyperopia that the patient experienced after aberrations of the eye.
undergoing a YAG capsulotomy.37 In the third case, the - There has been no reported effect of glistenings
retina was compromised, so the visual impact of the on contrast sensitivity.
glistenings could not be measured: the presentation of - 16 of 17 studies representing 99.9% of all eyes
glistening formation in this case was also atypical.38 studied show no significant difference in best
corrected visual acuity.
Table 1 - Brief Summary of Peer Reviewed Studies
Difference reported due to glistenings in:
Contrast Low Contrast Brightness Scotopic
Ref Title n BCVA Sensitivity Acuity Acuity Test Vision HOAs
9 Glistenings in foldable intraocular lenses 273 No
7 Glistenings in a large series of hydrophobic acrylic intraocular lenses 260 No
18 Image analysis of implanted rigid and foldable intraocular lenses in human 190 No No No
eyes using Scheimpflug photography
21 Clinical factors related to the frequency and intensity of glistenings in 129 No
AcrySof® intraocular lenses
10 Long-term results of wagon wheel packed acrylic intra-ocular lenses (AcrySof®) 115 No
20 Incidence of glistenings with the latest generation of yellow-tinted 111 No
hydrophobic acrylic intraocular lenses
39 Impact on visual function from light scattering and glistenings in intraocular 103 No No
lenses, a long-term study
40 Long-term effect of surface light scattering and glistenings of intraocular 102 No No (with No
lenses on visual function or without
glare)
8 Glistenings on intraocular lenses in healthy eyes: effects and associations 97 No No
27 Effects on visual function of glistenings and folding marks in 91 No Yes*
AcrySof® intraocular lenses
14 Glistenings with long-term follow-up of the Surgidev**** B20/20 73 No
polymethylmethacrylate intraocular lens
5 Clinical evaluation of the transparency of hydrophobic acrylic intraocular 65 No
lens optics
30 Surfactant induced glistenings: surface active ingredients in ophthalmic 63 No
solutions may enhance water entry into the voids of implanted acrylic
intraocular lenses
26 Visual significance of glistenings seen in the AcrySof® intraocular lens 56 No Yes** No
11 Glistenings in the single-piece, hydrophobic, acrylic intraocular lenses 53 No No
24 Glistenings in the AcrySof® intraocular lens: pilot study 42 Yes*** No, with or No
without glare
16 Glistenings in the Artiflex**** phakic intraocular lens 20 No
* non-standard contrast acuity test, different only at highest spatial frequency
** eye with partial iridotomy in AcrySof® IOL group
*** Snellen acuities averaged (yields incorrect results, equivalent logMAR shows no significant difference)
**** Trademarks are property of their respective ownersReferences 1. Miyata A, Yaguchi S. Equilibrium water content and 7. Colin J, Orignac I, Touboul D. Glistenings in a large series of glistenings in acrylic intraocular lenses. J Cataract Refract hydrophobic acrylic intraocular lenses. J Cataract Refract Surg. 2004 Aug;30(8):1768-72. PubMed PMID: 15313305 Surg. 2009 Dec;35(12):2121-6 PubMed PMID: 19969218 CONCLUSION: The change in the equilibrium water content CONCLUSION: The results suggest a potential association caused by temperature changes between 30 degrees C between the incidence of glistenings and IOL power and and 40 degrees C is an important factor in glistening glaucoma, but not between glistenings and age, sex, formation, and thus an IOL featuring less temperature- IOL model, length of follow-up, CDVA, SE, or most ocular dependent water absorption is less likely to form and systemic diseases and medications. glistenings. 8. Colin J, Orignac I. Glistenings on intraocular lenses in 2. Kato K, Nishida M, Yamane H, Nakamae K, Tagami Y, healthy eyes: effects and associations. J Refract Surg. 2011 Tetsumoto K. Glistening formation in an AcrySof lens Dec;27(12):869-75. doi: 10.3928/1081597X-20110725-01. initiated by spinodal decomposition of the polymer Epub 2011 Jul 29. PubMed PMID: 21800784 network by temperature change. J Cataract Refract Surg. CONCLUSION: In healthy eyes, glistening grade was not 2001 Sep;27(9):1493-8 PubMed PMID: 11566536 associated with contrast sensitivity, CDVA, intraocular light CONCLUSION: Glistenings formed in the bulk of an AcrySof® scatter, or any lens or demographic characteristics that were IOL as the medium temperature decreased. The mechanism investigated. may involve spinodal decomposition of the swollen 9. Tognetto D, Toto L, Sanguinetti G, Ravalico G. Glistenings polymer network, which initiates the formation of in foldable intraocular lenses. J Cataract Refract Surg. 2002 microvacuoles consisting of water and loosely packed Jul;28(7):1211-6. PubMed PMID: 12106730 network chains. CONCLUSION: Glistening formation was observed in 3. Miyata A, Uchida N, Nakajima K, Yaguchi S. Clinical and 7 different foldable IOLs. The AcrySof® group had a higher Experimental Observation of Glistening in Acrylic percentage and a greater density of glistenings. Intraocular Lenses. Jpn J Ophthalmol. 