Glistening on intraocular lenses: A review | Archivos de la Sociedad Española de Oftalmología (English Edition)

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Fila inferior: (C) Imagen mediante cámara de Scheimpflug de un paciente con glistening leve en la que es muy difícil de apreciar el mismo dada su limitada resolución de imagen; D) Imagen mediante cámara de Scheimpflug de un paciente con una lente opacificada en la que se aprecia el consiguiente aumento de densitometría asociado." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.I. Fernández-Vigo, M.T. Serrano González-Peramato, C. Nunila Gómez-de-Liaño, I. Sánchez-Guillén, J.Á. Fernández-Vigo, A. Macarro-Merino" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" ] 1 => array:2 [ "nombre" => "M.T." "apellidos" => "Serrano González-Peramato" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Nunila Gómez-de-Liaño" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Sánchez-Guillén" ] 4 => array:2 [ "nombre" => "J.Á." "apellidos" => "Fernández-Vigo" ] 5 => array:2 [ "nombre" => "A." 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"apellidos" => "Macarro-Merino" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro Internacional de Oftalmología Avanzada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Perpetuo Socorro, Badajoz, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro Internacional de Oftalmología Avanzada, Badajoz, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El glistening de las lentes intraoculares: revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2108 "Ancho" => 3341 "Tamanyo" => 364751 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Different severity of glistening assessed by OCT from lesser to greater presence of glistening (A–F)." ] ] ] "textoCompleto" => "IntroductionConcept and first descriptionsCataract surgery with intraocular lens implantation (IOL) is one of the most frequently performed surgical procedures worldwide.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Over the years, different IOL materials have been tested and used to achieve the best possible postoperative outcome with the fewest complications. Any IOL must meet fundamental standards, including biocompatibility, without inducing inflammation or tissue reaction, excellent optical properties and a lack of degradation of shape or optical transparency over time.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> However, two major complications specifically related to the loss of transparency of IOLs have been described. The first, severe but infrequent, is IOL opacification; while the second, glistening, is more frequent but classically described as less important.<a class="elsevierStyleCrossRefs" href="#bib0015">3–6</a>IOL glistening is a process of formation of small (usually 1–20 µm) whitish or yellowish shiny spots corresponding to fluid-filled microvacuoles (MVs) that appear inside the IOL after implantation when interacting with an aqueous medium.<a class="elsevierStyleCrossRefs" href="#bib0015">3,7</a> The mechanism that would explain their formation is the absorption of water by the IOL polymer, which forms MVs within the lens material. The difference in the refractive index between the water and the IOL polymer causes light to refract producing a scattering effect when hitting the VMs, resulting in their characteristic appearance on slit lamp examination (SLL).<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> Thus, the greater the difference between the refractive indices of the lens material and the water, the greater the induced glistening.This phenomenon was first observed by Norman Ballin in 1984 in a Surgidev Leiske lens (Surgidev Corp., CA, USA),<a class="elsevierStyleCrossRef" href="#bib0050">10</a> which he described as glittering inclusions in the lens body, similar to the presence of anterior chamber cells. After this, successive descriptions of this glistening phenomenon in the IOL material were made in in vitro analyses and in clinical practice after LH examinations.<a class="elsevierStyleCrossRefs" href="#bib0040">8,11–15</a>Different authors state that it cannot really be considered as a degenerative process of the IOL material, but as something intrinsic to it.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Another area of interest to be studied is nanoglistening, which, unlike glistening, occurs only on the lens surface and is due to lens degradation by hydrolysis, resulting in non-homogeneous lens surfaces.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a> They are water vacuoles about 200 nm in diameter and located up to 120 µm from the IOL surface. They can be very difficult to detect on conventional clinical examination and are described as a whitish appearance of the lens under tangential illumination.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> They have been described both in vitro and using the Scheimpflug chamber with densitometry and are described as progressive. Further studies are needed to analyse its possible influence or clinical significance, although it has been reported to increase light scattering on the IOL surface.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Risk factors for glisteningAs described by several authors, IOL glistening is influenced by multiple factors such as the manufacturing process, the packaging system, temperature changes, equilibrium of water content, IOL model and power, blood-retinal or blood-aqueous barrier disruption, and postoperative inflammation, especially in combined surgeries.<a class="elsevierStyleCrossRefs" href="#bib0020">4,7,16,17</a> In addition, it has been described in both children and adults.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a>Manufacturing processThe IOL manufacturing process is known to influence the formation of glistening.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> The different methods of IOL production correspond to techniques that can inherently give very different results in terms of the risk of glistening. In the method known as lathing, the polymerisation from the initial material is more homogeneous, which makes glistening more unlikely.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> On the other hand, the technique known as moulding favours the formation of spaces inside the material which, when implanted in the eye and subjected to hydration and temperature changes, can lead to the formation of VM. Another factor to be highlighted is the packaging, a manufacturing process that has been fundamental in conditioning the visual performance of IOLs, as it reduces glistening by optimising temperature control and humidity conditions.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>IOL design<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Edges: The square-edged design of the IOL has been shown to have a lower incidence of posterior capsule opacification, which is a determining factor in fibrosis proliferation. However, it does not play a relevant role in glistening proliferation.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22</a></li><li class="elsevierStyleListItem" id="lsti0010">-Preservative medium: the osmolarity of the aqueous medium surrounding the IOL influences the formation of glistening, so that lenses preserved in 10% saline induce an osmotic pressure difference after implantation, which may increase glistening. Studies with the EnVista IOL (Bausch & Lomb, Inc, Rochester, NY, USA) have shown that by varying the saline concentration from 10% to 0.9% the formation of MVs disappears.<a class="elsevierStyleCrossRef" href="#bib0115">23</a></li><li class="elsevierStyleListItem" id="lsti0015">-Temperature: Temperature changes are largely responsible for the mechanism of glistening formation.