A retrospective Cohort Research of the Impact of Intraocular Lens (IOL) Loading Methods on the Adhesion Phenomenon during Cataract Surgery

A retrospective Cohort Research of the Impact of Intraocular Lens (IOL) Loading Methods on the Adhesion Phenomenon during Cataract Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A retrospective Cohort Research of the Impact of Intraocular Lens (IOL) Loading Methods on the Adhesion Phenomenon during Cataract Surgery Li Yanan, Zhang Li, Wang Yiren, Miao Jinhong, Jing Liu, Liu Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4894287/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study aims to observe the optic and haptic adhesion phenomenon of different intraocular lens (IOL) and the impact of different methods of IOL loading on the occurrence of adhesion phenomena. Methods 253 patients (253 eyes) undergoing routine cataract surgery combined with IOL implantation at Peking University Third Hospital from July 2021 to July 2022 were enrolled. As an observative retrospective study, the Trial Registration Number (TRN) is not applicable for our research. Five types of IOLs including Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, A1UV, and A1UL22 were selected and loaded using 7 different methods to compare the incidence of different IOL adhesion types and additional device assistance. Results The incidence of adhesion and additional device assistance in A1UV and A1UL22 groups were significantly higher than that in other three groups (P < 0.05). Routine loading method group exhibited the highest incidence of haptic adhesions (55%), while balanced salt solution (BSS) group presented the lowest incidence of haptic adhesions (5.9%, P < 0.05). BSS and viscoelastic group showed the highest incidence of double haptic loop adhesions (33%) among all the loading ways groups. Conclusions A1UV and its preloaded A1UL22 IOL presented the highest incidence of adhesion, compared with the other three IOLs (Tecnis ZCB00、Tecnis ZXR00、Tecnis ZMT). The application of BSS during IOL loading was effective in reducing the adhesion incidence. Health sciences/Diseases/Eye diseases/Lens diseases Health sciences/Health care/Therapeutics/Surgery intraocular lens optic and haptic adhesion loading methods Figures Figure 1 Figure 2 INTRODUCTION With the development of cataract surgery equipment, intraocular lens (IOL) and the increasing demand of patients for visual quality, cataract surgery has transformed from the era of traditional restorative surgery to the era of refractive surgery, which brings more opportunities and challenges to cataract surgeons. 1 – 3 The success of the cataract surgery and patients’ postoperative cisual quality can be influenced by many factors, of which the material and characteristics of the IOL are of great imprtance. 4 – 5 Hydrophobic acrylate IOLs are composed of polymers of phenylacetate and phenylethylacrylate, which have the characteristics of lighter mass, high flexibility, high refractive index, and high surface viscosity 6 , and are now widely used in clinical practice. The characteristics of large surface viscosity make it easier to adhere to the lens capsule, especially bringing the posterior capsule into close contact with the optical part. Thus, this type of IOLs can prevent the migration of lens epithelial cells, and reduce the incidence of posterior capsule opacification. 7 – 9 However, this property leads to an increased risk of adhesion of the haptic part to the optical part during IOL implantation, which may prolong the operation, and increase the unforeseen risks of the surgery. Yiping Hu et al. 10 showed that hydrophobic acrylate IOLs have a higher risk of adhesion of haptic part to the optical area, and the use of viscoelastic during loading can shorten the adhesion time. They also found the application of polymethyl methacrylate (PMMA) in the haptic part can reduce the risk of the adhesion. In our research, we compared the hydrophobic acrylic IOLs with a high incidence of adhesion: A1UV and its preloaded form A1UL22 of Eyebright Medical Technology, with 3 other hydrophobic acrylic IOLs: Tecnis ZCB00, Tecnis ZXR00, and Tecnis ZMT of Advanced Medical Optics. Furthermore, we explored the effectiveness and safety of different IOL loading methods to prevent the occurrence of adhesion. MATERIALS AND METHODS Subjects This research is an observative retrospective study, approved by the Institutional Review Board of Peking University Third Hospital and conducted in accordance with the tenets of the Declaration of Helsinki. The ethics number of our research is D2016035. Informed consents were obtained from each patient. 253 patients (253 eyes) undergoing routine cataract surgery combined with IOL implantation at Peking University Third Hospital from July 2021 to July 2022 were enrolled, with implanted IOLs: Tecnis ZCB00 (45 eyes), Tecnis ZXR00 (29 eyes), Tecnis ZMT (28 eyes), A1UV (87 eyes) and A1UL22 (64 eyes) (The IOL parameters can be seen in Table 1 ). Table 1 Basic parameters of five kinds of IOLs Tecnis ZCB00 Tecnis ZXR00 Tecnis ZMT A1UV A1UL22 Optic material Hydrophobic acrylic Haptic material Hydrophobic acrylic Square edged Yes Heparin coated No Blue light-filtering No Optic dimension (mm) 6 Total dimension (mm) 13 Index of refraction 1.47 1.47 1.47 1.48 1.48 Haptic angle (°) Tri-Fix Tri-Fix Tri-Fix 1.5 1.5 A-constant 118.8 118.8 118.8 118.2 118.2 A1UL IOL is the preloaded type of A1UV IOL Inclusion and exclusion criteria Our inclusion criteria were as follows: (i) regular cataract surgery combined with IOL implantation; (ii) the implanted lens was one of Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, A1UV, and A1UL22; and (iii) the procedure was performed successfully without IOL-related complications. Exclusion criteria were as follows: (i) special cataract surgery, such