2000 Nov 1;44(6):693. 10. Peetermans E, Hennekes R. Long-term results of wagon PubMed PMID: 11094201 wheel packed acrylic intra-ocular lenses (AcrySof). Bull Soc CONCLUSION: The glistening in acrylic intraocular lenses Belge Ophtalmol. 1999;271:45-8. PubMed PMID: 10355159 seemed to become stable a few months after appearance. CONCLUSION: Vacuoles, as described with the AcryPak® Thus our experimental method is useful, because it gives us system, were also detectable in our Wagon Wheel packed glistening similar to clinical cases in a short time. lenses. They increased significantly in incidence and 4. Gregori NZ, Spencer TS, Mamalis N, Olson RJ. In vitro number with time. comparison of glistening formation among hydrophobic 11. Waite A, Faulkner N, Olson RJ. Glistenings in the single- acrylic intraocular lenses(1). J Cataract Refract Surg. 2002 piece, hydrophobic, acrylic intraocular lenses. Am J Jul;28(7):1262-8. PubMed PMID: 12106738 Ophthalmol. 2007 Jul;144(1):143-4. PubMed PMID: CONCLUSION: Glistening quantity varied among 17601442 hydrophobic acrylic IOLs and was temperature dependent. CONCLUSION: All IOLs studied had glistenings. High spatial Sensar* IOLs were more stable than the 2 other IOL types. resolution contrast sensitivity impact and severity The glistening phenomenon must be studied further to progression over time deserve further study. eliminate the problem. 12. Ballin N. Glistenings in injection-molded lens. J Am Intraocul * Trademarks are property of their respective owners. Implant Soc 1984 Fall;10(4):473. PubMed PMID: 6501064 5. Nagata M, Matsushima H, Mukai K, Terauchi W, Senoo T, CONCLUSION: None, a letter to the editor first identifying Wada H, Yoshida S. Clinical evaluation of the transparency glistenings in IOLs. of hydrophobic acrylic intraocular lens optics. J Cataract 13. Rønbeck M, Behndig A, Taube M, Koivula A, Kugelberg M. Refract Surg. 2010 Dec;36(12):2056-60. PubMed PMID: Comparison of glistenings in intraocular lenses with 21111307 three different materials: 12-year follow-up. CONCLUSION: Our results suggest that AcrySof® SA60AT Acta Ophthalmol. 2011 Oct 28. doi: 10.1111/j.1755- and AF-1 VA-60BB IOLs are likely to develop glistenings over 3768.2011.02277.x [Epub ahead of print] PubMed PMID: time and that the former may develop whitening. 22035345 6. Davison JA. Clinical performance of Alcon SA30AL and CONCLUSION: In this long-term follow-up study, the SA60AT single-piece acrylic intraocular lenses. J Cataract hydrophobic acrylic IOL had a significantly higher degree Refract Surg. 2002 Jul;28(7):1112-23 PubMed PMID: 12106718 of lens glistenings compared to the silicone and PMMA CONCLUSION: The single-piece acrylic lenses performed IOLs. The PMMA IOL had almost no lens glistenings. The IOL well in all regards. Although not as intense as observed dioptric power was not significantly correlated with the with the earlier 3-piece designs, pseudophakic degree of lens glistenings associated with the hydrophobic dysphotopsia occurred in a few patients with the single- acrylic IOL. piece acrylic lens. Intraocular lens exchanges with single- 14. Wilkins E, Olson RJ. Glistenings with long-term follow-up piece IOLs may be accomplished with less difficulty early of the Surgidev B20/20 polymethylmethacrylate intraocular rather than late. lens. Am J Ophthalmol. 2001 Nov;132(5):783-5. PubMed
References
PMID: 11704044 hydrophobic acrylic intraocular lenses. J Cataract Refract
CONCLUSION: Glistenings may occur in Surg. 2012 Jul;38(7):1140-6. PubMed PMID: 22727284
polymethylmethacrylate intraocular lenses with long-term CONCLUSION: Glistenings were common in eyes with the
follow-up, and they are progressive. blue light-filtering hydrophobic acrylic IOL and increased
