One-year evolution of DLCO changes and respiratory symptoms in patients with post COVID-19 respiratory syndrome.

PURPOSE: During a follow-up program of patients admitted for COVID-19 at our non-ICU Unit, we found that 37% of them had decreased diffusing lung capacity for carbon monoxide (DLCO) 3-6 months after discharge. This prospective observational study aimed to evaluate the evolution of changes in DLCO and respiratory symptoms at the 1-year follow-up visit. METHODS: Seventeen (mean age 71 years; 8 males) of 19 eligible patients (DLCO < 80% of predicted at the 3-6 months follow-up visit) completed the 1-year follow-up visit. One patient refused to participate and 1 patient had died 3 months earlier from myocardial infarction. The visit included a self-reported structured questionnaire, physical exam, blood tests, ECG, and spirometry with DLCO. RESULTS: Mean DLCO was significantly improved at the 1-year visit (from 64% of predicted at 3-6 months to 74% of predicted at 1 year; P = 0.003). A clinically significant increase in DLCO (10% or greater) was observed in 11 patients (65%) with complete normalization (> 80% of predicted) in 6 (35%); in the other 6 (35%) it remained unchanged. The prevalence of exertional dyspnea (65-35%, P = 0.17), cough (24-18%, P = 1), and fatigue (76-35%, P = 0.04) decreased at the 1-year visit. CONCLUSION: These results suggest that DLCO and respiratory symptoms tend to normalize or improve 1 year after hospitalization for COVID-19 in most patients. However, there is also a non-negligible number of patients (about one-third) in whom respiratory changes persist and will need prolonged follow-up.

COVID-19: persistence of symptoms and lung alterations after 3-6 months from hospital discharge.

PURPOSE: Few data are currently available on persistent symptoms and late organ damage in patients who have suffered from COVID-19. This prospective study aimed to evaluate the results of a follow-up program for patients discharged from a nonintensive COVID-19 ward. METHODS: 3-6 months after hospital discharge, 59 of 105 COVID-19 patients (31 males, aged 68.2 ± 12.8 years) were recruited in the study. Forty-six patients were excluded because of nontraceability, refusal, or inability to provide informed consent. The follow-up consisted of anamnesis (including a structured questionnaire), physical examination, blood tests, ECG, lower limb compression venous ultrasound (US), thoracic US, and spirometry with diffusion lung capacity for carbon monoxide (DLCO). RESULTS: 22% of patients reported no residual symptoms, 28.8% 1 or 2 symptoms and 49.2% 3 or more symptoms. The most frequently symptoms were fatigue, exertional dyspnea, insomnia, and anxiety. Among the inflammatory and coagulation parameters, only the median value of fibrinogen was slightly above normal. A deep vein thrombosis was detected in 1 patient (1.7%). Thoracic US detected mild pulmonary changes in 15 patients (25.4%), 10 of which reported exertional dyspnea. DLCO was mildly or moderately reduced in 19 patients (37.2%), 13 of which complained of exertional dyspnea. CONCLUSION: These results highlight that a substantial percentage of COVID-19 patients (77.8%) continue to complain of symptoms 3-6 months after hospital discharge. Exertional dyspnea was significantly associated with the persistence of lung US abnormalities and diffusing capacity alterations. Extended follow-up is required to assess the long-term evolution of postacute sequelae of COVID-19.

VITREOUS PROSTAGLANDIN E2 CHANGES AFTER TOPICAL ADMINISTRATION OF DICLOFENAC 0.1%, INDOMETHACIN 0.5%, NEPAFENAC 0.3%, AND BROMFENAC 0.09.