as traumatic cataract, pediatric cataract, dislocation of the lens, and cataract surgery in combination with other surgeries; (ii) unexpected events such as IOL rupture. IOL loading methods 5 non-preloaded IOLs, Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV, were loaded using 6 methods and the preloaded IOL A1UL22 was counted as the Looading methods VII. All the 6 manual loading methods were listed as follows. Loading method I (routine loading): The loading protocol in the instruction manual 10 was set as the control group: about 0.4 mL of sodium hyaluronate gel (Maxigen Biotech Inc.) was injected into the introducer head, the edge of the optical surface of the IOL was gripped with IOL forceps (Suzhou Xiehe Medical Instrument Co., Ltd.), and the crystal was gently placed in the reverse "S" shape to the posterior part of the introducer head, so that half of the optic surface enters the introducer head and the front haptic part covers the top of the optic surface, then hold the posterior haptic part so that it also covers the top of the optic surface, and gently push the IOL into the marking position of the introducer head with the IOL forceps against the root of the crystal. Then connect the pusher and consider the installation successful if there is no resistance to pushing. Loading method II (BSS loading): Cover the IOL surface with BSS (Shenyang Xingqi Pharmaceutical Co., Ltd.), and then load IOL according to loading method I. Loading method III (viscoelastic loading): Cover the IOL surface with sodium hyaluronate gel (viscoelastic) and then load IOL according to loading method I. Loading method IV (haptics interval loading): Load the front haptic first, and then load the posterior haptic after an interval of 1 minute. Loading method V (BSS + viscoelastic loading): Cover the IOL surface with BSS and viscoelastic, and then load IOL according to loading method I. Loading method VI (BSS + viscoelastic + haptics interval loading): Cover the IOL surface with BSS and viscoelastic, and then load the front haptic first, after an interval of 1 minute load the posterior haptic, which we called interval loading. Loading method VII (preloaded): The A1UL22 IOL is a preloaded IOL that is implanted directly into the eye without manual loading during the surgery and is operated according to the instructions[4]. Evaluation Incidence and type of adhesion: there are 4 types of adhesion: single haptic adhesion to the optical part (Fig. 1 A), two haptics adhesion to the optical part (Fig. 1 B), two haptic parts adhere to each other (double haptic loop adhesion, Fig. 1 C), and no adhesion (Fig. 1 D). Duration of IOL folding: The time from when the IOL in a folded and curled position at the front of the inducer until the entire IOL is pushed into the anterior chamber. Duration of IOL unfolding: The time from the curled position to the fully deployed position after the IOL is pushed into the anterior chamber from the inducer. The incidence of the need for additional instrument assist: The incidence of the situation where the surgeon needed to use additional instruments to assist in IOL deployment because of a certain type of IOL adhesion. (Fig. 2 ) Statistical analysis All statistical analyses were performed using IBM SPSS version 26.0 (IBM Corp., Armonk, NY, USA). The statistical data are expressed as rate (%), using the chi-square test, with P < 0.05 being a statistically significant difference and P < 0.001 being a highly significant difference. RESULTS Comparison of the adhesion incidence among the IOL groups when using Loading Method I After loading the IOLs according to Loading method I (routine method) [3], we observed a significant difference in the incidence of adhesion among 4 types of IOLs (P < 0.01), as detailed in Table 2 . The incidence of adhesion in the A1UV and A1UL22 IOL groups ware significantly higher than that in the other 3 groups. Table 2 Incidence of adhesion in different types of IOLs Type of IOLs Adhesion No adhesion P value A1UV 30 (34.5%) 57 (65.5%) 0.003** A1UL22 19 (29.7%) 45 (70.3%) ZCB00 7 (15.6%) 38 (84.4%) ZXR 1 (3.4%) 28 (96.6%) ZMT 4 (14.3%) 24 (85.7%) *: P < 0.05, **: P < 0.01, ***: P < 0.001. Comparison of the incidence of additional instrument assistance We conducted χ2 analysis on the percentage of additional instrument assistance among the 5 IOL groups. At room temperature of 25°C, there was a significant difference (P < 0.01) in the percentage of additional instrument assistance during implanting the IOL into the anterior chamber in each group (Table 3 ). The percentage of additional instrument assistance in A1UV and A1UL22 groups were significantly higher than that in the other 3 groups. Table 3 The incidence of the need for additional instrument assistance of different types of IOLs Type of IOLs Adhesion No adhesion P value A1UV 21 (24.1%) 66 (75.9%) 0.001** A1UL22 10 (15.6%) 54 (84.4%) ZCB00 1 (2.2%) 44 (97.8%) ZXR 0 (0.0%) 29 (100%) ZMT 2 (7.1%) 26 (92.9%) *: P < 0.05, **: P < 0.01, ***: P < 0.001. Comparison of the incidence of adhesion between different loading method groups in A1UV and A1UL22 groups We also conducted χ2 analysis on the incidence of adhesion among the 7 loading method groups. There was a significant difference in the incidence of adhesion among the 7 groups (P < 0.01), with Loading method I (routine loading) showing the highest incidence of adhesion (55%), and Loading method II (BSS loading) showing the lowest incidence of adhesion (5.9%), as shown in Table 4 . Table 4 The incidence of adhesions in different loading method Loading method Adhesion No adhesion P value I (routine loading) 11 (55.0%) 9 (45.0%) <0.001*** II (BSS loading) 1 (5.9%) 16 (95.1%) III (viscoelastic loading) 3 (10.0%) 27 (90.0%) IV (haptics interval loading) 5 (8.9%) 51 (91.1%) V (BSS + viscoelastic loading) 6 (40.0%) 9 (60.0%) VI (BSS + viscoelastic + haptics interval loading) 16 (31.4%) 35 (68.6%) VII (preloaded) 19 (29.7%) 45 (70.3%) *: P < 0.05, **: P < 0.01, ***: P < 0.001. Relationship between loading methods and the types of adhesion The types of adhesion significantly varied between different loading methods (P < 0.01). The incidence of single haptic adhesions was lowest in Loading method V group(0%), and highest in Loading method I group (25.0%). The incidence of double haptic-optic adhesions was the lowest in Loading methods II and III groups (0%), and highest in Loading method I group (10.0%). The incidence of double haptic loop adhesion was found lowest in Loading method II group (1%), and highest in Loading method V group (33.3.