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
Glistenings, or microvacuoles, are reflections of light
that occur from migrations of water within the matrix
of hydrated IOL material.1,2 Glistenings typically are 1
to 20 m in size3,4,32,35 and present from 1 to 6 months
postoperatively.3,5-7,9,32 Some studies suggest they are
stable over time,3,7,8,32 while others suggest they may be
progressive.5,9-11,32
Glistenings in Different Intraocular Lens Materials
Glistenings have been observed in most modern IOL
materials including polymethylmethacrylate
(PMMA),12-14,32 silicone,9,13,15-17,32 hydrophilic acrylic9,18,19,32
and hydrophobic acrylic.1-11,13,17,18,20-28,32
Glistenings are visible due to differences in refractive
indices between the IOL material and water within the
IOL material. The larger the difference between these 2
refractive indices, the more apparent the microvacuoles.
IOL material refractive indices are as follows:
PMMA (1.49)
silicone (1.43-1.46)
hydrophilic acrylic (1.47)
hydrophobic acrylic (1.47 to 1.55)
Water has a lower refractive index [1.33] than any IOL
material, which means that glistenings will be most
apparent in those IOL materials with the highest
refractive index. If the index of refraction were equal,
for instance, glistenings would be unnoticeable, since
the deviation of any light at the interface is a function of
the angle of incidence and the difference between the
refractive indices of the materials on either side of the
interface.
observed with a thin slit beam at a 45 angle. They are
usually more difficult to observe with retro illumination.
Formation of Glistenings
Microvacuoles result from water absorption and
subsequent condensation (phase separation) within the
matrix of the IOL material.1,2,32 Their formation appears to
be influenced by temperature,1,3,4,29 inflammation21 and
aqueous composition.30-32
Microvacuoles are not visible when an IOL is in a dry state.
When an IOL is implanted, a certain amount of water is
absorbed. About 1 to 6 months postoperatively, phase
separation may occur within the matrix of the IOL material,
allowing minute water particles to condense and form
microvacuoles.32
All IOL materials have a limited uptake of water, thus,
the self-limiting factor in glistening formation is the
achievement of a state of equilibrium in water content
within the IOL. For example, hydrophilic acrylic IOLs reach
a state of equilibrium at 18% to 33% water content, and
hydrophobic acrylic IOLs at 0.3% to 1.5%.32
A change in temperature is the most commonly-used
method of generating glistenings in vitro.4,9,29,33 The
glistenings formed in this manner are generally similar
to those that form in vivo; however, the density of in
vitro glistenings can sometimes exceed those that would
be expected in a clinical setting.34 While not directly
comparable, glistenings created in vitro will have optical
properties and effects consistent with those in-vivo, when
they are formed at clinically-relevant densities.

The observance of microvacuoles changes as the angle

of the slit beam changes. Microvacuoles are usually best
Literature Review
Methodology
The US National Library of Medicine has an on-line medical
publication search engine (pubmed.com) and database.
This on-line database was searched using a wide range of
terms designed to capture all potential articles related to
glistenings.
The search term below was used to identify all potential
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
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
retained or discarded as the detailed review indicated. In
this manner 428 articles were eliminated and 44 articles
were retained. Of the retained articles, one was an editorial
with no new information, one described a general
technique for measuring glistenings, one concerned
lens opacification but mentioned glistenings as a related
phenomenon and one was a single case report in a French
journal and was not translated.The final 40 articles are
referenced in this paper.
Impact on Optical Quality, Measured In Vitro
Of 18 in vitro studies of glistenings, the majority were
concerned with their formation and characteristics.
Only 2 studies measured optical quality as well.