<a class="elsevierStyleCrossRefs" href="#bib0065">13,24</a> Small changes in the temperature surrounding the lens induce the breakdown of the polymer network, altering the water balance and promoting the formation of glistening.<a class="elsevierStyleCrossRef" href="#bib0125">25</a></li><li class="elsevierStyleListItem" id="lsti0020">-Contact with the lens capsule and the presence of anterior capsule opacity have been described as another possible cause.<a class="elsevierStyleCrossRef" href="#bib0130">26</a></li></ul>PathologiesThere is a direct relationship between glistening and alteration of the blood-aqueous barrier. This can be altered in multiple situations such as diabetes mellitus, anterior uveitis, glaucoma (as a consequence of the pathology itself or associated with the use of topical hypotensive drugs), post-surgical inflammatory reactions or inflammatory diseases; so it is relevant in the formation of these VMs.<a class="elsevierStyleCrossRefs" href="#bib0040">8,17,20,24</a>,<a class="elsevierStyleCrossRefs" href="#bib0135">27–29</a> In addition, longer intraoperative times or more complex surgeries may also have the same effect.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Dioptric powerIOL power and IOL-derived thickness have been studied in relation to glistening, although most of the published results concur in the independence of IOL formation in relation to the dioptric power of the IOLs.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> However, there are other studies that find a greater correlation in IOLs with greater dioptric power and, therefore, greater thickness.<a class="elsevierStyleCrossRefs" href="#bib0085">17,26,31</a>IOL materialAlthough glistening has been observed in a wide variety of materials, including silicone, hydrogel and polymethylmethacrylate (PMMA) IOLs, it is particularly common in hydrophobic acrylic IOLs. <a class="elsevierStyleCrossRefs" href="#bib0005">1,7,32–34</a> These lenses repel water, and are designed from different monomers. These monomers combined in different proportions in various polymer chains produce multiple combinations in terms of IOL composition, which represent different characteristics and propensity of IOLs to develop glistening. Due to their versatility and characteristics, hydrophobic acrylic IOLs have become the most widely used IOLs today, allowing implantation through smaller incisions due to the flexibility of the material.One of the first IOLs in which the presence of glistening was described was the Acrysof lens (Alcon, Fort Worth, Texas, USA).<a class="elsevierStyleCrossRef" href="#bib0175">35</a> In particular, one of the most widely implanted hydrophobic lens models worldwide is the AcrySof SN60WF (Alcon, Fort Worth, Texas, USA), considered to have one of the lowest rates of posterior capsular opacification (PCO)<a class="elsevierStyleCrossRef" href="#bib0030">6</a> and has been one of the most studied IOLs in relation to glistening. In 2012, Colin et al. included in their study 111 eyes in which AcrySof SN60WF was implanted, and found glistening in 86.5% of them.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> Later, Johansson conducted a prospective, randomised, intraindividual clinical trial in which he observed a high number of glistening in most of the implanted SN60WF IOLs, which increased between the second and third year of follow-up.<a class="elsevierStyleCrossRef" href="#bib0180">36</a> Some other hydrophobic acrylic IOLs have also shown glistening, but generally at lower rates. As published by Yildirim et al.,<a class="elsevierStyleCrossRef" href="#bib0025">5</a> their analysis revealed that the SN60WF and CT Lucia 611 P IOL (Zeiss, Oberkochen, Germany) showed the highest number of MV/mm2, being 66.0 ± 45.5 and 30.7 ± 8.4 MV/mm2 respectively. The 800C (Rayner, Worthing, UK) and Vivinex XY1 (Hoya Inc, Chino Hills, CA, USA) showed similar values with 2.0 ± 3.6 and 2.7 ± 2.4 MVs/mm2, respectively, with the Tecnis ZCB00 (Johnson & Johnson Vision Care, Santa Ana, USA) showing the lowest number, being 0.9 ± 0.6 MVs/mm2.The reasons why some lenses are more prone to develop glistening than others remain unclear. In the meantime, different IOL manufacturers have tried to improve their manufacturing process to provide lenses that are more resistant to material changes and reduce glistening. This manufacturing progress was noted in 2013 by Thomes and Callaghan, who compared AcrySof IOLs (Alcon, Fort Worth, Texas, USA) manufactured in 2003 with those manufactured in 2012, observing a large decrease from 315.7 MV/mm2 to 39.9 MV/mm2 respectively.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>In 2021, Yildirim et al. published a reduction also in glistening in Lucia 611 P lenses (Zeiss, Oberkochen, Germany) (30.7 ± 8.4 MV/mm2) compared to their predecessors CT Lucia 601 P (85 ± 86 MV/mm2), which had been analysed in a previous study.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Recently, Stanojcic et al. compared two hydrophobic acrylic aspheric monofocal IOLs – Clareon, (Alcon, Fort Worth, Texas, USA) and Tecnis PCB00 (Johnson & Johnson Vision Care, Santa Ana, USA) – in terms of glistening occurrence, observing that at 12 months they were minimal (median grade 0), with no difference in grades between the groups (P = 0.2).<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In addition to improving the IOL manufacturing process, modification of the IOL polymer itself is becoming increasingly important. Thus, the term 'hygroscopy' refers to the ability of a material to retain water in its interior. By adding monomers with a large number of hydrophilic groups to IOLs, water entering the material binds to these groups instead of accumulating in vacuoles. Therefore, the more hygroscopic a material is, the higher its equilibrium in water content (EWC).<a class="elsevierStyleCrossRefs" href="#bib0185">37,38</a>Hydrophobic acrylic lenses considered standard have a very low EWC (<0.5%), unlike new models such as the Clareon CNA0T0 (Alcon, Fort Worth, Texas, USA), Eternity W-60 (Santen Inc, CA, USA) and enVista MX60 (Bausch & Lomb, Inc, Rochester, NY, USA) IOLs, with an EWC ranging from 1.5% to 4%. These new materials exhibit hydrophobic characteristics, but at the same time are considered to be glistening-free.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> In 2019, Werner et al. objectified these findings, as their results showed significantly lower MV density and size in Clareon CNA0T0 (Alcon, Fort Worth, Texas, USA) compared to Tecnis ZCB00, ZCB00 V (Johnson & Johnson Vision Care, Santa Ana, USA), and Vivinex XY1 (Hoya Surgical Optics, Inc. Chino Hills, CA, USA), while no significant differences were found between Clareon CNA0T0 (Alcon, Fort Worth, Texas, USA) versus Eternity W-60 (Santen Inc, CA, USA) (p = 0.413 for density and p = 0.565 for size) and inVista MX60 (Bausch & Lomb, Inc, Rochester, NY, USA) (p = 0.516 for density and p = 0.642 for size).<a class="elsevierStyleCrossRef" href="#bib0195">39</a>In diffractive multifocal lenses the presence of glistening would be more significant due to the lens geometry. Thus, in IOLs with Acrysof material, a higher incidence of glistening has been described in multifocal geometry compared to monofocal lenses.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9,13,40</a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the main studies that have been carried out in the evaluation of glistening in different IOL models.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Occurrence and evolution of IOL glisteningIt has been reported that their presence can be detected as early as one week after IOL implantation. There are studies that report its appearance one month or several months after the intervention, and it may remain stable over time in number and size after reaching a plateau phase according to some authors<a class="elsevierStyleCrossRefs" href="#bib0020">4,41</a> or it may evolve and increase over time according to others.