PURPOSE: To evaluate the vitreous concentration of different nonsteroidal anti-inflammatory drugs (NSAIDs) after topical administration and the related prostaglandin E2 (PGE2) levels in patients undergoing pars plana vitrectomy. METHODS: A prospective, randomized, investigator-masked study was performed. One hundred four patients scheduled for a pars plana vitrectomy for an epiretinal membrane or a macular hole were randomized to receive topical diclofenac 0.1%, indomethacin 0.5%, nepafenac 0.3%, bromfenac 0.09%, or placebo 3 days before surgery. At the beginning of surgery, a sample of undiluted vitreous was collected in each patient to assess NSAIDs concentration and PGE2 levels. RESULTS: The median vitreous concentrations were 203.35 (interquartile range 146.54-264.18) pg/mL for diclofenac, 243.45 (interquartile range 156.96-365.37) pg/mL for nepafenac, 438.21 pg/mL (interquartile range, 282.52-645.87) for its active metabolite amfenac, 350.14 (interquartile range, 290.88-481.95) pg/mL for indomethacin, and 274.59 (245.43-358.25) pg/mL for bromfenac. Vitreous PGE2 levels were significantly lower for all the NSAIDs groups compared with the control group (P < 0.001). A statistically significant higher vitreous PGE2 level was found in the diclofenac group compared with the other NSAIDs groups (P < 0.05). CONCLUSION: Topical NSAIDs achieve sufficient vitreous concentration to decrease vitreous PGE2 levels compared with the control group. The different efficacy in reducing PGE2 concentration may affect the management of posterior segment inflammation.

Scanning electron microscopy study of different one-piece foldable acrylic intraocular lenses after injection through microincisional cataract surgery cartridges.

PURPOSE: To evaluate possible surface alterations of different models of one-piece foldable acrylic intraocular lenses (IOLs) after folding and ejecting process through 2.2-mm microincisional cataract surgery (MICS) cartridges. METHODS: In this experimental laboratory study, the following IOLs were studied: Johnson&Johnson PCB00, HOYA iSert 251, Alcon AcrySof IQ SN60WF, Bausch&Lomb enVISTA MX-60. A total of 80 IOLs were analyzed. Twenty intraocular lenses of each type were studied: ten with a power of + 21 D ± 1 and ten with a power of + 28 D ± 1. IOLs were injected through a dedicated 2.2-mm MICS cartridge into a 50-mL vial containing 10 mL of deionized water. After rinsing and metallization process, scanning electron microscopy images were acquired. RESULTS: All IOLs presented high-quality construction biomaterials. Some IOLs showed superficial scratches and tears on the optic surface, mainly positioned according to the direction of the stress induced by the folding process. In other cases, small superficial tears were seen in a more peripheral position. CONCLUSIONS: All lenses showed excellent surface quality. After folding and injection process some superficial scratches and tears of the IOL optic were detected in some models. Further studies are needed to assess the possible effects of those superficial damages on the optical quality of the IOLs.

Comparative clinical study of Whitestar Signature phacoemulsification system with standard and Ellips FX handpieces.

PURPOSE: To compare the intraoperative parameters and postoperative outcomes using two different phaco handpieces with different energy delivery systems of the same phacoemulsification machine. METHODS: One hundred and sixty eyes of 160 cataract patients were randomly assigned to 2.40 mm phacoemulsification using the AMO WhiteStar Signature® phaco system with the standard phaco handpiece (Group 1) or the Ellips FX phaco handpiece (Group 2). According to the lens opacities classification system III, each group was divided into four subgroups of 20 patients each. U/S total time (UST), total phaco time (TPT), mean effective phaco time, cumulative dissipated energy (CDE) and balanced salt solution (BSS) consumption were studied. Visual acuity, corneal endothelium cell count and corneal pachymetry were evaluated before surgery and 1, 7 and 30 days after surgery. RESULTS: No statistically significant difference in terms of visual acuity was observed between the two groups. The postoperative endothelial cell loss and corneal pachymetry were similar between the two groups. In higher density cataracts, Ellips FX showed the lower CDE and the lowest UST. TPT and BSS consumption were significantly lower in the Ellips FX handpiece group. CONCLUSIONS: The two phaco handpieces appeared to be safe. AMO Ellips FX handpiece showed better performances and may be safer in lens removal, especially in hard cataract patients.

Surface profiles of new-generation IOLs with improved intermediate vision.

PURPOSE: To evaluate the surface profile of different new-generation intraocular lenses (IOLs) designed to improve intermediate vision. SETTING: Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy. DESIGN: Prospective experimental laboratory study. METHODS: One higher-order aspheric monofocal IOL (Tecnis Eyhance ICB00) and 2 extended depth-of-focus (EDOF) IOLs (Tecnis Symfony ZXR00, Mini Well Ready) were examined and compared with monofocal IOLs with the same platform (Sensar AAB00, Tecnis ZCB00, Mini 4 Ready) using contact profilometry. Raw profiles were obtained and compared. The best-fit circle was then subtracted from each raw profile to highlight differences. RESULTS: The new higher-order aspheric IOL presented a peculiar profile, which appeared similar to the conventional monofocal IOL based on the same platform, with just minimal differences in the central design. One of the EDOF IOLs showed a diffractive design. The EDOF IOL based on spherical aberration presented a central steepening surrounded by a symmetric lateral change in depths. CONCLUSIONS: Improved intermediate vision can be achieved by means of different optic designs. Unlike the traditional EDOF and multifocal IOLs based on a diffractive design, the profiles of new-generation IOLs are characterized by smooth and progressive changes of the superficial geometry.