15. Miyata A, Uchida N, Nakajima K, Yaguchi S. [Experimental over time.
study of glistening in silicone intraocular lenses]. Nihon 21. Moreno-Montañés J, Alvarez A, Rodríguez-Conde R,
Ganka Gakkai Zasshi. 2002 Feb;106(2):112-4. Japanese. Fernández-Hortelano A. Clinical factors related to the
PubMed PMID: 11915372 frequency and intensity of glistenings in AcrySof®
CONCLUSION: The presence of numerous microvacuoles intraocular lenses. J Cataract Refract Surg. 2003
in the SI40NB means there may be GP. The light clouding Oct;29(10):1980-4. PubMed PMID: 14604721
in the AQ110NV that was resolved with drying is thought to CONCLUSION: The frequency and intensity of glistenings in
be due to particles in the material which cause AcrySof® IOLs increased with time after surgery
discoloration. and were higher when postoperative inflammation
16. Cisneros-Lanuza A, Hurtado-Sarrió M, Duch-Samper was present. Glistenings developed more frequently
A, Gallego-Pinazo R, Menezo-Rozalén JL. Glistenings in the in cases of phacotrabeculectomy but not after combined
Artiflex phakic intraocular lens. J Cataract Refract Surg. 2007 phacoemulsification and deep sclerectomy. Glistenings did
Aug;33(8):1405-8. PubMed PMID: 17662432 not result in decreased Snellen BCVA.
CONCLUSION: Glistenings appeared some Artiflex* pIOLs 22. Mamalis N. Intraocular lens glistenings. J Cataract Refract
to varying degrees, although they were not visually Surg. 2012 Jul;38(7):1119-20. PubMed PMID: 22727278
significant in any case. A larger study of this IOL is needed CONCLUSION (EDITORIAL COMMENT): Even significant
to determine whether severe cases of glistenings affect glistenings and high-level light scattering from the IOLs
visual function and assess their cause and evolution over have not been shown to have a detectable impact on CDVA
time.* Trademarks are property of their respective owners. or low contrast visual acuity.
17. Schauersberger J, Amon M, Kruger A, Abela C, Schild 23. Chehade M, Elder MJ. Intraocular lens materials and styles: a
G, Kolodjaschna J. Comparison of the biocompatibility of review. Aust N Z J Ophthalmol. 1997 Nov;25(4):255-63.
2 foldable intraocular lenses with sharp optic edges. J Review. PubMed PMID: 9395827
Cataract Refract Surg. 2001 Oct;27(10):1579-85. PubMed CONCLUSION: Soft acrylic IOL unfold slowly, resulting in
PMID: 11687355 controlled insertion, but it is possible to crack the lens and
CONCLUSION: The findings show that a sharp-edged optic some lenses develop glistenings due to water
design is, to date, the most effective method of reducing accumulation. There are significant socioeconomic
the rate of PCO. Despite a subclinical foreign-body reaction implications to the large differences in posterior capsule
in the AcrySof® group, both lenses had a high degree of opacification rates between the various biomaterials and
capsular and uveal biocompatibility. the lens styles.
18. Klos KM, Richter R, Schnaudigel O, Ohrloff C. Image 24. Christiansen G, Durcan FJ, Olson RJ, Christiansen K.
analysis of implanted rigid and foldable intraocular lenses in Glistenings in the AcrySof® intraocular lens: pilot study. J
human eyes using Scheimpflug photography. Ophthalmic Cataract Refract Surg. 2001 May;27(5):728-33. PubMed
Res. 1999;31(2):130-3. PubMed PMID: 9933775 PMID: 11377904
CONCLUSION: Thus, we found in foldable IOLs 'glistenings', CONCLUSION: Glistenings occurred frequently in AcrySof®
which did not have any influence on functional results IOLs, with most cases mild. A larger study of this lens is
and we could distinguish them from lens damage. needed to determine whether severe presentations affect
We propose to use Scheimpflug tests regularly for the visual function and to understand how glistenings change
examination of implanted new types of IOLs. over time.
