暗場顯微鏡拍照

第三章實驗方法

4.4 P 4 HSE1I 系列

4.4.5 暗場顯微鏡拍照

P4HSE1I 系列為改變光起始劑濃度，濃度為 0.5%至 2%共四個配方，其 IOLs 材料的暗場顯微鏡照片如圖4.4.5.1 所示，從左到右分別為 P4HSE1I0.5 至

P4HSE1I2 的 IOLs 材料照片，而上到下分別為進行加速老化一天後、加速老化七天後以及加速老化十四天後的結果，可以發現不管加速老化多少天液泡最多最密集的都是最右方P4HSE1I2 的 IOLs 材料，而整體嚴重程度似乎是 P4HSE1I2 >

分子鏈段共容易聚集並產生巨大的缺陷，這些缺陷就是水分子聚集並形成液泡的位置，所以當光起始劑越多，就越容易產生缺陷，香檳液泡也會越來越嚴重；雖然這邊結論為光起始劑的比例會和香檳液泡嚴重程度成正比，但我們不能說光起始劑的比例越少越能避免香檳液泡的出現，因為光起始劑是扮演將單體聚合而成高分子的重要角色，當光起始劑低到一定的比例時，會使得單體無法聚合完全，

留下許多剩餘單體，剩餘的單體一旦經過沖洗浸泡的過程，將會隨著各種溶液流出高分子到外部，而原本單體佔據的位置就會形成缺陷，或許會使得香檳液泡更嚴重，但在這邊我們並沒有將光起始劑濃度往下調形成新的組別去尋找，也無從判定最好的光起始劑濃度。

圖 4.4.5.1 由左至右分別為 P4HSE1I0.5 至 P4HSE1I2 的配方，而上到下分別為加速老化1 天、7 天和 14 天後的暗場顯微鏡照片圖。

第五章結論

本研究選擇以 PEG-PEA、styrene 以及 HEMA 為主要單體，並選擇 EGDMA 作為交聯劑，並主要以光起始劑當作自由基引發劑，合成IOLs 的材料；在這裡我們同時改變主要單體的濃度比例、交聯劑濃度、PEG-PEA 中 EO 鏈段的長度甚至是光起始劑的濃度去觀察香檳液泡的情形變化，同時找出在這些組別中最適合做為IOLs 材料的配方。

固定 4wt%的交聯劑和 1wt%的光起始劑，並改變 PEG-PEA、styrene 和 HEMA 三種主要單體的 P4HS 系列，了解到三種單體分別對高分子材料的影響，

PEG-PEA 的可以輕微增加材料的親水性，並且可以讓材料更佳的柔軟可折疊，同時還具有相對高的折射率，但當含量高於60%時，就會使材料變得非常脆弱；

styrene 則是負責材料的疏水性、主要的硬度來源，同時也具有高折射率使得 IOLs 材料可以非常小的體積達到需求折射率，但當其重量濃度達到總重量濃度的 36%以上，就會使得材料本身過於疏水，無法分散進入材料內部的水分子，因此會形成香檳液泡；HEMA 提供 IOLs 材料的親水性和部分的硬度，當其重量濃度大於總濃度的30%時，就會大量抑制香檳液泡的出現，但因為親水性的增加就使得IOLs 材料的含水率增加，而在 IOLs 植入人眼的高含水率環境中，就會以飽和的狀態存在在於人眼中，當含水率增高後，會不會因此造成體積變化過大，導致原本的IOLs 方型邊緣溶脹接近圓形，使得 PCO 等其他症狀的出現需要注意；在這裡經由結果與討論的機械性質、光學性質等特性，我們將使用於IOLs 材料有潛力的配方於下方圖五.1 的三相圖中表示出來。

圖五.1 以 PEG-PEA、styrene 和 HEMA 三種主要單體組成的三相圖，紅色圈內為P4H30S (P440HS / P4HS26)、P4H40S、P4H50S、P450HS 等適合做為

IOLs 材料的配方

P4HSE 系列是以 P4H30S 為基礎將交聯劑的比例分別調整為 1wt%、2wt%、

3wt%以及 4wt%的四個配方，觀察交聯劑對於材料的機械性質和光學性質等影響；在機械性質部分，改變交聯劑即改變材料的交聯密度，交聯密度對於材料機械性質有直接的影響，交聯密度越高，材料就越硬同時形變量也會降低，可以藉由交聯劑濃度調整以達到想要的機械性質；在光學的部分發現P4HSE1 也就是交聯劑濃度最低的組別有嚴重的香檳液泡問題，其原因歸咎於交聯密度的降低使得自由體積的增加，水分子容易聚集形成肉眼可見的液泡；認為交聯劑的濃度控制