Oshika et al measured spectral transmittance, forward
scatter, the modulation transfer function and resolving
power at various contrasts with and without a glare
source. Several degrees of glistenings in the optic were
experimentally created by immersing lenses in water at
37C for 48 hours and then at 25C for 24 hours. Glistenings
were graded by inspection according to a visual scale
provided in the article, with Grade 1 being minimal
density. Grade 4+ glistening density was characterized
as extremely intense and beyond the range of clinical
settings.34 They found the optical quality of the acrylic
foldable intraocular lens is not significantly affected by the
level of glistenings usually seen in the clinical setting.34
(See Figure 1) In a separate study, Miura et al created
glistenings by immersing IOLs in in normal saline solution
at 50C for 2 hours and then at 35C for 3 days. They
examined possible polarization effects from glistenings
and found no significant effect.35
Figure 1
FROM OSHIKA et al. [Figure 1.] In-vitro glistenings and optical quality.
Impact on Vision
Seventeen studies, each with a minimum enrollment of 20
eyes, report on glistenings and their association with vision
loss. A total of 1,843 eyes are included. .
Three of the studies in question include patient evaluations
8 years or more after implantation, and account for 278
eyes (15% of the total).14,39,40 Monestam et al examined 103
eyes of 103 patients and graded the intensity of glistenings
according to the photographic classification of Dhaliwal et
al.26 They found that most patients had severe glistenings,
but that no detectable impact on BCVA, LCVA 10% and
2.5% was found.39 Hayashi et al studied 35 eyes more than
10 years after implantation, grading glistenings according
to the method of Miyata et al.3 They found 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. Glistenings
with the acrylic IOLs were not significantly correlated
with visual function and optical aberrations.40 The only
significant differences found between lenses were higher
light scatter and better corrected visual acuity in the
acrylic group. Wilkins et. al. examined patients an average
of 8 years postoperatively with a PMMA lens and found a
similar result; they saw significant glistenings but did not
document any clinical impact.14
Literature 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 owners
References
1. Miyata A, Yaguchi S. Equilibrium water content and
glistenings in acrylic intraocular lenses. J Cataract Refract
Surg. 2004 Aug;30(8):1768-72. PubMed PMID: 15313305
CONCLUSION: The change in the equilibrium water content
caused by temperature changes between 30 degrees C
and 40 degrees C is an important factor in glistening
formation, and thus an IOL featuring less temperature-
dependent water absorption is less likely to form
glistenings.
2. Kato K, Nishida M, Yamane H, Nakamae K, Tagami Y,
Tetsumoto K. Glistening formation in an AcrySof lens
initiated by spinodal decomposition of the polymer
network by temperature change. J Cataract Refract Surg.
2001 Sep;27(9):1493-8 PubMed PMID: 11566536
CONCLUSION: Glistenings formed in the bulk of an AcrySof
IOL as the medium temperature decreased. The mechanism
may involve spinodal decomposition of the swollen
polymer network, which initiates the formation of
microvacuoles consisting of water and loosely packed
network chains.
3. Miyata A, Uchida N, Nakajima K, Yaguchi S. Clinical and
Experimental Observation of Glistening in Acrylic
Intraocular Lenses. Jpn J Ophthalmol. 2000 Nov 1;44(6):693.
PubMed PMID: 11094201
CONCLUSION: The glistening in acrylic intraocular lenses
seemed to become stable a few months after appearance.
Thus our experimental method is useful, because it gives us
glistening similar to clinical cases in a short time.
4. Gregori NZ, Spencer TS, Mamalis N, Olson RJ. In vitro
comparison of glistening formation among hydrophobic
acrylic intraocular lenses(1). J Cataract Refract Surg. 2002
Jul;28(7):1262-8. PubMed PMID: 12106738
CONCLUSION: Glistening quantity varied among
hydrophobic acrylic IOLs and was temperature dependent.
Sensar* IOLs were more stable than the 2 other IOL types.
The glistening phenomenon must be studied further to
eliminate the problem.
* Trademarks are property of their respective owners.
5. Nagata M, Matsushima H, Mukai K, Terauchi W, Senoo T,
Wada H, Yoshida S. Clinical evaluation of the transparency
of hydrophobic acrylic intraocular lens optics. J Cataract
Refract Surg. 2010 Dec;36(12):2056-60. PubMed PMID:
21111307
CONCLUSION: Our results suggest that AcrySof SA60AT
and AF-1 VA-60BB IOLs are likely to develop glistenings over
time and that the former may develop whitening.