%). The incidence of unglued was found highest in Loading method II group (88.2%), and the lowest in Loading method I group (35.0%), as shown in Table 5 . Table 5 The incidence of adhesion types in different loading method Loading method Single haptic adhesion Two haptics adhesion Double haptic loop adhesion No adhesion P value I (routine loading) 5(25.0%) 2(10.0%) 6(30.0%) 7(35.0%) 0.031* II (BSS loading) 1(5.9%) 0(0.0%) 1(5.9%) 15(88.2%) III (viscoelastic loading) 2(6.7%) 0(0.0%) 3(10.0%) 25(83.3%) IV (haptics interval loading) 7(12.5%) 2(3.6%) 5(8.90%) 42(75.0%) V (BSS + viscoelastic loading) 0(0.0%) 1(6.7%) 5(33.3%) 9(60.0%) VI (BSS + viscoelastic + haptics interval loading) 2(3.9%) 2(3.9%) 12(23.5%) 35(68.6%) VII (preloaded) 9(14.1%) 4(6.3%) 14(21.9%) 37(57.8%) *: P < 0.05, **: P < 0.01, ***: P < 0.001. DISCUSSION The various advantages of hydrophobic acrylate make it one of the most commonly used materials for IOLs. 12 – 13 However, its viscosity leads to adhesion during implantation of IOLs, which needs extra equipment to deploy the IOLs, thus prolonging the surgery and increasing the difficulty and risk. In this study, we compared the incidence of adhesion of different types of hydrophobic acrylic IOLs and found that the incidence of adhesion of A1UV and A1UL22 IOLs was significantly greater than that of Tecnis ZCB00, Tecnis ZXR00, and Tecnis ZMT IOLs. Meanwhile, we investigated different loading methods in the effectiveness of prevention of adhesion. Our results showed that the incidence of adhesion and additional instrument assistance can be significantly reduced by applying BSS on the surface of the IOL during the loading. In the case of the same hydrophobic acrylic material and the same total length of the lens body, the angle between the haptic and optic of A1UV and A1UL22 is slightly smaller than that of ZCB00, ZXR00, and ZMT, and the area of the base of the haptic in the A1UV and A1UL22 is narrower than that of the others, resulting in a smaller rebound force of the haptic when the IOL is folded and the haptic is attached to the body, thus increasing the incidence of haptic and optic adhesion of the IOL and the time of adjustment, resulting in longer surgery time. Yiping Hu et al. 10 demonstrated that the base of the haptic of the Tecnis ZCB00 was 0.35 mm × 0.45 mm and that of the IQ SN60WF was 0.30 mm × 0.41 mm, suggesting that the width and thickness of the haptic base of the Tecnis ZCB00 is larger than that of the IQ SN60WF, thus the Tecnis ZCB00 has a greater resilience, resulting in easier separation of haptic and optic part. Another reason of the higher adhesion rate A1UV and A1UL22 is that the special haptic design, sanding treatment at the end of the haptic increases the friction. Once the IOL is folded, the contact between the loop and the optical part or between the two haptics will lead to adhesion, which is difficult to separate. In addition, our results showed no significant difference in adhesion rate between A1UV and A1UL22, indicating that preloading does not avoid adhesion compared to manual loading. However, the use of preloaded IOLs almost avoids the occurrence of rupture of haptic during IOL implantation 17 , so considering the safety of IOL implantation and the rational use of medical resources, preloaded IOLs have some value for clinical use. In this study, 7 different IOL loading methods were designed and experimented. The results showed that adding BSS showed the lowest adhesion incidence, and adding viscoelastic was the second, haptics interval loading was the third, and combining multiple methods was not as effective as the above three. And all these five methods we experimented were better than the control group (routine loading). We speculated that the viscosity of water is less than that of viscoelastic, which is less likely to cause adhesion compared to viscoelastic for hydrophobic IOL; the weaker effect of the combined method is considered to be due to the excessive volume of the added medium, which increases the pressure of the haptic on the optic part when the IOL is in the folded state inside the inducer, causing an increase in the incidence of adhesion. Our results indicated that the loading methods used in this study to prevent adhesion were effective, of which loading the IOLs with a small amount of BSS was the best. Previous studies have shown that the prolonged duration of the procedure increases the risk of Iatrogenic infection. 