升，導致在室溫下材料的堅硬度上升，甚至P1HSE 系列材料在室溫下表現非常硬且脆；同時在暗場顯微鏡照片圖可以發現，隨著PEG-PEA 中 EO 鏈段越短，香檳液泡的情形就會越嚴重，其原因為材料的親水性問題，PEG-PEA 中 EO 鏈段為親水性的部分，當鏈段越短，疏水性就越明顯，比較P1HSE 系列、P2HSE 系列和 P4HSE 系列的含水率可以得證；親水性越低，越難分散進入材料內部的水分子，

因此香檳液泡就會越嚴重；同時在P4HSE 系列中，難以觀察到的隨著交聯劑濃度降低，香檳液泡情形就會漸進式的嚴重則可在P1HSE 系列和 P2HSE 系列觀察到，清楚證明交聯密度對香檳液泡的影響；總結而言P1HSE 系列和 P2HSE 系列因為機械性質過高和香檳液泡出現都不建議使用在IOLs 材料上。

P4HSE1I 系列是以 P4HSE1 的配方為基礎，調整光起始劑的比例為 0.5wt%、

1wt%、1.5wt%和 2wt%；以 P4HSE1 為基礎的原因是為了能夠更清楚觀察香檳液泡的變化，來找出香檳液泡跟光起始劑的關係；在機械性質的部分我們發現 P4HSE1I0.5 也就是光起始劑最少有最高的楊氏係數，也就是在同樣情況下

P4HSE1I0.5 的配方比其他配方來得更堅硬，其原因為其擁有最高的平均分子量，

使得其糾纏數量也是最多的配方，所以其為楊氏係數最高的配方；在光學的部分，隨著光起始劑的濃度增加，其透光度也會隨之下降，而這和暗場顯微鏡照片顯示香檳液泡的嚴重程度有關，光起始劑的濃度越高，其香檳液泡越嚴重，與其平均分子量有關，當分子量越低，就會有越少糾纏，會使得材料內部的自由體積增加，高分子鏈段容易移動聚集，使得缺陷的部分擴大，水分子聚集出現液泡；

因此當光起始劑的濃度增加，香檳液泡的情形就越嚴嚴重，但這裡也並不是說光起始劑濃度越低越好，當低到一定程度也會使得聚合不完全，產生更多的缺陷，

但在這邊似乎在0.5wt%的光起始劑濃度似乎比 1wt%來得更有潛力。

Reference

(1) Wang, K.; Pierscionek, B. K. Biomechanics of the human lens and accommodative system: Functional relevance to physiological states.

Progress in retinal and eye research 2019, 71, 114-131.

(2) Sparrow, J. M.; Bron, A. J.; Brown, N. A. P.; Ayliffe, W.; Hill, A. R.

The Oxford Clinical Cataract Classification and Grading System.

International Ophthalmology 1986, 9 (4), 207-225.

(3) Koretz, J. F.; Cook, C. A.; Kaufman, P. L. Aging of the human lens:

changes in lens shape upon accommodation and with accommodative loss. JOSA A 2002, 19 (1), 144-151.

(4) Strenk, S. A.; Semmlow, J. L.; Strenk, L. M.; Munoz, P.; Gronlund-Jacob, J.; DeMarco, J. K. Age-related changes in human ciliary muscle and lens: a magnetic resonance imaging study. Investigative

Ophthalmology & Visual Science 1999, 40 (6), 1162-1169.

(5) Michael, R.; Barraquer, R. I.; Willekens, B.; van Marle, J.; Vrensen, G.

F. J. M. Morphology of age-related cuneiform cortical cataracts: The case for mechanical stress. Vision Research 2008, 48 (4), 626-634.

(6) Liu, Y.-C.; Wilkins, M.; Kim, T.; Malyugin, B.; Mehta, J. S. Cataracts.

The Lancet 2017, 390 (10094), 600-612.

(7) Allen, D.; Vasavada, A. Cataract and surgery for cataract. Bmj 2006,

Ophthalmology & Visual Science 1965, 4 (4), 377-383.