19. Fujita S, Tanaka T, Miyata A, Hirose M, Usui M. Cell adhesion 25. Prosdocimo G, Tassinari G, Sala M, Di Biase A, Toschi PG,
and glistening formation in hybrid copolymer intraocular Gismondi M, Corbanese U. Posterior capsule opacification
lenses. Ophthalmic Res 2012;48(2):102-8. Epub 2012 Apr 18. after phacoemulsification: silicone CeeOn* Edge versus
PubMed PMID: 22517197 acrylate AcrySof® intraocular lens. J Cataract Refract Surg
CONCLUSION: The MA IOLs exhibited a low level of 2003 Aug;29(8):1551-5. PubMed PMID: 12954304
adhering cells but a high level of glistening formation, CONCLUSION: Both the CeeOn* Edge and AcrySof® groups
the HEMA IOL exhibited the reverse tendency, and the MA/ had a low incidence of PCO after an 18-month follow-
HEMA IOL exhibited a low level of both, thus indicating that up. The CeeOn* Edge group had significantly less PCO than
hybrid MA/HEMA IOLs are less susceptible than HEMA IOLs the AcrySof® IOL group. These results confirm that IOLs with
to cell adhesion and less susceptible than MA IOLs to square truncated edges create a barrier effect at the optic
glistening formation. edge, reducing the overall incidence of PCO.
20. Colin J, Praud D, Touboul D, Schweitzer C. Incidence * Trademarks are property of their respective owners.
of glistenings with the latest generation of yellow-tintedReferences
26. Dhaliwal DK, Mamalis N, Olson RJ, Crandall AS, Res. 2001 Mar-Apr;33(2):61-7. PubMed PMID: 11244349
Zimmerman P, Alldredge OC, Durcan FJ, Omar O. Visual CONCLUSION: The number of vacuoles increases with
significance of glistenings seen in the AcrySof intraocular incubation time in aqueous humor containing serum.
lens. J Cataract Refract Surg. 1996 May;22(4):452-7. PubMed The addition of serum increased the proportion of
PMID: 8733849 lipids and proteins in the solution, which also occurs with
CONCLUSION: Patients who received AcrySof® IOLs that a breakdown in the blood-aqueous barrier. The results of
came in the AcryPak® had some degree of glistenings. the present study point to a physiological factor that may
There was also a significant decrease in contrast sensitivity lead to vacuole formation in IOLs and may aid clinicians in
compared with that of fellow eyes with silicone IOLs. The identifying risk factors involved in the formation of
glistenings are likely caused by water vacuoles that form vacuoles.
within the lens after hydration within the eyes. Further 32. Werner L. Glistenings and surface light scattering in
studies are necessary to assess the exact cause of these intraocular lenses. J Cataract Refract Surg. 2010
glistenings. Aug;36(8):1398-420. Review. PubMed PMID: 20656166
27. Gunenc U, Oner FH, Tongal S, Ferliel M. Effects on visual CONCLUSION: Although the impact of glistenings on
function of glistenings and folding marks in AcrySof® postoperative visual function and the evolution
intraocular lenses. J Cataract Refract Surg. 2001 of glistenings in the late postoperative period remain
Oct;27(10):1611-4. PubMed PMID: 11687360 controversial, IOL explantation has rarely been reported.
CONCLUSION: Although glistenings and folding marks were 33. Shiba T, Mitooka K, Tsuneoka H. In vitro analysis of AcrySof
observed after the implantation of AcrySof®IOLs, they did intraocular lens glistening. Eur J Ophthalmol. 2003 Nov-
not significantly affect visual function. Dec;13(9-10):759-63. PubMed PMID: 14700095
28. Allers A, Baumeister M, Steinkamp GW, Ohrloff C, CONCLUSION: AcrySof® lenses soaked in warm water for
Kohnen T. [Intra-individual comparison of intraocular a short time may change characteristics, and therefore,
lenses of highly refractive silicone (Allergan SI40NB) and close monitoring of the temperature and time of soaking is
hydrophobic acrylate (Alcon Acrysof MA60BM). 1-year necessary to prevent glistening formation.
follow-up] Ophthalmologe. 2000 Oct;97(10):669-75. 34. Oshika T, Shiokawa Y, Amano S, Mitomo K. Influence of
German. PubMed PMID: 11105542 glistenings on the optical quality of acrylic foldable
CONCLUSION: One year after implantation of foldable, intraocular lens. Br J Ophthalmol. 2001 Sep;85(9):1034-7.
highly refractive silicone and hydrophobic acrylic IOLs PubMed PMID: 11520749; PubMed Central PMCID:
using a self-sealing tunnel incision and phacoemulsification, PMC1724105
no significant functional or morphological differences CONCLUSION: The optical quality of the acrylic foldable
between the two IOL types were observed. intraocular lens is not significantly affected by the level of
29. Omar O, Pirayesh A, Mamalis N, Olson RJ. In vitro analysis glistenings usually seen in the clinical setting.
of AcrySof® intraocular lens glistenings in AcryPak® 35. Miura M, Osako M, Elsner AE, Kajizuka H, Yamada K, Usui M.
and Wagon Wheel packaging. J Cataract Refract Surg. 1998 Birefringence of intraocular lenses. J Cataract Refract Surg.