14 – 16 The results showed that adhesion was more severe in the A1UV and A1UL22 groups than that in the others, which increases the difficulty of surgery and the risk of surgical infection for less experienced surgeons. In conclusion, this study compared 5 hydrophobic acrylic IOLs using different loading methods to prevent adhesion of haptic and optic part, and loading hydrophobic acrylic IOLs with a small amount of BSS on the lens surface was the most effective. In addition, increasing the base area between the optic part and haptic part can effectively increase the resilience of the haptics and reduce the occurrence of adhesion. Preloading does not reduce the adjustment time compared with manual loading, but considering the safety of surgery and the rational use of medical resources, the preloading IOLs is worth promoting. Declarations Ethics approval and consent to participate This research is an observative retrospective study, approved by the Institutional Review Board of Peking University Third Hospital and conducted in accordance with the tenets of the Declaration of Helsinki. The ethics number of the research is S2023533. Consent for publication Not applicable. Data availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Funding There is no conflict of interest between this study and any commercial institution or company. There are no commercial or financial relationships that may create conflicts of interest in this study. We did not sign any agreements with any sponsoring units that may result in biased research results. All authors declare that they have no conflict of interest. Author Contribution Li Yanan and Zhang Li carried out the idea and designed the research. Liu Jing, Li Yanan, Miao Jinsong and Zhang Li collected the data. Wang Yiren wrote the main manuscript and all the authors reviewed the manuscript. References Kanclerz, P. & Alio, J. L. The benefits and drawbacks of femtosecond laser-assisted cataract surgery. Eur. J. Ophthalmol. 31 (3), 1021–1030. 10.1177/1120672120922448 (2021). Go, J. A., Mamalis, C. A. & Khandelwal, S. S. Cataract Surgery Considerations for Diabetic Patients. Curr. Diab Rep. 21 (12), 67. 10.1007/s11892-021-01418-z (2021). Naderi, K., Gormley, J. & O'Brart, D. Cataract surgery and dry eye disease: A review. Eur. J. Ophthalmol. 30 (5), 840–855. 10.1177/1120672120929958 (2020). López-Vázquez, Á., Contreras, I., Martin-Prieto, S. & López-Castro, Á. Weight of Different Intraocular Lenses: Evaluation of Toricity, Focality, Design, and Material. J. Ophthalmol. 2021 , 6686700. 10.1155/2021/6686700 (2021). Werner, L., Intraocular & Lenses Overview of Designs, Materials, and Pathophysiologic Features. 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Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020. Ann. Transl Med. 8 (22), 1554. 10.21037/atm-20-3490 (2020). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4894287","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":354681587,"identity":"17661343-1ee2-417f-98ca-98005ee1c451","order_by":0,"name":"Li Yanan","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Yanan","suffix":""},{"id":354681588,"identity":"3a6b1306-cf08-4492-b274-f54d2ff12aeb","order_by":1,"name":"Zhang Li","email":"","orcid":"","institution":"Peking University Third 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parts\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4894287/v1/e31e27ce4ad4425b7d0631a4.png"},{"id":66632850,"identity":"5597fd25-68d1-437f-a9e2-3b55a07262d9","added_by":"auto","created_at":"2024-10-15 05:01:35","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":5163489,"visible":true,"origin":"","legend":"\u003cp\u003eadditional instruments to assist in IOL deployment\u003c/p\u003e","description":"","filename":"Figure2.tiff.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4894287/v1/22a9e984e0ccc740215ba236.jpg"},{"id":70995285,"identity":"251258f0-a4ad-4b7b-8ed8-3f627b549a19","added_by":"auto","created_at":"2024-12-10 04:24:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":11879369,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4894287/v1/56388d11-d240-4f71-b3ee-e4eb00cb95b6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A retrospective Cohort Research of the Impact of Intraocular Lens (IOL) Loading Methods on the Adhesion Phenomenon during Cataract Surgery","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eWith the development of cataract surgery equipment, intraocular lens (IOL) and the increasing demand of patients for visual quality, cataract surgery has transformed from the era of traditional restorative surgery to the era of refractive surgery, which brings more opportunities and challenges to cataract surgeons.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The success of the cataract surgery and patients\u0026rsquo; postoperative cisual quality can be influenced by many factors, of which the material and characteristics of the IOL are of great imprtance.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHydrophobic acrylate IOLs are composed of polymers of phenylacetate and phenylethylacrylate, which have the characteristics of lighter mass, high flexibility, high refractive index, and high surface viscosity\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, and are now widely used in clinical practice. The characteristics of large surface viscosity make it easier to adhere to the lens capsule, especially bringing the posterior capsule into close contact with the optical part. Thus, this type of IOLs can prevent the migration of lens epithelial cells, and reduce the incidence of posterior capsule opacification.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e However, this property leads to an increased risk of adhesion of the haptic part to the optical part during IOL implantation, which may prolong the operation, and increase the unforeseen risks of the surgery. Yiping Hu et al.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e showed that hydrophobic acrylate IOLs have a higher risk of adhesion of haptic part to the optical area, and the use of viscoelastic during loading can shorten the adhesion time. They also found the application of polymethyl methacrylate (PMMA) in the haptic part can reduce the risk of the adhesion. In our research, we compared the hydrophobic acrylic IOLs with a high incidence of adhesion: A1UV and its preloaded form A1UL22 of Eyebright Medical Technology, with 3 other hydrophobic acrylic IOLs: Tecnis ZCB00, Tecnis ZXR00, and Tecnis ZMT of Advanced Medical Optics. Furthermore, we explored the effectiveness and safety of different IOL loading methods to prevent the occurrence of adhesion.