Mixed polymeric systems: New ophthalmic viscosurgical device created by mixing commercially available devices.

PURPOSE: To evaluate the rheological properties of mixtures of different commercially available ophthalmic viscosurgical devices (OVDs) containing sodium hyaluronate and chondroitin sulfate. SETTING: Eye Clinic, University of Trieste, Trieste, Italy. DESIGN: Laboratory study. METHODS: Blends were obtained combining a superviscous cohesive OVD (Healon GV [sodium hyaluronate 1%]) and a medium-viscosity dispersive OVD (Viscoat [sodium hyaluronate 3.0%-chondroitin sulfate 4.0%]). The 2 substances were combined in different ratios, and the rheological characteristics were analyzed to find the optimum proportion. A new viscous dispersive OVD, Discovisc (hyaluronic acid 1.6%-chondroitin sulfate 4.0%) was evaluated for comparison. The storage modulus, loss modulus, crossover point, complex viscosity, shear viscosity, and pseudoplasticity were studied. RESULTS: The rheological properties of the mixed solution (1:1 and 3:1) showed intermediate characteristics in comparison with the 2 original substances, characterized by a viscosity comparable to that of the superviscous cohesive OVD, but at a higher shear rate (similar to the medium-viscosity dispersive OVD). The new viscous dispersive OVD performed similarly to the medium-viscosity dispersive OVD at low shear rates but was comparable to the superviscous cohesive OVD at high shear rates. CONCLUSIONS: The mixture of dispersive and cohesive rheological properties in a single OVD might be an advantage during cataract surgery.

Scanning Electron Microscopy Evaluation of an EX-PRESS Mini Glaucoma Shunt After Explantation.

We report a case of an explanted stainless steel miniature glaucoma drainage device (EX-PRESS) implanted under a scleral flap for pseudoexfoliation open-angle glaucoma surgical treatment. The glaucoma shunt was implanted in a 75-year-old white man with medically refractive glaucoma. Cataract surgery was performed simultaneously. After 2 years, the shunt extruded through the scleral flap and the conjunctiva and it was, therefore, explanted. Scanning electron microscopy images of the EX-PRESS mini glaucoma shunt were acquired to verify the patency of the device lumen and the presence of fibrosis or cellular adhesion on the device. Energy dispersive spectroscopy for chemical surface characterization of the EX-PRESS shunt was performed. Scanning electron microscopy-acquired images showed minimal extracellular material proliferation on the lumen device. The energy dispersive spectroscopy analysis revealed a high peak of carbon suggesting the organic nature of the residuals found on the shunt lumen. The surface showed few superficial pits, likely due to an initial corrosion process.

Chemical and physical analysis of phaco handpiece tip surfaces before and after cataract surgery.

PURPOSE: To evaluate the surface chemical composition and roughness of different phaco tips before and after their use during cataract surgery. SETTING: Eye Clinic, University of Trieste, Trieste, Italy. DESIGN: Experimental study. METHODS: Of the 66 tips studied, 33 (15 new, 15 after single use, and 3 after multiple uses) were studied with X-ray photoemission spectroscopy and 33 (15 new, 15 after single use, and 3 after multiple uses) were examined using scanning electron microscopy with energy dispersive X-ray spectroscopy analysis and contact profilometry. All analyses were performed on the far end of the tip. RESULTS: Used phaco tips showed signs of wear at the end of the tip, with the deposition of debris. The cutting edge appeared to be rounded and irregular. After surgery, an increase in the surface roughness was detected. The chemical analyses showed modification of the superficial alloy composition and the biological origin of some debris deposited after surgery. The deterioration and wear observed were more remarkable after multiple surgical procedures. CONCLUSIONS: Used phaco tips showed relevant signs of deterioration and deposition of biological material, mostly involving the cutting edge. Reusable tips might release remnants of previous procedures. The adoption of single-use disposable phaco tips seems to be highly advisable.