6. Davison JA. Clinical performance of Alcon SA30AL and
SA60AT single-piece acrylic intraocular lenses. J Cataract
 Refract Surg. 2002 Jul;28(7):1112-23 PubMed PMID: 12106718
CONCLUSION: The single-piece acrylic lenses performed
well in all regards. Although not as intense as observed
with the earlier 3-piece designs, pseudophakic
dysphotopsia occurred in a few patients with the single-
piece acrylic lens. Intraocular lens exchanges with single-
piece IOLs may be accomplished with less difficulty early
rather than late.
7. Colin J, Orignac I, Touboul D. Glistenings in a large series of
hydrophobic acrylic intraocular lenses. J Cataract Refract
Surg. 2009 Dec;35(12):2121-6 PubMed PMID: 19969218
CONCLUSION: The results suggest a potential association
between the incidence of glistenings and IOL power and
glaucoma, but not between glistenings and age, sex,
IOL model, length of follow-up, CDVA, SE, or most ocular
and systemic diseases and medications.
8. Colin J, Orignac I. Glistenings on intraocular lenses in
healthy eyes: effects and associations. J Refract Surg. 2011
Dec;27(12):869-75. doi: 10.3928/1081597X-20110725-01.
Epub 2011 Jul 29. PubMed PMID: 21800784
CONCLUSION: In healthy eyes, glistening grade was not
associated with contrast sensitivity, CDVA, intraocular light
scatter, or any lens or demographic characteristics that were
investigated.
9. Tognetto D, Toto L, Sanguinetti G, Ravalico G. Glistenings
in foldable intraocular lenses. J Cataract Refract Surg. 2002
Jul;28(7):1211-6. PubMed PMID: 12106730
CONCLUSION: Glistening formation was observed in
7 different foldable IOLs. The AcrySof group had a higher
percentage and a greater density of glistenings.
10. Peetermans E, Hennekes R. Long-term results of wagon
wheel packed acrylic intra-ocular lenses (AcrySof). Bull Soc
Belge Ophtalmol. 1999;271:45-8. PubMed PMID: 10355159
CONCLUSION: Vacuoles, as described with the AcryPak
system, were also detectable in our Wagon Wheel packed
lenses. They increased significantly in incidence and
number with time.
11. Waite A, Faulkner N, Olson RJ. Glistenings in the single-
piece, hydrophobic, acrylic intraocular lenses. Am J
Ophthalmol. 2007 Jul;144(1):143-4. PubMed PMID:
17601442
CONCLUSION: All IOLs studied had glistenings. High spatial
resolution contrast sensitivity impact and severity
progression over time deserve further study.
12. Ballin N. Glistenings in injection-molded lens. J Am Intraocul
Implant Soc 1984 Fall;10(4):473. PubMed PMID: 6501064
CONCLUSION: None, a letter to the editor first identifying
glistenings in IOLs.
13. Rnbeck M, Behndig A, Taube M, Koivula A, Kugelberg M.
Comparison of glistenings in intraocular lenses with
three different materials: 12-year follow-up.
Acta Ophthalmol. 2011 Oct 28. doi: 10.1111/j.1755-
3768.2011.02277.x [Epub ahead of print] PubMed PMID:
22035345
CONCLUSION: In this long-term follow-up study, the
hydrophobic acrylic IOL had a significantly higher degree
of lens glistenings compared to the silicone and PMMA
IOLs. The PMMA IOL had almost no lens glistenings. The IOL
dioptric power was not significantly correlated with the
degree of lens glistenings associated with the hydrophobic
acrylic IOL.
14. Wilkins E, Olson RJ. Glistenings with long-term follow-up
of the Surgidev B20/20 polymethylmethacrylate intraocular
lens. Am J Ophthalmol. 2001 Nov;132(5):783-5. PubMed
References
PMID: 11704044
CONCLUSION: Glistenings may occur in
polymethylmethacrylate intraocular lenses with long-term
follow-up, and they are progressive.