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003e This research is an observative retrospective study, approved by the Institutional Review Board of Peking University Third Hospital and conducted in accordance with the tenets of the Declaration of Helsinki. The ethics number of our research is D2016035. Informed consents were obtained from each patient. 253 patients (253 eyes) undergoing routine cataract surgery combined with IOL implantation at Peking University Third Hospital from July 2021 to July 2022 were enrolled, with implanted IOLs: Tecnis ZCB00 (45 eyes), Tecnis ZXR00 (29 eyes), Tecnis ZMT (28 eyes), A1UV (87 eyes) and A1UL22 (64 eyes) (The IOL parameters can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic parameters of five kinds of IOLs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTecnis ZCB00\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTecnis ZXR00\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTecnis ZMT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA1UV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA1UL22\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOptic material\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eHydrophobic acrylic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaptic material\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eHydrophobic acrylic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSquare edged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeparin coated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlue light-filtering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOptic dimension (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal dimension (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndex of refraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaptic angle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTri-Fix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTri-Fix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTri-Fix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA-constant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e118.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eA1UL IOL is the preloaded type of A1UV IOL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eOur inclusion criteria were as follows: (i) regular cataract surgery combined with IOL implantation; (ii) the implanted lens was one of Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, A1UV, and A1UL22; and (iii) the procedure was performed successfully without IOL-related complications. Exclusion criteria were as follows: (i) special cataract surgery, such as traumatic cataract, pediatric cataract, dislocation of the lens, and cataract surgery in combination with other surgeries; (ii) unexpected events such as IOL rupture.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eIOL loading methods\u003c/h2\u003e \u003cp\u003e5 non-preloaded IOLs, Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, and A1UV, were loaded using 6 methods and the preloaded IOL A1UL22 was counted as the Looading methods VII. All the 6 manual loading methods were listed as follows.\u003c/p\u003e \u003cp\u003eLoading method I (routine loading): The loading protocol in the instruction manual\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e was set as the control group: about 0.4 mL of sodium hyaluronate gel (Maxigen Biotech Inc.) was injected into the introducer head, the edge of the optical surface of the IOL was gripped with IOL forceps (Suzhou Xiehe Medical Instrument Co., Ltd.), and the crystal was gently placed in the reverse \"S\" shape to the posterior part of the introducer head, so that half of the optic surface enters the introducer head and the front haptic part covers the top of the optic surface, then hold the posterior haptic part so that it also covers the top of the optic surface, and gently push the IOL into the marking position of the introducer head with the IOL forceps against the root of the crystal. Then connect the pusher and consider the installation successful if there is no resistance to pushing.\u003c/p\u003e \u003cp\u003eLoading method II (BSS loading): Cover the IOL surface with BSS (Shenyang Xingqi Pharmaceutical Co., Ltd.), and then load IOL according to loading method I.\u003c/p\u003e \u003cp\u003eLoading method III (viscoelastic loading): Cover the IOL surface with sodium hyaluronate gel (viscoelastic) and then load IOL according to loading method I.\u003c/p\u003e \u003cp\u003eLoading method IV (haptics interval loading): Load the front haptic first, and then load the posterior haptic after an interval of 1 minute.\u003c/p\u003e \u003cp\u003eLoading method V (BSS\u0026thinsp;+\u0026thinsp;viscoelastic loading): Cover the IOL surface with BSS and viscoelastic, and then load IOL according to loading method I.\u003c/p\u003e \u003cp\u003eLoading method VI (BSS\u0026thinsp;+\u0026thinsp;viscoelastic\u0026thinsp;+\u0026thinsp;haptics interval loading): Cover the IOL surface with BSS and viscoelastic, and then load the front haptic first, after an interval of 1 minute load the posterior haptic, which we called interval loading.\u003c/p\u003e \u003cp\u003eLoading method VII (preloaded): The A1UL22 IOL is a preloaded IOL that is implanted directly into the eye without manual loading during the surgery and is operated according to the instructions[4].