<a class="elsevierStyleCrossRefs" href="#bib0085">17,42</a> It has been reported that the incidence of glistening tends to increase 90 days after implantation in most cases, with the exception of Acrysoft, where there are published cases of an increase even 15 years after surgery.<a class="elsevierStyleCrossRefs" href="#bib0215">43,44</a>Recently, by means of OCT, our group has also found that glistening increases with lens implantation time,<a class="elsevierStyleCrossRef" href="#bib0225">45</a> and may affect different visual parameters as will be seen later.<a class="elsevierStyleCrossRef" href="#bib0230">46</a> Glistening usually starts in the centre of the lens and extends towards the periphery, while the rim and haptic surfaces are usually free of vacuoles.<a class="elsevierStyleCrossRef" href="#bib0235">47</a>Evaluation methodsIn vitroOne of the main methods for the assessment of glistening or VMs in the IOL is in vitro study in the laboratory using a microscope. This allows direct observation and analysis of the size and density of the VMs at a given temperature and location.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>Different methodologies have been applied for the assessment of glistening in vitro, such as the one proposed by Yildirim et al. in which the number of MVs in the central area and in four peripheral IOL sections were assessed.<a class="elsevierStyleCrossRef" href="#bib0185">37</a> For image analysis one of the most commonly used methodologies is to apply an automated thresholding system, in which the image contrast and glistening are optimised to create a binary (black and white) image. The software can then automatically calculate the number of MVs.There are different laboratory techniques to induce the appearance of glistening by introducing the IOL into an aqueous medium with certain characteristics and temperature. In this way, it is possible to simulate what happens under physiological conditions and to predict the evolution of glistening over time. Although the appearance or appearance of glistening may be somewhat exaggerated with respect to the real clinical situation, these techniques are really interesting for investigating IOL materials that are going to be implanted.<a class="elsevierStyleCrossRef" href="#bib0195">39</a>Slit lamp photographySlit lamp (SL) photography is considered the standard reference technique in clinical practice for the evaluation of glistening, which is detected as small bright spots inside the IOL. Its main advantage is its direct visualisation in clinical practice (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). Most authors quantify them subjectively, based on a grading scale.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>However, said technique has several drawbacks. Firstly, it requires an expert examiner with great photographic skill to obtain quality images of the IOL and to be able to assess glistening in a completely standardised way. This is because photography can be hampered by numerous factors such as lighting conditions (flash or backlight), the plane or angle of the photograph, size of the slit, pupillary dilation, transparency of the media and the brightness of the screen on which it is analysed. In addition, areas of the photograph that are slightly out of focus are not accurately displayed and the lighting on the different planes due to the thickness of the lens is not completely homogeneous, so that some glistening may go unnoticed and will not be taken into account. Therefore, although it is done in a standardised way, there is some variability depending on the criteria of the person taking the photo and the examiner who evaluates and quantifies the brightness. Finally, it is a time-consuming technique as complex post-processing of the images is required to assess and quantify glistening. Thus, it is not a fast method where quantification can be done on the fly during a clinical visit.The lack of an objective and independent examiner and a reproducible method for the assessment of glistening in vivo is a common problem.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Thus, we find that each study applies its own protocol when taking LH microscopic images for analysis.<a class="elsevierStyleCrossRefs" href="#bib0040">8,12,14,15</a>,<a class="elsevierStyleCrossRef" href="#bib0240">48</a> Furthermore, there is no consensus on the size of the IOL region to be assessed, the magnification, the plane along the thickness of the lens to be examined, the number of regions studied within the IOL or the number of photographs of each sample to be taken.Scheimpflug chamberRecently, several authors have proposed the use of devices based on the Scheimpflug camera to assess and classify glistening in the IOL.<a class="elsevierStyleCrossRef" href="#bib0245">49</a> This technology uses a rotational camera to analyse and reconstruct the structures of the ocular anterior segment, allowing measurements to be taken. It typically captures 25 images per scan. However, this technology does not provide images of sufficient resolution to perform automated glistening counting and classification.<a class="elsevierStyleCrossRef" href="#bib0250">50</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D). This technology has been proposed for glistening assessment because it is more objective and less scanner-dependent than LH photography.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>In 2015, Biwer et al. used a specially designed digital image analysis programme (Matlab, Mathworks, CA, USA) to automatically count MVs or visible glistening in Scheimpflug images.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> They encountered two main difficulties: firstly, the exported Scheimpflug images did not have sufficient resolution for the digital analysis programme; and secondly, the manifestation of glistening was lower in the Scheimpflug images than in the slit-lamp examination, which made them difficult to distinguish from different image artefacts.Optical coherence tomography (OCT)To date, no objective, rapid and reproducible method has been described for the assessment of IOL glistening in clinical practice. However, in recent years some authors have used OCT for this purpose. Werner et al. were the first authors to observe glistening using anterior segment OCT (AS-OCT) by ex vivo analysis of hydrophobic acrylic IOLs explanted due to various complications.<a class="elsevierStyleCrossRef" href="#bib0255">51</a> They stated that this technique was useful for analysing the location and density of glistening, observing that glistening was homogeneously distributed within the entire optic, although sometimes it was absent in a small area. Subsequently, in 2019, Tripathy and Sridhar published an image of IOL glistening via OCT in a patient.<a class="elsevierStyleCrossRef" href="#bib0260">52</a>Very recently, our group has proposed the usefulness of OCT in the evaluation of IOL glistening, in a simple and objective way, observed as hyper-reflective spots within the lens optics.<a class="elsevierStyleCrossRef" href="#bib0225">45</a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). High reproducibility of this method and high correlation between horizontal and vertical scans was observed. In addition, one of the main advantages of OCT is that it assesses almost the entire optic in an OCT-scan, which is approximately 3 mm2 (6 mm length and 0.5 mm IOL thickness), and does not analyse only a small area of 1 mm2 as is usually the case with LH-based photography. Another advantage is that it allows a cube or sweep to be made in just a few seconds, so that multiple slices covering the entire optical zone can be assessed.