Current Issue Highlights

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    Scanning electron microscopy of artificial corneal endothelial keratoplasty implant

    August 2026: 52(8):819-824

    Purpose:

    To characterize the surface morphology and edge profile of the artificial corneal endothelial device (EndoArt) using environmental scanning electron microscopy (SEM).

    Setting:

    University of Brighton, Brighton, United Kingdom.

    Design:

    High-resolution environmental SEM study.

    Methods:

    EndoArt specimens underwent examination using an environmental scanning electron microscope (EVO LS15) with variable pressure chamber capabilities, enabling artifact-free examination of hydrophilic materials. Images were digitized at 2048 × 1760 dpi resolution with 200 μm scale markers. Both inner (corneal) and outer (aqueous) surfaces were evaluated at magnifications ranging from 395× to 10.46K×, focusing on surface topography and edge profile characteristics.

    Results:

    The EndoArt device exhibited a dome-shaped configuration measuring 6.5 mm in diameter with uniform 50 μm thickness. Surface analysis revealed exceptionally smooth topographical characteristics on both surfaces with minimal variation. Both inner and outer surfaces demonstrated pristine, uniform appearance without visible manufacturing marks, scratches, or polymeric irregularities. Surface roughness measurements indicated values well below thresholds associated with cellular adhesion or protein deposition. The edge profile demonstrated optimal tapered design balancing stable tissue adhesion with minimal mechanical trauma. Mirror-like surface quality extended consistently across examined areas, superior to conventional hydrophilic acrylic intraocular lenses which typically exhibit surface irregularities and textural defects.

    Conclusions:

    The exceptional surface smoothness and optimized tapered edge profile documented support the device's barrier function mechanism, correlating with clinical outcomes showing 18% to 37% corneal thickness reductions and representing significant advances in artificial endothelial replacement technology with EndoArt.

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    Study on the relationship between bacterial endotoxin and the onset of toxic anterior segment syndrome

    August 2026: 52(8):813-818

    Purpose:

    To comprehensively analyze the contamination status of pyrogen including bacterial endotoxins, considered as one of the onset agents of toxic anterior segment syndrome (TASS), in medical devices used for cataract surgery, and to improve the cleanliness of the devices by new sterilization technology.

    Setting:

    Innovative Decontamination Technology Development and Evaluation Center, Miura Co. Ltd., Yokohama, Japan.

    Design:

    Experimental study.

    Methods:

    The pyrogen levels of the medical devices were evaluated using a direct human cell-based pyrogen test that is not affected by the recovery ratio, unlike the endotoxin test. Pyrogen inactivation tests were further performed using low-temperature ozone/hydrogen peroxide mixed gas sterilization.

    Results:

    Significant pyrogen levels from 0.22 to 11.6 endotoxin units (EU)/product as a worst case were detected in 7 of 11 medical devices. These products might have exceeded the previously reported threshold (0.02 to 0.05 EU/eye) for inducing dose-dependent inflammatory responses in the mammalian vitreous during actual use. However, our study revealed that pyrogen contamination in the devices was reduced below the detection limit after ozone/hydrogen peroxide mixed gas sterilization under an elaborate treatment mode at 50°C.

    Conclusions:

    The precise amount of pyrogen required to induce human TASS remains unknown; however, currently available medical products for intraocular surgery were found to be contaminated with nonnegligible amounts of pyrogens, and the possibility of a causal relationship between actual product use and the onset of TASS cannot be ruled out. This potential risk could be eliminated by replacing the current sterilization method with ozone/hydrogen peroxide mixed gas treatment.

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    Long-term implant cytology evaluation of explanted intraocular lenses manufactured from different materials

    August 2026: 52(8):806-812

    Purpose:

    To evaluate long-term cell deposition on the surface of intraocular lenses (IOLs) made from different materials, focusing on late foreign-body inflammatory responses.

    Setting:

    John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

    Design:

    Experimental study.

    Methods:

    IOLs explanted as part of standard of care were received in our laboratory immersed in fixative. Patient demographics, implantation and explantation dates, reasons for explantation, and IOL model and manufacturer were obtained. Lenses underwent gross and light microscopic evaluation without previous staining; those explanted 2 or more years after implantation underwent implant cytology staining (hematoxylin/eosin staining) to assess for the presence of cell deposits and proteinaceous deposits on their anterior optic surface.