Reading acuity in children: evaluation and reliability using MNREAD charts.

PURPOSE: To study reading acuity in children and assess the reliability of its measurement using the Italian version of the MNREAD reading chart. METHODS: One hundred sixteen children from grades 3 to 8 with normal near vision were tested at a pediatric eye care institution in northeastern Italy. Visual acuity was evaluated with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and reading acuity with MNREAD charts. Examination with charts 1 and 2 by the same examiner in the same visit were used as test-retest measurements. RESULTS: Mean improvement of performance from grades 3 to 8 was approximately 1 line for ETDRS acuity and 1.5 sentences for reading acuity and critical print size. Mean maximum reading speed increased from 96 to 167 words/minute. Regression analysis showed that a stable reading speed was obtained throughout sentences of decreasing size up to the critical print size. Measurement error, expressed as 95% limits of agreement, was +/- 0.136 logarithm of the minimum angle of resolution (logMAR) and +/- 0.142 logMAR for ETDRS acuity and reading acuity, respectively. Critical print size had the lowest reliability (+/- 0.193 logMAR). Maximum reading speed limits of agreement were +/- 0.077 logarithm of words per minute (logWPM), or a 19% change in words per minute. There were no detectable effects of grade and refractive error on measurement errors. CONCLUSIONS: In children, MNREAD charts provide measurements of reading acuity as reliable as ETDRS chart measurements of distance acuity on a logMAR scale. They also provide highly reliable measurements of the maximum reading speed across all grades, independent of its noticeable increase.

Analysis of the optical quality of intraocular lenses.

PURPOSE: To evaluate the optical quality of different intraocular lenses (IOLs). METHODS: An optical test bench and suitable software were used to assist in analysis of the optical Fourier transform (OFT) of a test image and to determine the quality of the lens in terms of spatial frequency response. The OFT was automatically converted, by means of an optical-electronic calibration procedure, into a modulation transfer function (MTF) for each lens. The passband value calculated by computer analysis of the MTF is an objective index of the lens quality. Three randomly acquired samples of 24 different models of foldable IOLs were compared. Statistical analysis was performed with two-way and one-way ANOVA for repeated measurements and with the Ryan-Einot-Gabriel-Welsch multiple F test. RESULTS: The method was demonstrated to be precise and accurate. A large range of passband values was found. Statistically significant differences between the mean passband values for different lenses were found. The lowest passband value (125.60 line pairs [lp]/mm) was measured for the IOL (Lenstec LH3000; Lenstec, Inc., St. Petersburg, FL) and the highest (191.48 lp/mm) for the Acrysof SA30AL (Alcon, Fort Worth, TX). CONCLUSIONS: Different IOLs can transmit different spectra of spatial frequencies. The best frequency response was provided by acrylic IOLs, particularly those with an asymmetrically biconvex profile. This could be due to a reduction of optical degradation provided by this type of profile. A lens with a higher frequency response should determine a better quality of vision once implanted and the frequency response should therefore be considered when choosing the intraocular lens model.

Magnocellular-dorsal pathway and sub-lexical route in developmental dyslexia.

Although developmental dyslexia (DD) is frequently associate with a phonological deficit, the underlying neurobiological cause remains undetermined. Recently, a new model, called "temporal sampling framework" (TSF), provided an innovative prospect in the DD study. TSF suggests that deficits in syllabic perception at a specific temporal frequencies are the critical basis for the poor reading performance in DD. This approach was presented as a possible neurobiological substrate of the phonological deficit of DD but the TSF can also easily be applied to the visual modality deficits. The deficit in the magnocellular-dorsal (M-D) pathway - often found in individuals with DD - fits well with a temporal oscillatory deficit specifically related to this visual pathway. This study investigated the visual M-D and parvocellular-ventral (P-V) pathways in dyslexic and in chronological age and IQ-matched normally reading children by measuring temporal (frequency doubling illusion) and static stimuli sensitivity, respectively. A specific deficit in M-D temporal oscillation was found. Importantly, the M-D deficit was selectively shown in poor phonological decoders. M-D deficit appears to be frequent because 75% of poor pseudo-word readers were at least 1 SD below the mean of the controls. Finally, a replication study by using a new group of poor phonological decoders and reading level controls suggested a crucial role of M-D deficit in DD. These results showed that a M-D deficit might impair the sub-lexical mechanisms that are critical for reading development. The possible link between these findings and TSF is discussed.