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In contrast to glistening VMs, pigment deposits or pseudo-exfoliative materials are easily distinguishable as these are deposits on the surface of the IOL, as well as OCP or mass remnants that are clearly visible between the posterior aspect of the IOL and the posterior capsule of the saccule (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>One of the main limitations of this technique is the image resolution (usually 5–8 microns axial, and 20 microns transverse), which allows the detection of VMs above this size, thus underestimating the number of VMs detected in vitro. However, the influence of the detection of the smallest VMs is debated.In addition, it would be interesting to have some comparative study between OCT and LH photography for glistening assessment. However, a direct comparison of quantification and grading systems between LH photography (based on a frontal plane of the IOL) and the proposed OCT (based on a transverse plane of the IOL) is methodologically difficult.Classification proposals: glistening scaleThe quantification of IOL glistenings has been a matter of debate in different studies in order to find a reproducible, objective and examiner-independent method for in vivo examinations. Scales have typically been used to subjectively assess the degree of glistening observed through an IOL.<a class="elsevierStyleCrossRefs" href="#bib0020">4,46,53,54</a>At present, one of the most popular glistening classification systems is the Miyata scale, which is based on LH images and ranges from grade 0: no glistening, grade 1: up to 50/mm2, grade 2: up to 100/mm2 and grade 3: 200/mm2 (considered severe glistening).<a class="elsevierStyleCrossRef" href="#bib0265">53</a> Different authors consider that by biomicroscopic or LH scanning MVs smaller than 2 µm would not be detectable.<a class="elsevierStyleCrossRefs" href="#bib0130">26,42</a> Colin and Origna designed an automatic programme to measure the density of VMs formed in an IOL from images taken with LH, showing a high correlation with the subjective method.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Specifically, they analysed a core area of 0.75–2 mm using Image J, a digital image processing programme.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Sizes between 0 and 0.001 mm2 were set as limits for the Image J programme to recognise the VMs. Mean values for objective glistening grading were: 26 ± 43 MV/mm2 for grade 0, 152 ± 142 MV/mm2 for grade 1 and 261 ± 139 MV/mm2 for grade 2. Interestingly, in their study, only 4 lenses had >400 MV/mm2; the maximum observed density was 597 MV/mm2.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Stanojcic et al. carried out a similar approach to glistenings quantification by proposing the Saint Thomas scale.<a class="elsevierStyleCrossRef" href="#bib0270">54</a> The methodology used to classify glistenings was based on 10 × 2 mm central vertical LH images obtained at a 40-degree angle. The images were processed by adjusting the pupil, identifying its centre and superimposing a 1 × 3 mm grid divided into 1 mm areas2. Three ophthalmologists independently assessed and graded the images within the 3 defined 1 mm grids2 by counting the number of MVs. Grades of glistenings density were assigned to each 1 mm area2 according to an 8-point ordinal scale based on increments of 10 glistenings/mm2 from 0 (grade 0) to more than 60 (grade 7).To quantify the degree of glistening in an IOL, both the number and diameter of the VMs should be taken into account. Thus, Henriksen et al., also using photography, proposed that instead of classifying glistening based on the number of VMs, glistening should be classified into two groups according to the size of the VMs (6−25 µm and more than 25 µm).<a class="elsevierStyleCrossRef" href="#bib0230">46</a>In an in vitro analysis using binarisation and automatic quantification, Yildirim et al. proposed a modification of the Miyata scale, establishing: Grade 0 (<25 MV/mm2), grade 1 (25−100 MV/mm2), grade 2 (100−200 MV/mm2) and grade 3 (>200 MV/mm2).<a class="elsevierStyleCrossRef" href="#bib0185">37</a> Relevantly, they observed that the central section was the region with the highest glistening density.More recently, Fernandez-Vigo et al. classified the degree of glistening detected on the central pupillary OCT scan into four categories: 0: ≤5 MV; 1: 6–15 MV; 2: 16–30 MV; and 3: >30 MV.<a class="elsevierStyleCrossRef" href="#bib0225">45</a> Therefore, glistening was described as the absolute number of MV and a degree of severity was established. In this study, the mean number of VM in grade 0 was 1.0 ± 1.4; in grade 1 it was 9.6 ± 2.5; in grade 2 it was 20.7 ± 4.6 and in grade 3 it was 74.5 ± 46.2, with the highest number observed being 239.Impact on visual function and clinical relevanceAlthough symptoms of glistening may include glare, blurred vision or difficulties in dynamic light conditions, most studies report no apparent effect of glistening's influence on VA.<a class="elsevierStyleCrossRefs" href="#bib0015">3,7</a> For these reasons, along with others, IOL explantation has rarely been described in the literature as a consequence of glistening.<a class="elsevierStyleCrossRef" href="#bib0275">55</a> However, the full impact of glistening on postoperative visual function, and its long-term changes, has not yet been fully elucidated.What seems clear is that, considering that cataract surgery is being performed on younger and younger patients with increasing life expectancy, it is highly recommended that IOLs with minimal risk of changes in optical quality or transparency over time be implanted.<a class="elsevierStyleCrossRef" href="#bib0280">56</a> Based on this concern, the impact of IOL glistening on visual quality has long been a topic of debate.The main effect of glistening on vision appears to be an increase in intraocular light scatter,<a class="elsevierStyleCrossRef" href="#bib0285">57</a> which does not necessarily correlate with a decrease in VA or contrast sensitivity. Some authors have reported that intraocular light scatter increases proportionally with respect to the number of VMs<a class="elsevierStyleCrossRefs" href="#bib0055">11,31,48</a> and that smaller glistenings seem to create more scatter even at equal percentages of obscured area.<a class="elsevierStyleCrossRef" href="#bib0230">46</a> Thus, it has been described that it is even possible that VMs not visible during the LH examination may have clinical significance, also taking into account that the scatter of light entering the eye and perceived by the patient is 300 times stronger than the scatter that is reflected and seen by the external observer.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Regarding the clinical relevance of glistening, it has been observed in different studies that the effect of glistening on the quality of vision (measured by VA and contrast sensitivity) was limited or non-existent.<a class="elsevierStyleCrossRefs" href="#bib0285">57,58</a> In actual fact, these parameters reflect subjectively perceived in vivo image quality; but vision quality can also be measured objectively by the modulation transfer function (MTF). One study reported that only MVs larger than 10 µm induce a worsening of the MTF.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Furthermore, Weindler et al. demonstrated that it takes a fairly large number of glistenings (>500/mm2) to reduce the optical quality (MTF and Strehl ratio) and that, even in those cases of severe glistenings, the impact on the MTF and Strehl ratio remains low.<a class="elsevierStyleCrossRef" href="#bib0295">59</a> Oshika et al. also concluded that grade 4 glistening causes only a "slight deterioration" of the MTF.