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation\u003c/h2\u003e \u003cp\u003eIncidence and type of adhesion: there are 4 types of adhesion: single haptic adhesion to the optical part (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eA), two haptics adhesion to the optical part (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eB), two haptic parts adhere to each other (double haptic loop adhesion, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eC), and no adhesion (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eD).\u003c/p\u003e \u003cp\u003eDuration of IOL folding: The time from when the IOL in a folded and curled position at the front of the inducer until the entire IOL is pushed into the anterior chamber.\u003c/p\u003e \u003cp\u003eDuration of IOL unfolding: The time from the curled position to the fully deployed position after the IOL is pushed into the anterior chamber from the inducer.\u003c/p\u003e \u003cp\u003eThe incidence of the need for additional instrument assist: The incidence of the situation where the surgeon needed to use additional instruments to assist in IOL deployment because of a certain type of IOL adhesion. (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS version 26.0 (IBM Corp., Armonk, NY, USA). The statistical data are expressed as rate (%), using the chi-square test, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 being a statistically significant difference and P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 being a highly significant difference.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the adhesion incidence among the IOL groups when using Loading Method I\u003c/h2\u003e \u003cp\u003eAfter loading the IOLs according to Loading method I (routine method) [3], we observed a significant difference in the incidence of adhesion among 4 types of IOLs (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The incidence of adhesion in the A1UV and A1UL22 IOL groups ware significantly higher than that in the other 3 groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of adhesion in different types of IOLs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of IOLs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo adhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1UV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.003**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1UL22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZCB00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (84.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZXR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (96.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZMT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **: P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***: P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the incidence of additional instrument assistance\u003c/h2\u003e \u003cp\u003eWe conducted χ2 analysis on the percentage of additional instrument assistance among the 5 IOL groups. At room temperature of 25\u0026deg;C, there was a significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) in the percentage of additional instrument assistance during implanting the IOL into the anterior chamber in each group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The percentage of additional instrument assistance in A1UV and A1UL22 groups were significantly higher than that in the other 3 groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe incidence of the need for additional instrument assistance of different types of IOLs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of IOLs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo adhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1UV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (75.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1UL22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (84.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZCB00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (97.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZXR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZMT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (92.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **: P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***: P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of the incidence of adhesion between different loading method groups in A1UV and A1UL22 groups\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe also conducted χ2 analysis on the incidence of adhesion among the 7 loading method groups. There was a significant difference in the incidence of adhesion among the 7 groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with Loading method I (routine loading) showing the highest incidence of adhesion (55%), and Loading method II (BSS loading) showing the lowest incidence of adhesion (5.9%), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe incidence of adhesions in different loading method\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoading method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo adhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI (routine loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII (BSS loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (95.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII (viscoelastic loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV (haptics interval loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (91.