Jan;24(1):107-13. PubMed PMID: 9494907 2004 Jul;30(7):1549-55. PubMed PMID: 15210237
CONCLUSION: The glistenings in AcrySof® IOLs were CONCLUSION: The birefringence of the 824C IOL could be a
temperature dependent and confined to IOLs packaged source of error during polarization measurements of the
in AcryPak® System folders and maintained at constant fundus or with instruments that transmit polarized light
(body) temperatures. These findings are believed to through the IOL.
be consistent with fluid formation within the acrylic optic, 36. Oshika T, Santou S, Kato S, Amano S. Secondary closure of
somehow related to the AcryPak® packaging system. neodymium:YAG laser posterior capsulotomy. J Cataract
30. Ayaki M, Nishihara H, Yaguchi S, Koide R. Surfactant Refract Surg. 2001 Oct;27(10):1695-7. PubMed PMID:
induced glistenings: surface active ingredients in 11687373
ophthalmic solutions may enhance water entry into the CONCLUSION: Although IOL exchange surgery was
voids of implanted acrylic intraocular lenses. J Long Term Eff considered, a second Nd:YAG laser intervention successfully
Med Implants. 2006;16(6):451-7. PubMed PMID: 17956212 removed the proliferated lens materials and restored the
CONCLUSION: The Diclod test group had a greater visual acuity. The glistenings were not the cause of the
number of glistenings than the Rinderon test group. Both reduced vision.
drugs have similar anti-inflammatory properties and Diclod, 37. Dogru M, Tetsumoto K, Tagami Y, Kato K, Nakamae
unlike Rinderon, also contains the surfactant polysorbate. K. Optical and atomic force microscopy of an explanted
We proposed that the presence of surfactant, or other AcrySof®intraocular lens with glistenings. J Cataract Refract
ingredient, in commercially available eyedrops may Surg. 2000 Apr;26(4):571-5. PubMed PMID: 10771232
enhance the development of glistenings. CONCLUSION: The glistenings in the explanted AcrySof® IOL
31. Dick HB, Olson RJ, Augustin AJ, Schwenn O, Magdowski G, were likely caused by temperature changes and not
Pfeiffer N. Vacuoles in the Acrysof intraocular lens as factor mechanical stress from folding.
of the presence of serum in aqueous humor. OphthalmicReferences
38. Werner L, Storsberg J, Mauger O, Brasse K, Gerl R, Müller M,
Tetz M. Unusual pattern of glistening formation on a
3-piece hydrophobic acrylic intraocular lens. J Cataract
Refract Surg. 2008 Sep;34(9):1604-9. PubMed PMID:
18721729
CONCLUSION: Analyses of the explanted IOL and the
control IOL under differential scanning calorimetry, as well
as by attenuated total reflection Fourier transform infrared
spectroscopy, revealed slight differences between the IOLs.
39. Mönestam E, Behndig A. Impact on visual function from
light scattering and glistenings in intraocular lenses, a
long-term study. Acta Ophthalmol. 2011 Dec;89(8):724-8.
doi: 10.1111/j.1755-3768.2009.01833.x. Epub 2010 Jan 8.
PubMed PMID: 20064111
CONCLUSION: Most patients in this case series operated 10
years previously had severe glistenings and a high level
of light scattering from their intraocular lenses. No
detectable impact on BCVA, LCVA 10% and 2.5% was found.
40. Hayashi K, Hirata A, Yoshida M, Yoshimura K, Hayashi H.
Long-term effect of surface light scattering and glistenings
of intraocular lenses on visual function. Am J Ophthalmol.
2012 Aug;154(2):240-251.e2. Epub 2012 May 23. PubMed
PMID: 22633349
CONCLUSION: At more than 10 years postoperatively, visual
function, including contrast sensitivity, and ocular HOAs
were comparable among eyes that received acrylic, silicone,
and PMMA IOLs. Surface scattering and glistenings with the
acrylic IOLs were not significantly correlated with visual
function and optical aberrations.
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