<a class="elsevierStyleCrossRefs" href="#bib0280">56,60</a> In this line of study, other grading systems have been proposed. Waite et al. suggested the use of a severity index, which was defined as the size of the flashes multiplied by the density of the flashes (% area),<a class="elsevierStyleCrossRef" href="#bib0290">58</a> or by analysing size as a measure of area (% area/size).<a class="elsevierStyleCrossRefs" href="#bib0230">46,48</a> Henriksen et al. concluded that the percentage glistening area, from a key size, correlated with random light scattering.<a class="elsevierStyleCrossRef" href="#bib0230">46</a> In another study, by evaluating the Strehl function, it was found that higher order aberrations have more impact on visual image quality than the presence of glistening.<a class="elsevierStyleCrossRef" href="#bib0295">59</a> The presence of glistening in grades 1–3 on the Miyata scale does not seem to affect post-surgical visual quality; however, IOLs with grade 4 do cause visual impairment, especially with reference to contrast sensitivity, light sensitivity and glare and glare phenomena. Interestingly, it has been reported that MTF function is decreased by glistening in multifocal IOLs due to the design of the lens itself compared to monofocal IOLs.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Finally, in an analysis carried out by Neuhann et al. on a sample of 200 explanted IOLs, only 2 lenses were found to be glistened, one from Alcon and one from Medennium.<a class="elsevierStyleCrossRef" href="#bib0275">55</a>Current limitations and future studiesAlthough some recent proposals have been made to achieve an objective quantification of glistening, the vast majority of studies are subjectively based on observations with LH.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Thus, the different methods used to quantify glistening in the study materials may explain some of the differences observed in the results of different publications. Accordingly, until a consistent, reproducible and examiner-independent method for glistening detection is available, it will be difficult to correlate findings between different studies.In what concerns the OCT approach, although it is a quick and easy, highly reproducible and easily objectifiable examination, its main limitation remains image resolution. However, this is an aspect that will most likely be overcome in the coming years with technology developments. The potential usefulness of OCT models other than those published remains to be demonstrated to assess their ability to identify glistening.There is a need for tools that provide an objective classification, allow prospective evaluation and can serve as a valid tool to study new IOL designs and materials. In this way, their resistance to glistening could be analysed in clinical trials prior to implantation of these lenses.In both LH and OCT imaging, it is difficult to establish a cut-off point for determining the size at which a VM is considered to be correctly identified. Recently developed materials focus on formulations that show minimal glistening, such as Alcon's recently introduced Clareon, an acrylic copolymer of 2-hydroxyethylmethacrylate combined with phenylethyl acrylate as a hydrophobic component to which a UV filter has been added.<a class="elsevierStyleCrossRefs" href="#bib0190">38,61</a> However, there is still no consensus or strict criteria to determine how many MV can be "tolerated" to label a certain IOL model as "glistening-free",<a class="elsevierStyleCrossRef" href="#bib0010">2</a> although traditionally most authors have used 50 MV/mm2 as the cut-off point.<a class="elsevierStyleCrossRef" href="#bib0265">53</a>Although much progress has been made in the assessment of glistening in recent years,<a class="elsevierStyleCrossRefs" href="#bib0310">62–66</a> future studies are needed to analyse whether glistening progresses over time in newer IOL models, with prolonged follow-up, ideally more than 20−25 years, being necessary. Cataract surgery is being performed on increasingly younger patients, a fact which, together with increasing life expectancy, means that newer implanted IOLs must maintain optical clarity or transparency for several decades.<a class="elsevierStyleCrossRefs" href="#bib0010">2,54</a> In fact, it has been reported that the presence of glistening increased up to 15 years post-operatively, with an increase in surface light scattering on the IOL surface.<a class="elsevierStyleCrossRefs" href="#bib0215">43,44,67</a>Finally, studies applying artificial intelligence such as deep learning-based algorithms that could provide an automatic description and classification of glistening in both LH and OCT, which could even predict its stability or progression, will be very relevant.ConclusionsIOL glistening is common, especially in hydrophobic acrylic lenses, and there are numerous risk factors that facilitate its occurrence. In addition to their analysis and quantification in vitro and by slit-lamp photography, quantification techniques based on the Scheimpflug chamber, and more recently optical coherence tomography, have been described in the past few years and may be useful alternatives in routine clinical practice. In recent years, with improvements in lens material, design and manufacture, this phenomenon has been greatly reduced. However, since it is a progressive phenomenon and its clinical relevance is only detectable in severe stages, follow-up and long-term evaluation is required in these patients.Conflict of interestsThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1955826" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1683383" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1955827" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1683384" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Concept and first descriptions" ] ] ] 5 => array:3 [ "identificador" => "sec0015" "titulo" => "Risk factors for glistening" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Manufacturing process" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "IOL design" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Pathologies" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Dioptric power" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "IOL material" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Occurrence and evolution of IOL glistening" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Evaluation methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "In vitro" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Slit lamp photography" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Scheimpflug chamber" ] 3 => array:2 [ "identificador" => "sec0070" "titulo" => "Optical coherence tomography (OCT)" ] 4 => array:2 [ "identificador" => "sec0075" "titulo" => "Classification proposals: glistening scale" ] 5 => array:2 [ "identificador" => "sec0080" "titulo" => "Impact on visual function and clinical relevance" ] ] ] 7 => array:2 [ "identificador" => "sec0085" "titulo" => "Current limitations and future studies" ] 8 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0091" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-14" "fechaAceptado" => "2023-06-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1683383" "palabras" => array:4 [ 0 => "Glistening" 1 => "Intraocular lens" 2 => "Opacification" 3 => "Optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1683384" "palabras" => array:5 [ 0 => "Glistening" 1 => "Tomografía de coherencia óptica" 2 => "Lente intraocular" 3 => "Catarata" 4 => "Opacificación lente intraocular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The glistening in intraocular lenses (IOLs) is a phenomenon in which tiny water-filled microvacuoles (MVs) form within the IOL material, causing light to scatter and create a sparkling or shimmering effect. The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence, risk