(10) Barraquer, J. Drugs and instruments used in cataract surgery. American Journal of Ophthalmology 1966, 61 (1), 184-185.

(11) Pandey, S. K.; Milverton, E. J.; Maloof, A. J. A tribute to Charles David Kelman MD: ophthalmologist, inventor and pioneer of

phacoemulsification surgery. Clinical & experimental ophthalmology 2004, 32 (5), 529-533.

(12) Apple, D. J.; Escobar-Gomez, M.; Zaugg, B.; Kleinmann, G.;

Borkenstein, A. F. Modern Cataract Surgery: Unfinished Business and Unanswered Questions. Survey of Ophthalmology 2011, 56 (6,

Supplement), S3-S53.

(13) Tetz, M.; Jorgensen, M. R. New hydrophobic IOL materials and

understanding the science of glistenings. Current eye research 2015, 40 (10), 969-981.

(14) Epstein, E. History of intraocular lens implant surgery. In Soft implant lenses in cataract surgery, Slack, Inc Thorofare, NJ, 1986; pp 1-10.

(15) Hao, X.; Jeffery, J. L.; Le, T. P.; McFarland, G.; Johnson, G.; Mulder, R. J.; Garrett, Q.; Manns, F.; Nankivil, D.; Arrieta, E. High refractive index polysiloxane as injectable, in situ curable accommodating intraocular lens. Biomaterials 2012, 33 (23), 5659-5671.

(16) Xu, X.; Wu, C.; Zhang, B.; Dong, H. Preparation, structure

characterization, and thermal performance of phenyl‐modified MQ silicone resins. Journal of applied polymer science 2013, 128 (6), 4189-4200.

(17) Steinert, R. F. Cataract surgery technique, complications, management.

Clin. Exp. Optom. 2004, 87, 413-416.

(18) Barrett, G. D. A new hydrogel intraocular lens design. Journal of Cataract & Refractive Surgery 1994, 20 (1), 18-25.

(19) Wilson, M.; Pandey, S.; Thakur, J. Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium. British Journal of Ophthalmology 2003, 87 (1), 14-19.

(20) Menapace, R.; Amon, M.; Radax, U. Evaluation of 200 consecutive IOGEL 1103 capsular-bag lenses implanted through a small incision.

Journal of Cataract & Refractive Surgery 1992, 18 (3), 252-264.

(21) Ziemba, S. L. SIlicone intraocular lens implant discoloration in humans-reply. Archives of Ophthalmology 1991, 109 (7), 914-915.

(22) Koch, D. D.; Heit, L. E. Discoloration of silicone intraocular lenses.

Archives of Ophthalmology 1992, 110 (3), 319-320.

(23) Allarakhia, L.; Knoll, R. L.; Lindstrom, R. L. Soft intraocular lenses.

Journal of Cataract & Refractive Surgery 1987, 13 (6), 607-620.

(24) Tehrani, M.; Dick, H. B.; Wolters, B.; Pakula, T.; Wolf, E. Material properties of various intraocular lenses in an experimental study.

Ophthalmologica 2004, 218 (1), 57-63.

(25) Werner, L.; Tetz, M.; Feldmann, I.; Bücker, M. Evaluating and defining the sharpness of intraocular lenses: microedge structure of

commercially available square-edged hydrophilic intraocular lenses.

(27) STEELE MCINTYRE, M.; WERNER, L.; MAMALIS, N.

Hydrophobic Acrylic IOLs: A Primer.

(28) Vasavada, A. R.; Raj, S. M.; Shah, A.; Shah, G.; Vasavada, V.;

Vasavada, V. Comparison of posterior capsule opacification with

hydrophobic acrylic and hydrophilic acrylic intraocular lenses. Journal of Cataract & Refractive Surgery 2011, 37 (6), 1050-1059.

(29) Heatley, C. J.; Spalton, D. J.; Kumar, A.; Jose, R.; Boyce, J.; Bender, L.

E. Comparison of posterior capsule opacification rates between hydrophilic and hydrophobic single-piece acrylic intraocular lenses.

Journal of Cataract & Refractive Surgery 2005, 31 (4), 718-724.

(30) Abela-Formanek, C.; Amon, M.; Schild, G.; Schauersberger, J.;

Heinze, G.; Kruger, A. Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses. Journal of Cataract & Refractive Surgery 2002, 28 (1), 50-61..