Stroke dynamics and frequency of 3 phacoemulsification machines.

PURPOSE: To measure the working frequency and the stroke dynamics of the phaco tip of 3 phacoemulsification machines. SETTING: University Eye Clinic of Trieste, Italy. DESIGN: Experimental study. METHODS: A video wet fixture was assembled to measure the working frequency using a micro camera and a micropulsed strobe-light system. A different video wet fixture was created to measure tip displacement as vectorial movement at different phaco powers using a microscopic video apparatus. RESULTS: The working frequency of the Infiniti Ozil machine was 43.0 kHz in longitudinal mode and 31.6 kHz in torsional mode. The frequency of the Whitestar Signature machine was 29.0 kHz in longitudinal mode and 38.0 kHz with the Ellips FX handpiece. The Stellaris machine had a frequency of 28.8 kHz. The longitudinal stroke of the 3 machines at different phaco powers was statistically significantly different. The Stellaris machine had the highest stroke extent (139 µm). The lateral movement of the Infiniti Ozil and Whitestar Signature machines differed significantly. No movement on the y-axis was observed for the Infiniti Ozil machine in torsional mode. The elliptical path of the Ellips FX handpiece had different x and y components at different phaco powers. CONCLUSIONS: The 3 phaco machines performed differently in terms of working frequency and stroke dynamics. The knowledge of the peculiar lateral and elliptical path strokes of Infiniti and Whitestar Signature machines may allow the surgeon to fully use these features for lens removal.

Subretinal recombinant tissue plasminogen activator and pneumatic displacement for the management of subretinal hemorrhage occurring after anti-VEGF injections for wet AMD.

We describe three cases of submacular hemorrhage that occurred two to four days after anti-VEGF intravitreal injection for occult choroidal neovascularisation in age-related macular degeneration and their management with 25 gauge pars plana vitrectomy with injection of subretinal recombinant tissue plasminogen activator (rTPA) followed by fluid-air exchange and postoperative prone position. Vitrectomy, subretinal rTPA injection and fluid-gas exchange apply as a safe and effective treatment in these cases. Functional results seem to be positive especially if surgical treatment is promptly performed.

Congenital aplasia of the optic chiasm and esophageal atresia: a case report.

INTRODUCTION: The complete absence of the chiasm (chiasmal aplasia) is a rare clinical condition. Hypoplasia of the optic nerve and congenital nystagmus are almost invariably associated characteristics. Microphthalmos or anophthalmos are common features in chiasmal aplasia, while central nervous system abnormalities are less frequent. Esophageal atresia can be isolated or syndromic. In syndromic cases, it is frequently associated with cardiac, limb, renal or vertebral malformations and anal atresia. More rarely, esophageal atresia can be part of anophthalmia-esophageal-genital syndrome, which comprises anophthalmia or microphthalmia, genital abnormalities, vertebral defects and cerebral malformations. Here, a previously unreported case of chiasmal aplasia presenting without microphthalmos and associated with esophageal atresia is described. CASE PRESENTATION: Aplasia of the optic chiasm was identified in a Caucasian Italian 8-month-old boy with esophageal atresia. An ultrasound examination carried out at 21 weeks' gestation revealed polyhydramnios. Intrauterine growth retardation, esophageal atresia and a small atrial-septal defect were subsequently detected at 28 weeks' gestation. Repair of the esophageal atresia was carried out shortly after birth. A jejunostomy was carried out at four months to facilitate enteral feeding. The child was subsequently noted to be visually inattentive and to be neurodevelopmentally delayed. Magnetic resonance imaging revealed chiasmal aplasia. No other midline brain defects were found. His karyotype was normal. CONCLUSION: If achiasmia is a spectrum, our patient seems to depict the most severe form, since he appears to have an extremely severe visual impairment. This is in contrast to most of the cases described in the literature, where patients maintain good--or at least useful-- visual function. To the best of our knowledge, the association of optic nerve hypoplasia, complete chiasmal aplasia, esophageal atresia and atrial-septal defect, choanal atresia, hypertelorism and psychomotor retardation has never been described before.