factors, evolution, and possible clinical relevance. Classically, it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp, but these were techniques that required either specific technology or an expert explorer, complex image processing, and required a lot of time. In recent years, proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs. It has been described that the manufacturing process, the hydrophobic acrylic material, or the time since surgery are risk factors for the appearance of glistening. In addition, many issues related to this phenomenon are still unknown, such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El glistening en las lentes intraoculares (LIO) es un fenómeno en el que se forman diminutas microvacuolas (MV) llenas de agua dentro del material de la LIO, lo que hace que la luz se disperse y cree un efecto centelleante o reluciente. La presencia del glistening es frecuente en muchos tipos de materiales y modelos de LIO, y se ha estudiado ampliamente en los últimos años para conocer su incidencia, factores de riesgo, evolución y posible relevancia clínica. Clásicamente se ha estudiado in vitro en laboratorio o mediante fotografía obtenida con lámpara de hendidura. Sin embargo, eran técnicas que requerían o tecnología específica o un explorador experto, además de un complejo procesado de imágenes y mucho tiempo. En los últimos años, han surgido propuestas basadas en la cámara de Scheimpflug y en la tomografía de coherencia óptica como forma de simplificar el análisis del glistening en las LIOs. Se ha descrito que tanto el proceso de fabricación, como el propio material acrílico hidrofóbico, y el tiempo desde la cirugía son factores de riesgo relacionados con la aparición de glistening. Además, aún se desconocen numerosas cuestiones relacionadas con este fenómeno, como la cantidad de puntos o el tamaño de los mismos, necesarios para causar afectación de la función visual, ya que se han descrito diferentes fenómenos ópticos relacionados con el glistening de las LIOs." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1890 "Ancho" => 3341 "Tamanyo" => 350061 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Top row: Examples of intraocular lens (IOL) with a high number of microvacuoles or glistening in the lens optic as seen by slit-lamp photography. Bottom row: (B) Scheimpflug camera images of a patient with mild glistening (left), which is very difficult to see due to its limited resolution, and a patient with an opacified lens (bottom right) and associated increased densitometry." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2108 "Ancho" => 3341 "Tamanyo" => 364751 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Different severity of glistening assessed by OCT from lesser to greater presence of glistening (A–F)." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1219 "Ancho" => 3341 "Tamanyo" => 369481 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Optical coherence tomography (OCT) images of intraocular lens (IOL) optics. A) Glistening. B) IOL opacification showing hyper-reflective bands on the anterior and posterior aspect of the lens. C) Crystalline lens masses between the posterior aspect of the IOL and the capsular bag in a patient with hyper-reflective spots or glistening inside the optic. D) Posterior capsular opacity is seen as the presence of hyperreflective material in the space between the capsular bag and the posterior aspect of the IOL. It should be noted that the iris is inverted, but the image of the posterior capsule of the sac is correct." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "VA (Visual Acuity), CS (Contrast Sensitivity), SL (Slit Lamp), IOL (IntraOcular Lens), MTF (Modulation Transfer Function), MVs (MicroVacuoles), N/S (Not Specified), No. (numbers), PMMA (Polymethylmethacrylate), SS-OCT (Swept-Source Optical Coherence Tomography)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Studio \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Iols assessed \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IOL area assessed \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evaluation conditions \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Scale \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions of the study \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Miyata et al, 2000<a class="elsevierStyleCrossRef" href="#bib0310">62</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 LIO (MA60BM/MA30BA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5−20 months follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Miyata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57% of IOLs develop glistening within 2−16 months post-surgery. Glistening stabilises within months of onset. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tognetto et al, 2002<a class="elsevierStyleCrossRef" href="#bib0065">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 911A, 36 ACR6D, 37 AcrySof, 41 SI-40NB, 32 H60M, 40 Sensar, 30 Stabibag \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7, 30, 90, 180, 180, 360 and 720 days post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−3 (I mild II moderate III severe) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glistening was observed in all IOLs but higher % and density of MVs in AcrySof \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Miyata et al, 2009<a class="elsevierStyleCrossRef" href="#bib0315">63</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 MA60BM, 17 SA60AT, 16 AR40, 17 ClariFlex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scheimpflug in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 mm central IOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,6,12,24,36 months post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glistening at 3 years post-surgery higher in MA60BM and SA60AT than in AR60 and ClariFlex. VA without significant differences \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colin et al, 2011<a class="elsevierStyleCrossRef" href="#bib0020">4</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 MA, 15 SA60AT, 41 SN60AT, 37 SN60WF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.75 × 2 mm central IOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic counting. 18  ± 13 months monitoring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No correlation found between the degree of glistening and IOL/VA power/contrast sensitivity/scattering. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hayashi et al, 2012<a class="elsevierStyleCrossRef" href="#bib0285">57</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 acrylics (MA60BM), 35 silicone, 35 PMMA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manual counting (2 ophthalmologists) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Miyata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Light scattering and glistening are not significantly related to visual function and optical aberrations. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thomes et al, 2013<a class="elsevierStyleCrossRef" href="#bib0070">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 SB30AL [2003], 270 SN60WF [2012]. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 mm2: at 0.6, 1.6 and 2.6 mm from the edge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic counting (zone with + MVs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absolute numbers only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IOLs manufactured in 2012 show significantly less glistening compared to those manufactured in 2003. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Biwer et al, 2015<a class="elsevierStyleCrossRef" href="#bib0080">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 monofocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL + Scheimpflug in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variable area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic + manual counting. 