(31) Zeng, L.; Fang, F. Advances and challenges of intraocular lens design [Invited]. Appl. Opt. 2018, 57 (25), 7363-7376.

(32) Findl, O.; Buehl, W.; Bauer, P.; Sycha, T. Interventions for preventing posterior capsule opacification. Cochrane database of systematic reviews 2010, (2).

(33) Cooksley, G.; Lacey, J.; Dymond, M. K.; Sandeman, S. Factors Affecting Posterior Capsule Opacification in the Development of Intraocular Lens Materials. Pharmaceutics 2021, 13 (6).

(34) Davidson, M. G.; Morgan, D. K.; McGahan, M. C. Effect of surgical

technique on in vitro posterior capsule opacification11None of the

authors has a financial or proprietary interest in any material or method

mentioned. Journal of Cataract & Refractive Surgery 2000, 26 (10), 1550-1554.

(35) Johar, K. Post-operative capsular opacification.

(36) Nagata, T.; Watanabe, I. Optic sharp edge or convexity: comparison of effects on posterior capsular opacification. Jpn J Ophthalmol 1996, 40 (3), 397-403.

(37) Nishi, O.; Nishi, K. Preventing posterior capsule opacification by creating a discontinuous sharp bend in the capsule. Journal of Cataract

& Refractive Surgery 1999, 25 (4), 521-526.

(38) Cheng, J.-W.; Wei, R.-L.; Cai, J.-P.; Xi, G.-L.; Zhu, H.; Li, Y.; Ma, X.-Y. Efficacy of different intraocular lens materials and optic edge

designs in preventing posterior capsular opacification: a meta-analysis.

American journal of ophthalmology 2007, 143 (3), 428-436. e423.

(39) Peng, Q.; Visessook, N.; Apple, D. J.; Pandey, S. K.; Werner, L.;

Escobar-Gomez, M.; Schoderbek, R.; Solomon, K. D.; Guindi, A.

Surgical prevention of posterior capsule opacification: Part 3:

Intraocular lens optic barrier effect as a second line of defense11None of the authors has a financial or proprietary interest in any product mentioned. Journal of Cataract & Refractive Surgery 2000, 26 (2), 198-213.

(40) Neuhann, I. M.; Kleinmann, G.; Apple, D. J. A New Classification of

(42) Neuhann, I. M.; Werner, L.; Izak, A. M.; Pandey, S. K.; Kleinmann, G.;

Mamalis, N.; Neuhann, T. F.; Apple, D. J. Late postoperative

opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants. Ophthalmology 2004, 111 (11), 2094-2101.

(43) Werner, L. Causes of intraocular lens opacification or discoloration.

Journal of Cataract & Refractive Surgery 2007, 33 (4), 713-726.

(44) Werner, L. Glistenings and surface light scattering in intraocular lenses.

Journal of Cataract & Refractive Surgery 2010, 36 (8), 1398-1420.

(45) Ballin, N. Glistenings in Injection-Molded Lens. American Intra-Ocular Implant Society Journal 1984, 10 (4), 473.

(46) Yildirim, T. M.; Fang, H.; Schickhardt, S. K.; Wang, Q.; Merz, P. R.;

Auffarth, G. U. Glistening formation in a new hydrophobic acrylic intraocular lens. BMC Ophthalmology 2020, 20 (1), 186.

(47) Mototora, K. Polymer material and intraocular lens. Google Patents:

2021.

(48) Weindler, J. N.; Łabuz, G.; Yildirim, T. M.; Tandogan, T.; Khoramnia, R.; Auffarth, G. U. The impact of glistenings on the optical quality of a hydrophobic acrylic intraocular lens. Journal of Cataract & Refractive Surgery 2019, 45 (7), 1020-1025.

(49) Reimschuessel, H. On the glass transition temperature of comblike polymers: Effects of side chain length and backbone chain structure.

Journal of Polymer Science: Polymer Chemistry Edition 1979, 17 (8), 2447-2457.

(50) Fukano, Y.; Knowles, N. G.; Usui, M. L.; Underwood, R. A.; Hauch,

K. D.; Marshall, A. J.; Ratner, B. D.; Giachelli, C.; Carter, W. G.;

Fleckman, P. Characterization of an in vitro model for evaluating the interface between skin and percutaneous biomaterials. Wound repair and regeneration 2006, 14 (4), 484-491.