Hospital admission of patients referred to the Emergency Department for syncope: a single-hospital prospective study based on the application of the European Society of Cardiology Guidelines on syncope.

AIMS: To evaluate the applicability and the clinical impact of the European Society of Cardiology (ESC) Guidelines' recommendations for hospital admission of patients with syncope in a District Hospital Emergency Department (ED). METHODS AND RESULTS: From September 2002 to August 2004, 1124 patients with syncope [out of 1308 with transient loss of consciousness (TLC)] were evaluated according to the ESC Guidelines. Overall, 566 patients with syncope (50.1%) were admitted and 558 (49.9%) were discharged. Out of the 1124 patients with syncope, 440 (39.1%) presented at least one ESC Guidelines' criterion for hospitalization. Out of the 440, 393 (89.3%) were admitted, whereas 511 out of the 684 (74.7%) without indication for admission were discharged. A significant difference was found between the adherence rates for admission and for discharge (P<0.001). The appropriateness of the ED medical decision was 69.4% for hospital admission and 91.6% for discharge (P<0.001). CONCLUSION: Although an acceptable ED adherence to the guidelines' indications was attained, better implementation strategies are still advisable. The ESC Guidelines' indications are applicable to the majority of patients entering the ED for a TLC. In addition, when the guidelines' indications are observed, a high percentage of patients with syncope have still to be hospitalized.

Survey of ophthalmic viscosurgical devices.

PURPOSE OF REVIEW: Cataract treatment is evolving, thanks to new phaco systems and innovative surgical techniques. Recent ophthalmic viscosurgical devices (OVDs) play an important role in the development of new approaches to surgery. Knowledge of the new techniques and advances in new OVDs is crucial to performing routine and complicated surgeries. RECENT FINDINGS: Viscoadaptive substances have been introduced as a particular kind of OVD and are distinguished by high viscosity at a low flow rate and a tendency to fracture at higher flow rates, assuming pseudodispersive behavior. The ultimate soft shell technique emphasizes the rheology of viscoadaptive OVDs to perform phacoemulsification procedures, exploiting all the useful properties of these OVDs in terms of space maintenance and tissue protection. Recent studies have highlighted some new and interesting aspects of the use of OVDs. Current reports suggest that the association of lidocaine and OVD seems to be safe and useful in providing anesthesia during cataract surgery. Concern has been expressed in other studies regarding the presence of contaminants, such as endotoxins, which may be responsible for postoperative uveitis-like reactions. Finally, OVDs are widely known to protect the corneal endothelium during cataract surgery. Their role is also assuming relevance in vitreoretinal surgery. SUMMARY: New OVDs and related techniques represent an advancement in cataract surgery.

Lens epithelial cell reaction after implantation of different intraocular lens materials: two-year results of a randomized prospective trial.

PURPOSE: To determine the influence of intraocular lens (IOL) material on anterior capsular opacification and membrane growth over the anterior IOL surface in patients who have undergone standardized small-incision cataract surgery and foldable IOL implantation in the capsular bag. DESIGN: Randomized controlled trial. PARTICIPANTS: Eighty-eight cataract patients (88 eyes). METHODS: Patients were randomly assigned to receive one of four different foldable IOLs after phacoemulsification: Storz Hydroview H60M, Corneal ACR6D, AMO SI40NB, and Alcon AcrySof MA60BM. Examinations on days 7, 30, 90, 180, 360, and 720 after surgery included ophthalmologic examination, slit-lamp biomicroscopy, and photography using red reflex and focal illumination of the anterior IOL surface. MAIN OUTCOME MEASURES: Best-corrected visual acuity was measured at each examination. In addition, the anterior capsule opacification and the membrane growth on the anterior IOL surface were graded according to a subjective method by the same researcher. RESULTS: The fibrosis of the anterior capsule was more frequently observed in the group using Corneal ACR6D and AMO SI40NB. The Hydroview and ACR6D groups showed a higher percentage of cases with membrane growth from the rhexis edge on the anterior IOL surface. AcrySof showed the lowest presence of fibrosis of the anterior capsule, and no membrane growth was noted. CONCLUSIONS: Anterior capsule opacification is an index of IOL biocompatibility. The natural location of lens epithelial cells (LECs) precludes the possibility of the IOL's design influencing the anterior capsule behavior. The local response of LECs varies according to the IOL studied. This may be related to the chemical and physical properties of the materials used in the different IOLs.