    Results:

    This study included 31 poly(methyl methacrylate) (PMMA), 58 hydrophobic acrylic, 40 hydrophilic acrylic, and 31 silicone IOLs explanted 21.51 ± 6.55, 10.53 ± 4.74, 7.41 ± 3.67, and 10.73 ± 4.31 years after implantation, respectively. Main reason for explantation was dislocation, followed by optic opacification (of hydrophilic acrylic IOLs). Giant cells were observed in 9 PMMA and 6 hydrophobic acrylic lenses, with many cases related to rough surfaces of positioning holes, multiple Nd:YAG laser pits, and recent history of secondary surgery. A proteinaceous material was estimated to cover 22.52% ± 19.42%, 22.71% ± 15.82%, 5.52% ± 7.43%, and 6.53% ± 5.85% of the anterior optic surface in these 4 groups.

    Conclusions:

    This study showed that inflammatory cell deposits are rarely observed on IOLs explanted more than 2 years after implantation.

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    Hypnosis in photoablative refractive surgery: monocentric prospective study

    August 2026: 52(8):801-805

    Purpose:

    To evaluate the efficacy of hypnosis in anxiety, fear control, and surgical ease in refractive surgery.

    Setting:

    1 single outpatient ophthalmological clinic in Belgium.

    Design:

    Monocentric randomized prospective study conducted from September 2024 to March 2025.

    Methods:

    34 patients aged 18 to 60 were randomized into 2 groups: standard care (photorefractive keratectomy or laser in situ keratomileusis) (control) and standard care plus hypnosis (experimental) where patients underwent real-time hypnosis during surgery. Anxiety levels were measured preoperatively and postoperatively using the Amsterdam Preoperative Anxiety and Information Scale, along with heart rate monitoring and surgeon-rated intraoperative parameters. Patient satisfaction and communication quality were also assessed.

    Results:

    Anxiety scores were similar across groups, with no significant hemodynamic differences. However, the hypnosis group showed significantly better co-operation (P = .004) and surgical comfort (P < .0001). They also reported higher intraoperative comfort, satisfaction, and communication quality (P < .05).

    Conclusions:

    To the authors' knowledge, this is the first study to demonstrate that conversational hypnosis significantly enhances patient experience and surgical co-operation during refractive laser surgery, despite no effect on physiological markers. It represents a promising adjunct relaxing technique useful in outpatient settings.

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    Rate of posterior capsular opacification and complications of YAG capsulotomy in patients with uveitis

    August 2026: 52(8):795-800

    Purpose:

    To determine the rate of posterior capsular opacification (PCO) and outcomes and complications of YAG capsulotomy after cataract surgery in eyes with uveitis.

    Setting:

    Tertiary public hospital setting in Auckland, New Zealand, between 2009 and 2023.

    Design:

    Retrospective observational cohort study.

    Methods:

    Patients who underwent cataract surgery after a diagnosis of uveitis were included. The main outcome measures studied were time from cataract surgery to development of PCO and flare of uveitis after YAG capsulotomy.

    Results:

    In 4430 patients with uveitis, cataract surgery was performed in 596 patients (13.5%, 746 eyes). PCO developed in 250 eyes with a median time to PCO of 77 months. PCO developed in 17.3% (95% CI 14.6%-20.5%) by 1 year, 24.2% (95% CI 21.0%-27.8%) by 2 years, and 33.8% (95% CI 30.3%-37.7%) by 5 years. 120 eyes underwent YAG capsulotomy during the study period. Complications occurred in 19 participants (15.8%) and included uveitis flare (15.0%), cystoid macular edema (3.3%), and retinal detachment (0.8%). On multivariate analysis, younger age was associated with higher risk of uveitis flare (odds ratio [OR] 0.968, P = .038) and 3 months quiescence with lower risk of flare (OR 0.190, P = .004).

    Conclusions:

    PCO is a common complication after cataract surgery in participants with uveitis, occurring in more than one-third of patients by 5 years. Complications of YAG capsulotomy occur in 15.8% with increased frequency in younger participants and in those with <3 months of uveitis quiescence.

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