(51) Kim, T. H.; Song, K. C. Effect of types of hydrophilic acrylic

monomers in reducing glistenings of hydrophobic acrylic intraocular lenses. Optical Materials 2021, 119, 111401.

(52) Kessel, L.; Lundeman, J. H.; Herbst, K.; Andersen, T. V.; Larsen, M.

Age-related changes in the transmission properties of the human lens and their relevance to circadian entrainment. Journal of Cataract &

Refractive Surgery 2010, 36 (2), 308-312.

Appendix

圖 A.1 白內障摘除手術及人工水晶體植入手術概述。

(a) (b) (c)

圖 A.2 人工水晶體植入人眼概況，(a) IOL 剛放進注射器內 (b) IOL 受到管壁變窄的壓縮開始摺疊 (c) IOL 注射至後囊展開並固定。

圖 A.3 P4HS 系列共聚物分子結構

圖 A.4 P4HSE 系列、P2HSE 系列、P1HSE 系列期共聚物分子結構

P₄H20S P₄H30S P₄H40S P₄H50S 0

5 10 15 20 25 30 35

Young's modulus (Mpa) break elongation (%) break stress (MPa)

0 40 80 120 160

0.0 0.5 1.0 1.5 2.0 2.5

圖 A.5 P4H20S 至 P4H50S 靜態拉伸得到的楊氏係數、斷裂應變及斷裂應力圖，隨著HEMA 含量增加，楊氏係數增加，斷裂應變下降。

P₄30HS P₄40HS P₄50HS P₄60HS 0

30 60 90 120

Young's modulus (Mpa) break elongation (%) break stress (MPa)

0 30 60 90 120 150 180

-9 -6 -3 0 3

圖 A.6P430HS 至 P460HS 靜態拉伸得到的楊氏係數、斷裂應變及斷裂應力圖，隨著PEG-PEA 含量增加，楊氏係數下降，斷裂應變也下降。

P₄HS16 P₄HS26 P₄HS36 P₄HS46 0

100 200 300 400 500 600

Young's modulus (Mpa) break elongation (%) break stress (MPa)

0 40 80 120 160 200

-40 -30 -20 -10 0 10 20

圖 A.7 P HS16 至 P HS46 靜態拉伸得到的楊氏係數、斷裂應變及斷裂應力

P₄HSE1 P₄HSE2 P₄HSE3 P₄HSE4 0

4 8 12 16 20

Young's modulus (Mpa) break elongation (%) break stress (MPa)

0 40 80 120 160 200 240 280 320

-8 -6 -4 -2 0 2

圖 A.8 P4HSE1 至 P4HSE4 靜態拉伸得到的楊氏係數、斷裂應變及斷裂應力圖，隨著EGDMA 含量增加，楊氏係數增加，斷裂應變下降

P₂HSE1 P₂HSE2 P₂HSE3 P₂HSE4 0

20 40 60 80 100 120 140

Young's modulus (Mpa) break elongation (%) break stress (MPa)

0 50 100 150 200 250 300 350

-9 -6 -3 0 3 6

圖 A.9 P2HSE1 至 P2HSE4 靜態拉伸得到的楊氏係數、斷裂應變及斷裂應力圖，隨著EGDMA 含量增加，楊氏係數增加，斷裂應變下降，同時跟 P4HSE

系列相比，有較高的楊氏係數。

P₁HSE1 P₁HSE2 P₁HSE3 P₁HSE4 0

100 200 300 400 500 600 700

Young's modulus (Mpa) break elongation (%) break stress (MPa)

0 10 20 30 40 50 60 70 80

-8 -4 0 4 8 12 16 20

圖 A.10 P1HSE1 至 P1HSE4 靜態拉伸得到的楊氏係數、斷裂應變及斷裂應力圖，受到Tg 的影響，P1HSE 系列材料呈現非常堅硬且脆的性質。

P₄HSE1I0.5 P₄HSE1I1 P₄HSE1I1.5 P₄HSE1I2 0

1 2 3 4 5

Young's modulus (Mpa) break elongation (%) break stress (MPa)

0 50 100 150 200 250 300 350

-4 -3 -2 -1 0 1

圖 A.11P HSE1I0.5 至 P HSE1I2 靜態拉伸得到的楊氏係數、斷裂應變及斷裂

在文檔中以疏水/親水共聚高分子開發可摺疊式人工水晶體及其配方/性質關聯研究 (頁 127-146)

第三章 實驗方法

4.4 P 4 HSE1I 系列

4.4.5 暗場顯微鏡拍照

Reference

(1) Wang, K.; Pierscionek, B. K. Biomechanics of the human lens and accommodative system: Functional relevance to physiological states.