6 months post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−4 (IV > 40 MV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manual and automatic counts at SL showed moderate correlation. Scheimpflug images do not have sufficient resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Henriksen et al, 2015<a class="elsevierStyleCrossRef" href="#bib0190">38</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 SN60WF, 36 SN60AT, 4 SN60T5, 1 SN60T4, 1 SN60T3, 1 SN6AD3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5−1 mm2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic counting. 1−4 years post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diameter MV 6−25 and > 25 microns \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The area affected by glistening correlates with light scatter. IOL age affects both MVs size and VA. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Labuz et al, 2017<a class="elsevierStyleCrossRef" href="#bib0155">31</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 SN60WF, 2 SN60AT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic + manual counting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absolute numbers only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Light deflection is proportional to the number of MVs and IOL area affected. Numerous glistenings are necessary to cause significant light deflection. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oshika et al, 2018<a class="elsevierStyleCrossRef" href="#bib0335">67</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 hydrophobic (MA30BA/MA60BM), 37 silicone, 30 PMMA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15−21 years of follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glistening is more frequent in hydrophobics than in silicone and PMMA. However, VA and CS with no significant differences \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Labuz et al, 2018 <a class="elsevierStyleCrossRef" href="#bib0075">15</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 601P, 5 PY60AD, 5 SN60WF, 5 MA60AC, 5 NS60YG, 5 Avansee \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central and/or peripheral area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic counting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absolute numbers only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Greater glistening in PY60D (3058−4061 MV/mm2). No glistening was observed in Avansee. Light scattering is related to the number of MV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Werner et al, 2019<a class="elsevierStyleCrossRef" href="#bib0230">46</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 CNA0T0, 30 ZCB00, 30 ZCB00V, 30 W-60, 30 MX60, 30 XY1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Edge, mid-periphery, centre IOL and area with more glistening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absolute numbers only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CNA0T0, W-60 and MX60: IOLs with less glistening \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weindler et al, 2019<a class="elsevierStyleCrossRef" href="#bib0295">59</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 SA60AT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−4 (IV > 500 MV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glistening < 500 MV/mm2 does not affect the quality of vision. In glistening grade IV (>500) FTM and Strehl radius are affected. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stanojcic et al, 2019<a class="elsevierStyleCrossRef" href="#bib0270">54</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 SA60AT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 × 1 mm, central area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manual counting (3 ophthalmologists) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−7 (VII > 61 MV), Miyata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glistening does not correlate with VA, CS or light scattering. New glistening quantification scale (grades 0−7) proposed. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oshika et al, 2020<a class="elsevierStyleCrossRef" href="#bib0280">56</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110 Clareon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Day 1, week 1, months 1, 6 and 12 post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No glistening was observed in Clareon in the first 12 months after surgery. At 9 years, 20 were evaluated with no MVs found. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stanojcic et al, 2020<a class="elsevierStyleCrossRef" href="#bib0010">2</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">140 Clareon, 134 PCB00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 areas of 1mm2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manual counting (3 ophthalmologists). 12 months post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 0−7 (and Miyata) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Minimal glistening (mean grade 0) between Clareon and PCB00, with no significant differences (in glistening or VA). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borghesi et al, 2020<a class="elsevierStyleCrossRef" href="#bib0320">64</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basis V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.2 mm2, 30 photos (one shot every 23 microns thickness) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic counting + 2 observers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absolute numbers only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The density of MVs decreases near the edges of the IOL, and follows normal distribution along the thickness of the IOL. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yildrim et al, 2020<a class="elsevierStyleCrossRef" href="#bib0220">44</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 ASHFY600, 10 SN60WF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 sections of each IOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Miyata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">More frequent glistening in centre section. ASHFY600 more resistant to glistening than SN60WF (0.52+/-0.24 MVs VS 41.84+/-27.67 MVs). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yildrim et al, 2021<a class="elsevierStyleCrossRef" href="#bib0025">5</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 800C, 5 SN60WF, 5 ZCB00, 5 XY1, 5 611P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.63 mm2 central \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Modified Miyata (III > 200 MV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glistening in IOLs: SN60WF (66+/-45.5) > 611 P (30.7+/-8.4) > 800C (2.0+/-3.6) and XY1 (2.7+/-2.4) > ZCB00 (0.9+/-0.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wang et al, 2021<a class="elsevierStyleCrossRef" href="#bib0190">38</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 MA30BA/MA60AC [1990], 5 MA60AC, 5 SA60AT, 5 TFNT00 and 5 SN60WF [2014−2017], 5 Clareon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic counting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Modified Miyata (III > 200 MV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IOLs manufactured in 1990 with significantly higher glistening compared to IOLs manufactured in 2014−2017. Clareon minimum glistening (grade 0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oshika et al, 2021<a class="elsevierStyleCrossRef" href="#bib0300">60</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">384 Clareon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 day, 1 week, 1, 6 and 12 months post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Modified Miyata (III > 151 MV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clareon does not develop glistening in the first postoperative year. