The effect of ionizing radiation on intraocular lenses.

BACKGROUND: The native crystalline lens is the principal shield against ultraviolet radiation (UV), damage to the human retina. Every year in the United States, more than one million patients undergo removal of the natural lens in the course of cataract surgery (phakectomy), at which time an intraocular lens (IOL) is placed in the lens capsule. The IOL thenceforth serves as the principal barrier to ultraviolet radiation over the life of the implant, potentially for decades. The synthetic organic molecules of which IOLs are composed offer little UV protection unless ultraviolet-absorbing chromophores are incorporated into the lens material during manufacture. However, chromophores are alkenes potentially subject to radiolytic degradation. It is unknown whether ionizing radiation at clinical doses (e.g., to the brain or in the head-and-neck region) affects the UV-absorbing capacity of chromophore-bearing IOLs and consequently exposes the retina to potentially chronic UV damage. In addition, the polymers of which IOLs are composed are themselves subject to radiation damage, which theoretically might result in optical distortion in the visible light range. OBJECTIVE: To determine whether megavoltage photon ionizing radiation alters the absorption spectra of ultraviolet-shielding polymethylmethacrylate (PMMA) and organopolysiloxane (silicone) intraocular lenses (IOLs) in the UV (280 nm < or = lambda < 400 nm), visible (400 nm < or = lambda < or = 700 nm), and low-end near-infrared (700 nm < lambda < or = 830 nm) ranges. DESIGN: Prospective, nonrandomized trial of dose-paired IOL cohorts. METHODS: Fourteen IOLs, seven of PMMA (Chiron 6842B) and seven of silicone (IOLAB L141U), were paired and examined for absorption spectra in 1-nm intervals over the range lambda = 280-830 nm on a Cary 400 deuterium and quartz halogen source-lamp UV/visible spectrophotometer before and after undergoing megavoltage ionizing irradiation to doses of 2, 5, 10, 20, 40, 60, and 100 Gray, respectively. Because of artifactual aberrations inherent in analyzing convex lenses on a conventional flat-plate spectrophotometer, post-irradiation absorption spectra were subsequently reanalyzed on a Cary 300 spectrophotometer outfitted with a Labsphere Diffused Reflectance Accessory (DRA-CA-30-I) incorporating a Spectralon-coated integrating sphere. MAIN OUTCOME MEASURES: Primary: Changes in UV absorbance after irradiation. Secondary: Changes in visible and low-end near-infrared absorbance after irradiation. RESULTS: Photon ionizing radiation in the 2-Gy to 100-Gy range produced no detectable alterations in the UV (280 nm < or = lambda < 400 nm), visible (400 nm < or = lambda < or = 700 nm), or low-end near-infrared (700 nm < lambda < or = 830 nm) absorption spectra of any of the lenses irradiated. However, silicone IOLs as a group revealed peak post-irradiation UV absorption at a shorter wavelength than did PMMA IOLs, with marginally greater UV transmission at the uppermost extreme of the UV spectrum (lambda = 384.5-400 nm). CONCLUSIONS: At clinically relevant doses used in radiation therapy, megavoltage photon ionizing radiation produces no significant alterations in the absorption spectra of PMMA and silicone IOLs over the range lambda = 280- 830 nm. These findings indicate that, even at supraclinical doses, the UV-absorbing capacity of chromophore-bearing PMMA and silicone IOLs remains unimpaired. It is not clear whether the lower UV peak of silicone lenses represents a radiation effect or a peculiarity of the chromophore used in the lenses tested.

Experimental study of muscle-nerve-muscle neurotization.

A laboratory model for the study of possible reinnervation by muscle-nerve-muscle (MNM) neurotization is presented. Preliminary studies revealed that MNM neurotization occurs in synergistically closely-related facial muscles. However, for larger antagonistic somatic muscle (flexor and extensor), this phenomenon could not be reproduced. The potential clinical relevance of these findings is presented and discussed.

Electron dose calculation using multiple-scattering theory: thin planar inhomogeneities.

In this article in our series on electron dose calculation using multiple-scattering theory, we apply the Fermi-Eyges theory to the problem of a thin planar inhomogeneity present in an otherwise-layered medium. We derive expressions for the distribution function P and the location distribution L (which multiplied by the restricted mass collision stopping power is the dose directly deposited by the primary electrons) for various types of incident beams: a completely arbitrary distribution, a Gaussian point source, a pencil beam, an isotropic point source, and a broad parallel beam. We show how divergent-beam dose distributions can be determined from parallel-beam calculations, through use of equivalent configurations dependent upon the depth of dose calculation. Also, we indicate how this work can be applied to the design of wedges (or "compensators") for beam shaping to provide desired dose distributions or to match juxtaposed radiation fields. Explicit formulas for thin plates are then worked out, and we examine the appearance of hot and cold spots distal to the edge of a localized inhomogeneity, for thin half-slabs and for narrow strips. Finally, considering the case of a thin straight wedge-shaped inhomogeneity, we theoretically discover the phenomenon of a "focused hot spot" without an accompanying cold spot, and suggest the design of a "multiple-scattering lens".

Collimated electron beams and their associated penumbra widths.

The Fermi-Eyges multiple-scattering theory for electrons is applied to calculate profiles of collimated electron beams. The dose profile below the collimator is a convolution of the intensity distribution of the electrons at the level of the collimator and the distribution arising from the propagation of a Gaussian point source from the collimator to the level of the calculation. The electrons at the level of the collimator possess an angular distribution characteristic of the configuration of the electron beam at the vacuum window. Hence, the dose profile and its associated penumbra width can be expressed in terms of the angular moments of the distribution of the electrons at the collimator. The dependence of the penumbra width on the configuration-dependent angular spread of the electrons at the collimator accounts for differences in the size of the penumbra between two broad-beam configurations. These differences are also seen experimentally. We have also studied the dependence of the angular moments of the electrons upon scattering foils present above the collimator and the position of the beam-broadening device in the accelerator head.