1. “Cataract formation after implantation of phakic posterior chamber intraocular lenses: A brief overview and review of the literature” Liliana Werner, MD, PhD David J. Apple, MD FDA Ophthalmic Devices Advisory Panel Meeting August 2, 2002, Rockville, MD

2. Center for Research on Ocular Therapeutics and Biodevices Director: David J. Apple, MD Director of Research: Liliana Werner, MD, PhD Post-Doctoral Fellows: Suresh K. Pandey, MD, Andrea M. Izak, MD Storm Eye Institute Medical University of South Carolina Charleston, SC, USA

3. 09/02: David J. Apple MD Laboratories for Ophthalmic Devices Research Directors: David J. Apple, MD, Nick Mamalis, MD Director of Research: Liliana Werner, MD, PhD Clinical Directors: Randall J. Olson, MD, Alan S. Crandall, MD Instructors: Suresh K. Pandey, MD, Andrea M. Izak, MD John A. Moran Eye Center, University of Utah Salt Lake City, UT, USA

4. Phakic posterior chamber IOLs 1.Cells involved in crystalline lens and capsular bag opacification 2.Evolution of designs of PPCIOLs 3.Relevant aspects of fixation and sizing 4.Sizing issue: New studies 5.Surgical implantation 6.Relationship between cataract and myopia 7.Cataractogenesis Specimens analyzed in our Center Mechanisms Review of the literature Classification of cataracts after phakic IOL implantation?

5. Crystalline lens

6. Anterior capsuleEpithelial cells (A-cells) Cortical fibers Area of active mitosis (E-cells) Epithelial lens bow Posterior capsule Nucleus Anterior subcapsular cataract (A-cells) Interlenticular opacification (A-cells + E-cells) Posterior capsule opacification (A-cells + E-cells) Anterior capsule opacification (A-cells)

7. A-cells: Anterior capsule opacification

8. A-cells: Capsule contraction syndrome

9. A-cells: Anterior capsule opacification

10. Courtesy: Paul Koch, MD, Koch Eye Surgicenter, Inc., Warwick, RI, USA A-cells: anterior subcapsular cataract after Staar ICL implantation OD OS

11. Courtesy: Arturo Chayet, MD, Mexico A-cells: anterior subcapsular cataract after Staar ICL implantation

12. Anterior Capsule Opacification Anterior Subcapsular Cataract (Uveitis) Anterior Subcapsular Cataract (Phakic IOL)

13. E-cells: Posterior capsule opacification Rabbit eye

14. E-cells: Posterior capsule opacification Cadaver eye

15. E-cells: Interlenticular opacification

16. Cataractous lens (Ocular Pathology David J. Apple, Maurice F. Rabb 1998 - 5th Edition) Material between piggyback lenses

17. Phakic posterior chamber IOLs Cells involved in crystalline lens and capsular bag opacification Evolution of designs of PPCIOLs Relevant aspects of fixation and sizing Sizing issue: New studies Surgical implantation Relationship between cataract and myopia Cataractogenesis Specimens analyzed in our Center Mechanisms Review of the literature Classification of cataracts after phakic IOL implantation?

18. Phakic Posterior Chamber Intraocular Lenses -Introduced by Fyodorov in 1986 -Avoid potential problems associated with phakic anterior chamber IOLs, such as corneal descompensation and pupil ovalization Courtesy: Professor Georges Baikoff, Marseille, France

19. First generation: Fyodorov “mushroom” lens Courtesy: Dimitrii D. Dementiev, MD, Milano, Italy

20. First generation: Fyodorov “mushroom” lens Courtesy: Dimitrii D. Dementiev, MD, Milano, Italy

21. Second generation: Chiron-Adatomed silicone lens