Scanning electron microscopic analysis for the quality of diffractive surface of ReSTOR IOL inserted into anterior chamber Department of Ophthalmology Ilsan Paik Hospital, Inje University, Korea Hee Sung Kim M.D., Suk kyue Choi M.D., Jin Hyoung Kim M.D., Doh Lee. MD.PhD.

Purpose To analyze the quality of the anterior diffractive surface of ReSTOR IOL after injection into anterior chamber of porcine eyes 1. different incision through 2.2 mm incision & 2.8 mm incision 2. different cartriadge ( B or C cartridge) 3. different loading style into cartridge

Material & Method Ten ReSTOR® IOL (range 17.5D to 24.0D) Group I & 24.0 D IOL through 2.2 mm incision with C-cartridge & 24.0 D IOL through 2.8 mm incision with C-cartridge & 24.0 D IOL through 2.8 mm incision with B-cartridge Group II 1. Backside position of haptic plates loading method (17.5 D & 19.5D IOL through 2.8 mm incision with C-cartridge ) 2. Extension of haptic plates loading method (17.5 D & 19.5D IOL through 2.8 mm incision with C-cartridge) Scanning electron microscopy (SEM) was performed

Material & Method B, In cartridge, the haptic plates of IOL is not overlapped with optic plate A.The haptic plates of IOL are located behind optic plate Extension of haptic plate loading method Backside position of haptic plate loading method

Results B. it is difficult to differentiate diffractive step heights and the circular lines of diffractive step heights are disrupted sporadically Group I & 24.0 D IOL through 2.2 mm incision with C-cartridge A. Central circle of step height is pressed sporadically through oclock and 1- 4 oclock

Results Group I & 24.0 D IOL through 2.8 mm incision with C-cartridge A.Anterior diffractive surface of IOL through 2.8 mm incision with C cartridge is left whole on low power magnification B.Under high power magnification, the black shadow of diffractive step height appears to be uniform

Results Group I & 24.0 D IOL through 2.8 mm incision with B-cartridge Anterior diffractive surface of IOL through 2.8 mm incision with B cartridge is left whole and diffractive step heights are intact

Results Group II 1. Backside position of haptic plates loading method (17.5 D & 19.5 D IOL through 2.8mm incision with C-cartridge ) Anterior diffractive step heights of backside position of haptic plates loading method seems to be more clear than those of other cases. This photograph of SEM shows diffractive step heights of IOL are apparent in whole

Results Diffractive step heights of these IOLs are relatively intact in whole although its surface appeared to be more coarse Group II 2. Extension of haptic plates loading method (17.5 D & 19.5 D IOL through 2.8 mm incision with C-cartridge)

Discussion On condition of 2.2 mm incision, the diffractive step heights was damaged and depressed. On the contrary, IOL through 2.8 mm incision was intact and the diffractive step heights were left whole. Cartridges have relatively a little influence on anterior diffractive surface under the condition of 2.8 mm incision size. It seems to be possible that anterior diffractive surface of ReSTOR is damaged if it is inserted through 2.2 mm incision. It means that if the incision size is large sufficiently, C- cartridge that is smaller than B- cartridge has little influence on anterior diffractive surface and diffractive step height. From Group I

anterior diffractive surface of these IOLs inserted by methods as previous stated seemed to be less damaged. On SEM of Group II, diffractive step height of these IOLs was intact in whole. Extension of haptic plates loading method and backside position of haptic plates loading method seem to be also available. Especially Anterior diffractive step heights of backside position of haptic plates loading method seem to be more clear than other cases. From Group II Discussion