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV (BSS\u0026thinsp;+\u0026thinsp;viscoelastic loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVI (BSS\u0026thinsp;+\u0026thinsp;viscoelastic\u0026thinsp;+\u0026thinsp;haptics interval loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVII (preloaded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **: P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***: P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between loading methods and the types of adhesion\u003c/h2\u003e \u003cp\u003eThe types of adhesion significantly varied between different loading methods (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The incidence of single haptic adhesions was lowest in Loading method V group(0%), and highest in Loading method I group (25.0%). The incidence of double haptic-optic adhesions was the lowest in Loading methods II and III groups (0%), and highest in Loading method I group (10.0%). The incidence of double haptic loop adhesion was found lowest in Loading method II group (1%), and highest in Loading method V group (33.3.%). The incidence of unglued was found highest in Loading method II group (88.2%), and the lowest in Loading method I group (35.0%), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe incidence of adhesion types in different loading method\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoading method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle haptic adhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwo haptics adhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDouble haptic loop adhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo adhesion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI (routine loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.031*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII (BSS loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15(88.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII (viscoelastic loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(83.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV (haptics interval loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(8.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42(75.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV (BSS\u0026thinsp;+\u0026thinsp;viscoelastic loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(60.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVI (BSS\u0026thinsp;+\u0026thinsp;viscoelastic\u0026thinsp;+\u0026thinsp;haptics interval loading)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35(68.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVII (preloaded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(57.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **: P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***: P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe various advantages of hydrophobic acrylate make it one of the most commonly used materials for IOLs.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e However, its viscosity leads to adhesion during implantation of IOLs, which needs extra equipment to deploy the IOLs, thus prolonging the surgery and increasing the difficulty and risk.\u003c/p\u003e \u003cp\u003eIn this study, we compared the incidence of adhesion of different types of hydrophobic acrylic IOLs and found that the incidence of adhesion of A1UV and A1UL22 IOLs was significantly greater than that of Tecnis ZCB00, Tecnis ZXR00, and Tecnis ZMT IOLs. Meanwhile, we investigated different loading methods in the effectiveness of prevention of adhesion. Our results showed that the incidence of adhesion and additional instrument assistance can be significantly reduced by applying BSS on the surface of the IOL during the loading.\u003c/p\u003e \u003cp\u003eIn the case of the same hydrophobic acrylic material and the same total length of the lens body, the angle between the haptic and optic of A1UV and A1UL22 is slightly smaller than that of ZCB00, ZXR00, and ZMT, and the area of the base of the haptic in the A1UV and A1UL22 is narrower than that of the others, resulting in a smaller rebound force of the haptic when the IOL is folded and the haptic is attached to the body, thus increasing the incidence of haptic and optic adhesion of the IOL and the time of adjustment, resulting in longer surgery time. Yiping Hu et al.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e demonstrated that the base of the haptic of the Tecnis ZCB00 was 0.35 mm \u0026times; 0.45 mm and that of the IQ SN60WF was 0.30 mm \u0026times; 0.41 mm, suggesting that the width and thickness of the haptic base of the Tecnis ZCB00 is larger than that of the IQ SN60WF, thus the Tecnis ZCB00 has a greater resilience, resulting in easier separation of haptic and optic part.\u003c/p\u003e \u003cp\u003eAnother reason of the higher adhesion rate A1UV and A1UL22 is that the special haptic design, sanding treatment at the end of the haptic increases the friction. Once the IOL is folded, the contact between the loop and the optical part or between the two haptics will lead to adhesion, which is difficult to separate.\u003c/p\u003e \u003cp\u003eIn addition, our results showed no significant difference in adhesion rate between A1UV and A1UL22, indicating that preloading does not avoid adhesion compared to manual loading. However, the use of preloaded IOLs almost avoids the occurrence of rupture of haptic during IOL implantation\u003csup\u003e17\u003c/sup\u003e, so considering the safety of IOL implantation and the rational use of medical resources, preloaded IOLs have some value for clinical use.\u003c/p\u003e \u003cp\u003eIn this study, 7 different IOL loading methods were designed and experimented. The results showed that adding BSS showed the lowest adhesion incidence, and adding viscoelastic was the second, haptics interval loading was the third, and combining multiple methods was not as effective as the above three. And all these five methods we experimented were better than the control group (routine loading). We speculated that the viscosity of water is less than that of viscoelastic, which is less likely to cause adhesion compared to viscoelastic for hydrophobic IOL; the weaker effect of the combined method is considered to be due to the excessive volume of the added medium, which increases the pressure of the haptic on the optic part when the IOL is in the folded state inside the inducer, causing an increase in the incidence of adhesion. Our results indicated that the loading methods used in this study to prevent adhesion were effective, of which loading the IOLs with a small amount of BSS was the best.