Progress in retinal and eye research 2019, 71, 114-131.

(2) Sparrow, J. M.; Bron, A. J.; Brown, N. A. P.; Ayliffe, W.; Hill, A. R.

The Oxford Clinical Cataract Classification and Grading System.

International Ophthalmology 1986, 9 (4), 207-225.

(3) Koretz, J. F.; Cook, C. A.; Kaufman, P. L. Aging of the human lens:

changes in lens shape upon accommodation and with accommodative loss. JOSA A 2002, 19 (1), 144-151.

(4) Strenk, S. A.; Semmlow, J. L.; Strenk, L. M.; Munoz, P.; Gronlund-Jacob, J.; DeMarco, J. K. Age-related changes in human ciliary muscle and lens: a magnetic resonance imaging study. Investigative

Ophthalmology & Visual Science 1999, 40 (6), 1162-1169.

(5) Michael, R.; Barraquer, R. I.; Willekens, B.; van Marle, J.; Vrensen, G.

F. J. M. Morphology of age-related cuneiform cortical cataracts: The case for mechanical stress. Vision Research 2008, 48 (4), 626-634.

(6) Liu, Y.-C.; Wilkins, M.; Kim, T.; Malyugin, B.; Mehta, J. S. Cataracts.

The Lancet 2017, 390 (10094), 600-612.

(7) Allen, D.; Vasavada, A. Cataract and surgery for cataract. Bmj 2006,

Ophthalmology & Visual Science 1965, 4 (4), 377-383.

(10) Barraquer, J. Drugs and instruments used in cataract surgery. American Journal of Ophthalmology 1966, 61 (1), 184-185.

(11) Pandey, S. K.; Milverton, E. J.; Maloof, A. J. A tribute to Charles David Kelman MD: ophthalmologist, inventor and pioneer of

phacoemulsification surgery. Clinical & experimental ophthalmology 2004, 32 (5), 529-533.

(12) Apple, D. J.; Escobar-Gomez, M.; Zaugg, B.; Kleinmann, G.;

Borkenstein, A. F. Modern Cataract Surgery: Unfinished Business and Unanswered Questions. Survey of Ophthalmology 2011, 56 (6,

Supplement), S3-S53.

(13) Tetz, M.; Jorgensen, M. R. New hydrophobic IOL materials and

understanding the science of glistenings. Current eye research 2015, 40 (10), 969-981.

(14) Epstein, E. History of intraocular lens implant surgery. In Soft implant lenses in cataract surgery, Slack, Inc Thorofare, NJ, 1986; pp 1-10.

(15) Hao, X.; Jeffery, J. L.; Le, T. P.; McFarland, G.; Johnson, G.; Mulder, R. J.; Garrett, Q.; Manns, F.; Nankivil, D.; Arrieta, E. High refractive index polysiloxane as injectable, in situ curable accommodating intraocular lens. Biomaterials 2012, 33 (23), 5659-5671.

(16) Xu, X.; Wu, C.; Zhang, B.; Dong, H. Preparation, structure

characterization, and thermal performance of phenyl‐modified MQ silicone resins. Journal of applied polymer science 2013, 128 (6), 4189-4200.

(17) Steinert, R. F. Cataract surgery technique, complications, management.

Clin. Exp. Optom. 2004, 87, 413-416.

(18) Barrett, G. D. A new hydrogel intraocular lens design. Journal of Cataract & Refractive Surgery 1994, 20 (1), 18-25.

(19) Wilson, M.; Pandey, S.; Thakur, J. Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium. British Journal of Ophthalmology 2003, 87 (1), 14-19.

(20) Menapace, R.; Amon, M.; Radax, U. Evaluation of 200 consecutive IOGEL 1103 capsular-bag lenses implanted through a small incision.

Journal of Cataract & Refractive Surgery 1992, 18 (3), 252-264.

(21) Ziemba, S. L. SIlicone intraocular lens implant discoloration in humans-reply. Archives of Ophthalmology 1991, 109 (7), 914-915.

(22) Koch, D. D.; Heit, L. E. Discoloration of silicone intraocular lenses.

Archives of Ophthalmology 1992, 110 (3), 319-320.