15. Miyata A, Uchida N, Nakajima K, Yaguchi S. [Experimental
study of glistening in silicone intraocular lenses]. Nihon
Ganka Gakkai Zasshi. 2002 Feb;106(2):112-4. Japanese.
PubMed PMID: 11915372
CONCLUSION: The presence of numerous microvacuoles
in the SI40NB means there may be GP. The light clouding
in the AQ110NV that was resolved with drying is thought to
be due to particles in the material which cause
discoloration.
16. Cisneros-Lanuza A, Hurtado-Sarri M, Duch-Samper
A, Gallego-Pinazo R, Menezo-Rozaln JL. Glistenings in the
Artiflex phakic intraocular lens. J Cataract Refract Surg. 2007
Aug;33(8):1405-8. PubMed PMID: 17662432
CONCLUSION: Glistenings appeared some Artiflex* pIOLs
to varying degrees, although they were not visually
significant in any case. A larger study of this IOL is needed
to determine whether severe cases of glistenings affect
visual function and assess their cause and evolution over
time.* Trademarks are property of their respective owners.
17. Schauersberger J, Amon M, Kruger A, Abela C, Schild
G, Kolodjaschna J. Comparison of the biocompatibility of
2 foldable intraocular lenses with sharp optic edges. J
Cataract Refract Surg. 2001 Oct;27(10):1579-85. PubMed
PMID: 11687355
CONCLUSION: The findings show that a sharp-edged optic
design is, to date, the most effective method of reducing
the rate of PCO. Despite a subclinical foreign-body reaction
in the AcrySof group, both lenses had a high degree of
capsular and uveal biocompatibility.
18. Klos KM, Richter R, Schnaudigel O, Ohrloff C. Image
analysis of implanted rigid and foldable intraocular lenses in
human eyes using Scheimpflug photography. Ophthalmic
Res. 1999;31(2):130-3. PubMed PMID: 9933775
CONCLUSION: Thus, we found in foldable IOLs 'glistenings',
which did not have any influence on functional results
and we could distinguish them from lens damage.
We propose to use Scheimpflug tests regularly for the
examination of implanted new types of IOLs.
19. Fujita S, Tanaka T, Miyata A, Hirose M, Usui M. Cell adhesion
and glistening formation in hybrid copolymer intraocular
lenses. Ophthalmic Res 2012;48(2):102-8. Epub 2012 Apr 18.
PubMed PMID: 22517197
CONCLUSION: The MA IOLs exhibited a low level of
adhering cells but a high level of glistening formation,
the HEMA IOL exhibited the reverse tendency, and the MA/
HEMA IOL exhibited a low level of both, thus indicating that
hybrid MA/HEMA IOLs are less susceptible than HEMA IOLs
to cell adhesion and less susceptible than MA IOLs to
glistening formation.
20. Colin J, Praud D, Touboul D, Schweitzer C. Incidence
of glistenings with the latest generation of yellow-tinted
hydrophobic acrylic intraocular lenses. J Cataract Refract
Surg. 2012 Jul;38(7):1140-6. PubMed PMID: 22727284
CONCLUSION: Glistenings were common in eyes with the
blue light-filtering hydrophobic acrylic IOL and increased
over time.
21. Moreno-Montas J, Alvarez A, Rodrguez-Conde R,
Fernndez-Hortelano A. Clinical factors related to the
frequency and intensity of glistenings in AcrySof
intraocular lenses. J Cataract Refract Surg. 2003
Oct;29(10):1980-4. PubMed PMID: 14604721
CONCLUSION: The frequency and intensity of glistenings in
AcrySof IOLs increased with time after surgery
and were higher when postoperative inflammation
was present. Glistenings developed more frequently
in cases of phacotrabeculectomy but not after combined
phacoemulsification and deep sclerectomy. Glistenings did
not result in decreased Snellen BCVA.
22. Mamalis N. Intraocular lens glistenings. J Cataract Refract
Surg. 2012 Jul;38(7):1119-20. PubMed PMID: 22727278
CONCLUSION (EDITORIAL COMMENT): Even significant
glistenings and high-level light scattering from the IOLs
have not been shown to have a detectable impact on CDVA
or low contrast visual acuity.