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that the prolonged duration of the procedure increases the risk of Iatrogenic infection.\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The results showed that adhesion was more severe in the A1UV and A1UL22 groups than that in the others, which increases the difficulty of surgery and the risk of surgical infection for less experienced surgeons.\u003c/p\u003e \u003cp\u003eIn conclusion, this study compared 5 hydrophobic acrylic IOLs using different loading methods to prevent adhesion of haptic and optic part, and loading hydrophobic acrylic IOLs with a small amount of BSS on the lens surface was the most effective. In addition, increasing the base area between the optic part and haptic part can effectively increase the resilience of the haptics and reduce the occurrence of adhesion. Preloading does not reduce the adjustment time compared with manual loading, but considering the safety of surgery and the rational use of medical resources, the preloading IOLs is worth promoting.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is an observative retrospective study, approved by the Institutional Review Board of Peking University Third Hospital and conducted in accordance with the tenets of the Declaration of Helsinki. The ethics number of the research is S2023533.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest between this study and any commercial institution or company. There are no commercial or financial relationships that may create conflicts of interest in this study. We did not sign any agreements with any sponsoring units that may result in biased research results. All authors declare that they have no conflict of interest.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLi Yanan and Zhang Li carried out the idea and designed the research. Liu Jing, Li Yanan, Miao Jinsong and Zhang Li collected the data. Wang Yiren wrote the main manuscript and all the authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKanclerz, P. \u0026amp; Alio, J. L. The benefits and drawbacks of femtosecond laser-assisted cataract surgery. \u003cem\u003eEur. J. Ophthalmol.\u003c/em\u003e \u003cb\u003e31\u003c/b\u003e (3), 1021\u0026ndash;1030. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1120672120922448\u003c/span\u003e\u003cspan address=\"10.1177/1120672120922448\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGo, J. A., Mamalis, C. 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Transl Med.\u003c/em\u003e \u003cb\u003e8\u003c/b\u003e (22), 1554. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/atm-20-3490\u003c/span\u003e\u003cspan address=\"10.21037/atm-20-3490\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"intraocular lens, optic and haptic adhesion, loading methods","lastPublishedDoi":"10.21203/rs.3.rs-4894287/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4894287/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aims to observe the optic and haptic adhesion phenomenon of different intraocular lens (IOL) and the impact of different methods of IOL loading on the occurrence of adhesion phenomena.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e253 patients (253 eyes) undergoing routine cataract surgery combined with IOL implantation at Peking University Third Hospital from July 2021 to July 2022 were enrolled. As an observative retrospective study, the Trial Registration Number (TRN) is not applicable for our research. Five types of IOLs including Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, A1UV, and A1UL22 were selected and loaded using 7 different methods to compare the incidence of different IOL adhesion types and additional device assistance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe incidence of adhesion and additional device assistance in A1UV and A1UL22 groups were significantly higher than that in other three groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Routine loading method group exhibited the highest incidence of haptic adhesions (55%), while balanced salt solution (BSS) group presented the lowest incidence of haptic adhesions (5.9%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). BSS and viscoelastic group showed the highest incidence of double haptic loop adhesions (33%) among all the loading ways groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eA1UV and its preloaded A1UL22 IOL presented the highest incidence of adhesion, compared with the other three IOLs (Tecnis ZCB00、Tecnis ZXR00、Tecnis ZMT). The application of BSS during IOL loading was effective in reducing the adhesion incidence.\u003c/p\u003e","manuscriptTitle":"A retrospective Cohort Research of the Impact of Intraocular Lens (IOL) Loading Methods on the Adhesion Phenomenon during Cataract Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-15 05:01:29","doi":"10.21203/rs.3.rs-4894287/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"204013a0-403d-42ca-80c1-3f7bd7e28048","owner":[],"postedDate":"October 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":37695534,"name":"Health sciences/Diseases/Eye diseases/Lens diseases"},{"id":37695535,"name":"Health sciences/Health care/Therapeutics/Surgery"}],"tags":[],"updatedAt":"2024-12-10T04:23:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-15 05:01:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4894287","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4894287","identity":"rs-4894287","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}