(23) Allarakhia, L.; Knoll, R. L.; Lindstrom, R. L. Soft intraocular lenses.

Journal of Cataract & Refractive Surgery 1987, 13 (6), 607-620.

(24) Tehrani, M.; Dick, H. B.; Wolters, B.; Pakula, T.; Wolf, E. Material properties of various intraocular lenses in an experimental study.

Ophthalmologica 2004, 218 (1), 57-63.

(25) Werner, L.; Tetz, M.; Feldmann, I.; Bücker, M. Evaluating and defining the sharpness of intraocular lenses: microedge structure of

commercially available square-edged hydrophilic intraocular lenses.

(27) STEELE MCINTYRE, M.; WERNER, L.; MAMALIS, N.

Hydrophobic Acrylic IOLs: A Primer.

(28) Vasavada, A. R.; Raj, S. M.; Shah, A.; Shah, G.; Vasavada, V.;

Vasavada, V. Comparison of posterior capsule opacification with

hydrophobic acrylic and hydrophilic acrylic intraocular lenses. Journal of Cataract & Refractive Surgery 2011, 37 (6), 1050-1059.

(29) Heatley, C. J.; Spalton, D. J.; Kumar, A.; Jose, R.; Boyce, J.; Bender, L.

E. Comparison of posterior capsule opacification rates between hydrophilic and hydrophobic single-piece acrylic intraocular lenses.

Journal of Cataract & Refractive Surgery 2005, 31 (4), 718-724.

(30) Abela-Formanek, C.; Amon, M.; Schild, G.; Schauersberger, J.;

Heinze, G.; Kruger, A. Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses. Journal of Cataract & Refractive Surgery 2002, 28 (1), 50-61..

(31) Zeng, L.; Fang, F. Advances and challenges of intraocular lens design [Invited]. Appl. Opt. 2018, 57 (25), 7363-7376.

(32) Findl, O.; Buehl, W.; Bauer, P.; Sycha, T. Interventions for preventing posterior capsule opacification. Cochrane database of systematic reviews 2010, (2).

(33) Cooksley, G.; Lacey, J.; Dymond, M. K.; Sandeman, S. Factors Affecting Posterior Capsule Opacification in the Development of Intraocular Lens Materials. Pharmaceutics 2021, 13 (6).

(34) Davidson, M. G.; Morgan, D. K.; McGahan, M. C. Effect of surgical

technique on in vitro posterior capsule opacification11None of the

authors has a financial or proprietary interest in any material or method

mentioned. Journal of Cataract & Refractive Surgery 2000, 26 (10), 1550-1554.

(35) Johar, K. Post-operative capsular opacification.

(36) Nagata, T.; Watanabe, I. Optic sharp edge or convexity: comparison of effects on posterior capsular opacification. Jpn J Ophthalmol 1996, 40 (3), 397-403.

(37) Nishi, O.; Nishi, K. Preventing posterior capsule opacification by creating a discontinuous sharp bend in the capsule. Journal of Cataract

& Refractive Surgery 1999, 25 (4), 521-526.

(38) Cheng, J.-W.; Wei, R.-L.; Cai, J.-P.; Xi, G.-L.; Zhu, H.; Li, Y.; Ma, X.-Y. Efficacy of different intraocular lens materials and optic edge

designs in preventing posterior capsular opacification: a meta-analysis.

American journal of ophthalmology 2007, 143 (3), 428-436. e423.

(39) Peng, Q.; Visessook, N.; Apple, D. J.; Pandey, S. K.; Werner, L.;

Escobar-Gomez, M.; Schoderbek, R.; Solomon, K. D.; Guindi, A.

Surgical prevention of posterior capsule opacification: Part 3:

Intraocular lens optic barrier effect as a second line of defense11None of the authors has a financial or proprietary interest in any product mentioned. Journal of Cataract & Refractive Surgery 2000, 26 (2), 198-213.

(40) Neuhann, I. M.; Kleinmann, G.; Apple, D. J. A New Classification of

(42) Neuhann, I. M.; Werner, L.; Izak, A. M.; Pandey, S. K.; Kleinmann, G.;

Mamalis, N.; Neuhann, T. F.; Apple, D. J. Late postoperative

opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants. Ophthalmology 2004, 111 (11), 2094-2101.

(43) Werner, L. Causes of intraocular lens opacification or discoloration.

第三章實驗方法