23. Chehade M, Elder MJ. Intraocular lens materials and styles: a
review. Aust N Z J Ophthalmol. 1997 Nov;25(4):255-63.
Review. PubMed PMID: 9395827
CONCLUSION: Soft acrylic IOL unfold slowly, resulting in
controlled insertion, but it is possible to crack the lens and
some lenses develop glistenings due to water
accumulation. There are significant socioeconomic
implications to the large differences in posterior capsule
opacification rates between the various biomaterials and
the lens styles.
24. Christiansen G, Durcan FJ, Olson RJ, Christiansen K.
Glistenings in the AcrySof intraocular lens: pilot study. J
Cataract Refract Surg. 2001 May;27(5):728-33. PubMed
PMID: 11377904
CONCLUSION: Glistenings occurred frequently in AcrySof
IOLs, with most cases mild. A larger study of this lens is
needed to determine whether severe presentations affect
visual function and to understand how glistenings change
over time.
25. Prosdocimo G, Tassinari G, Sala M, Di Biase A, Toschi PG,
Gismondi M, Corbanese U. Posterior capsule opacification
after phacoemulsification: silicone CeeOn* Edge versus
acrylate AcrySof intraocular lens. J Cataract Refract Surg
2003 Aug;29(8):1551-5. PubMed PMID: 12954304
CONCLUSION: Both the CeeOn* Edge and AcrySof groups
had a low incidence of PCO after an 18-month follow-
up. The CeeOn* Edge group had significantly less PCO than
the AcrySof IOL group. These results confirm that IOLs with
square truncated edges create a barrier effect at the optic
edge, reducing the overall incidence of PCO.
* Trademarks are property of their respective owners.
References
26. Dhaliwal DK, Mamalis N, Olson RJ, Crandall AS,
Zimmerman P, Alldredge OC, Durcan FJ, Omar O. Visual
significance of glistenings seen in the AcrySof intraocular
lens. J Cataract Refract Surg. 1996 May;22(4):452-7. PubMed
PMID: 8733849
CONCLUSION: Patients who received AcrySof IOLs that
came in the AcryPak had some degree of glistenings.
There was also a significant decrease in contrast sensitivity
compared with that of fellow eyes with silicone IOLs. The
glistenings are likely caused by water vacuoles that form
within the lens after hydration within the eyes. Further
studies are necessary to assess the exact cause of these
glistenings.
27. Gunenc U, Oner FH, Tongal S, Ferliel M. Effects on visual
function of glistenings and folding marks in AcrySof
intraocular lenses. J Cataract Refract Surg. 2001
Oct;27(10):1611-4. PubMed PMID: 11687360
CONCLUSION: Although glistenings and folding marks were
observed after the implantation of AcrySofIOLs, they did
not significantly affect visual function.
28. Allers A, Baumeister M, Steinkamp GW, Ohrloff C,
Kohnen T. [Intra-individual comparison of intraocular
lenses of highly refractive silicone (Allergan SI40NB) and
hydrophobic acrylate (Alcon Acrysof MA60BM). 1-year
follow-up] Ophthalmologe. 2000 Oct;97(10):669-75.
German. PubMed PMID: 11105542
CONCLUSION: One year after implantation of foldable,
highly refractive silicone and hydrophobic acrylic IOLs
using a self-sealing tunnel incision and phacoemulsification,
no significant functional or morphological differences
between the two IOL types were observed.
29. Omar O, Pirayesh A, Mamalis N, Olson RJ. In vitro analysis
of AcrySof intraocular lens glistenings in AcryPak
and Wagon Wheel packaging. J Cataract Refract Surg. 1998
Jan;24(1):107-13. PubMed PMID: 9494907
CONCLUSION: The glistenings in AcrySof IOLs were
temperature dependent and confined to IOLs packaged
in AcryPak System folders and maintained at constant
(body) temperatures. These findings are believed to
be consistent with fluid formation within the acrylic optic,
somehow related to the AcryPak packaging system.
