Lenticular Imaging: A New Experimental and Quantitative Analysis of Capsular Dynamics, “Choi-Apple View”

PURPOSE: Development of a means for quantitative estimation of lenticular and zonular dynamics by using real-time imaging of human autopsy eyes during implantation of different intraocular lens (IOL) models. METHODS: Isolated lenticular structures from human autopsy eyes were prepared in vitro. The following IOLs were implanted: a one-piece C-loop haptic IOL, a three-piece C-loop haptic IOL, and a one-piece plate-type IOL. The amount of deformation of lenticular structures during implantation was calculated and the movements visualized with two cameras. The results were transformed to two-dimensional graphs using a newly developed image-processing algorithm. RESULTS: For both one-piece plate-type and one-piece C-loop haptic IOLs, the amount of capsular bag deformation from its initial shape was greater in the direction of posterior center of the capsule, as detected by side camera, than in the direction of the equator (or periphery), as detected by front camera. The mean peak deformation values were 51% and 36% (as measured by side and front cameras, respectively) for one-piece plate-type IOL and 25% and 20% for one-piece C-loop haptic IOL. For three-piece C-loop haptic IOL, the capsular bag distention was almost equal in both posterior and peripheral directions, with mean peak deformation values reaching 39% and 38%. CONCLUSIONS: The new experimental means of lenticular imaging and quantified dynamics from two different angles allowed three-dimensional understanding of specific behavior of each IOL. Our model not only exposes the capsular bag for recording during implantation, but also objectively compares the individual movement values and reveals different zonular and capsular stress patterns, depending on IOL model. TRANSLATIONAL RELEVANCE: The novel “Choi-Apple View” allows a three-dimensional quantitative analysis of capsular dynamics and IOL implantation behavior.