30. Ayaki M, Nishihara H, Yaguchi S, Koide R. Surfactant
induced glistenings: surface active ingredients in
ophthalmic solutions may enhance water entry into the
voids of implanted acrylic intraocular lenses. J Long Term Eff
Med Implants. 2006;16(6):451-7. PubMed PMID: 17956212
CONCLUSION: The Diclod test group had a greater
number of glistenings than the Rinderon test group. Both
drugs have similar anti-inflammatory properties and Diclod,
unlike Rinderon, also contains the surfactant polysorbate.
We proposed that the presence of surfactant, or other
ingredient, in commercially available eyedrops may
enhance the development of glistenings.
31. Dick HB, Olson RJ, Augustin AJ, Schwenn O, Magdowski G,
Pfeiffer N. Vacuoles in the Acrysof intraocular lens as factor
of the presence of serum in aqueous humor. Ophthalmic
Res. 2001 Mar-Apr;33(2):61-7. PubMed PMID: 11244349
CONCLUSION: The number of vacuoles increases with
incubation time in aqueous humor containing serum.
The addition of serum increased the proportion of
lipids and proteins in the solution, which also occurs with
a breakdown in the blood-aqueous barrier. The results of
the present study point to a physiological factor that may
lead to vacuole formation in IOLs and may aid clinicians in
identifying risk factors involved in the formation of
vacuoles.
32. Werner L. Glistenings and surface light scattering in
intraocular lenses. J Cataract Refract Surg. 2010
Aug;36(8):1398-420. Review. PubMed PMID: 20656166
CONCLUSION: Although the impact of glistenings on
postoperative visual function and the evolution
of glistenings in the late postoperative period remain
controversial, IOL explantation has rarely been reported.
33. Shiba T, Mitooka K, Tsuneoka H. In vitro analysis of AcrySof
intraocular lens glistening. Eur J Ophthalmol. 2003 Nov-
Dec;13(9-10):759-63. PubMed PMID: 14700095
CONCLUSION: AcrySof lenses soaked in warm water for
a short time may change characteristics, and therefore,
close monitoring of the temperature and time of soaking is
necessary to prevent glistening formation.
34. Oshika T, Shiokawa Y, Amano S, Mitomo K. Influence of
glistenings on the optical quality of acrylic foldable
intraocular lens. Br J Ophthalmol. 2001 Sep;85(9):1034-7.
PubMed PMID: 11520749; PubMed Central PMCID:
PMC1724105
CONCLUSION: The optical quality of the acrylic foldable
intraocular lens is not significantly affected by the level of
glistenings usually seen in the clinical setting.
35. Miura M, Osako M, Elsner AE, Kajizuka H, Yamada K, Usui M.
Birefringence of intraocular lenses. J Cataract Refract Surg.
2004 Jul;30(7):1549-55. PubMed PMID: 15210237
CONCLUSION: The birefringence of the 824C IOL could be a
source of error during polarization measurements of the
fundus or with instruments that transmit polarized light
through the IOL.
36. Oshika T, Santou S, Kato S, Amano S. Secondary closure of
neodymium:YAG laser posterior capsulotomy. J Cataract
Refract Surg. 2001 Oct;27(10):1695-7. PubMed PMID:
11687373
CONCLUSION: Although IOL exchange surgery was
considered, a second Nd:YAG laser intervention successfully
removed the proliferated lens materials and restored the
visual acuity. The glistenings were not the cause of the
reduced vision.
37. Dogru M, Tetsumoto K, Tagami Y, Kato K, Nakamae
K. Optical and atomic force microscopy of an explanted
AcrySofintraocular lens with glistenings. J Cataract Refract
Surg. 2000 Apr;26(4):571-5. PubMed PMID: 10771232
CONCLUSION: The glistenings in the explanted AcrySof IOL
were likely caused by temperature changes and not
mechanical stress from folding.
References
38. Werner L, Storsberg J, Mauger O, Brasse K, Gerl R, Mller 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. Mnestam 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.

2012 Novartis 12/12 NIQ12422SA