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kawai et al, 2021<a class="elsevierStyleCrossRef" href="#bib0325">65</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 SN60WF, 5 XY1, 5 NS60YG, 5 ZCB00V, 5 AN6KA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In vitro induction + SL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Automatic counting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absolute numbers only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SN60WF showed higher glistening for a longer time. XYI, SN60WF and AN6K showed signs of degradation, NS-60YG and ZCB00 V did not. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lehmann et al, 2021<a class="elsevierStyleCrossRef" href="#bib0330">66</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">350 SY60CL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SL in vivo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 st day, 1st week, 1, 6 and 12 months post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not quantify \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">At 12 months post-surgery, no glistening was observed in any of the lenses. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fernández-Vigo et al, 2023<a class="elsevierStyleCrossRef" href="#bib0185">37</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">150 SN60WF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SS-OCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central zone IOL (3 mm)2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manual counting (2 ophthalmologists). Minimum 600 days post-surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grades 0−3 (III > 30 MVs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of SS-OCT facilitates the identification, quantification and classification of the degree of glistening in an objective and reproducible manner. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3255629.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary of the main published studies on the occurrence of glistening in different lens models." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:67 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of late intraocular lens opacifications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. 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Review

Glistening on intraocular lenses: A review

El glistening de las lentes intraoculares: revisión de la literatura

J.I. Fernández-Vigoa,b,

Corresponding author

jfvigo@hotmail.com

Corresponding author.

, M.T. Serrano González-Peramatoc, C. Nunila Gómez-de-Liañoa, I. Sánchez-Guillénc,d, J.Á. Fernández-Vigob,d,e, A. Macarro-Merinob,d

a Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain

b Centro Internacional de Oftalmología Avanzada, Madrid, Spain

c Servicio de Oftalmología, Hospital Perpetuo Socorro, Badajoz, Spain

d Centro Internacional de Oftalmología Avanzada, Badajoz, Spain

e Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain

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two major complications specifically related to the loss of transparency of IOLs have been described&#46; The first&#44; severe but infrequent&#44; is IOL opacification&#59; while the second&#44; glistening&#44; is more frequent but classically described as less important&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">IOL glistening is a process of formation of small &#40;usually 1&#8211;20&#8239;&#181;m&#41; whitish or yellowish shiny spots corresponding to fluid-filled microvacuoles &#40;MVs&#41; that appear inside the IOL after implantation when interacting with an aqueous medium&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7</span></a> The mechanism that would explain their formation is the absorption of water by the IOL polymer&#44; which forms MVs within the lens material&#46; The difference in the refractive index between the water and the IOL polymer causes light to refract producing a scattering effect when hitting the VMs&#44; resulting in their characteristic appearance on slit lamp examination &#40;SLL&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Thus&#44; the greater the difference between the refractive indices of the lens material and the water&#44; the greater the induced glistening&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This phenomenon was first observed by Norman Ballin in 1984 in a Surgidev Leiske lens &#40;Surgidev Corp&#46;&#44; CA&#44; USA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which he described as glittering inclusions in the lens body&#44; similar to the presence of anterior chamber cells&#46; After this&#44; successive descriptions of this glistening phenomenon in the IOL material were made in in vitro analyses and in clinical practice after LH examinations&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11&#8211;15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Different authors state that it cannot really be considered as a degenerative process of the IOL material&#44; but as something intrinsic to it&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Another area of interest to be studied is nanoglistening&#44; which&#44; unlike glistening&#44; occurs only on the lens surface and is due to lens degradation by hydrolysis&#44; resulting in non-homogeneous lens surfaces&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> They are water vacuoles about 200&#8239;nm in diameter and located up to 120&#8239;&#181;m from the IOL surface&#46; They can be very difficult to detect on conventional clinical examination and are described as a whitish appearance of the lens under tangential illumination&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They have been described both in vitro and using the Scheimpflug chamber with densitometry and are described as progressive&#46; Further studies are needed to analyse its possible influence or clinical significance&#44; although it has been reported to increase light scattering on the IOL surface&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Risk factors for glistening</span><p id="par0035" class="elsevierStylePara elsevierViewall">As described by several authors&#44; IOL glistening is influenced by multiple factors such as the manufacturing process&#44; the packaging system&#44; temperature changes&#44; equilibrium of water content&#44; IOL model and power&#44; blood-retinal or blood-aqueous barrier disruption&#44; and postoperative inflammation&#44; especially in combined surgeries&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7&#44;16&#44;17</span></a> In addition&#44; it has been described in both children and adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Manufacturing process</span><p id="par0040" class="elsevierStylePara elsevierViewall">The IOL manufacturing process is known to influence the formation of glistening&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The different methods of IOL production correspond to techniques that can inherently give very different results in terms of the risk of glistening&#46; In the method known as lathing&#44; the polymerisation from the initial material is more homogeneous&#44; which makes glistening more unlikely&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> On the other hand&#44; the technique known as moulding favours the formation of spaces inside the material which&#44; when implanted in the eye and subjected to hydration and temperature changes&#44; can lead to the formation of VM&#46; Another factor to be highlighted is the packaging&#44; a manufacturing process that has been fundamental in conditioning the visual performance of IOLs&#44; as it reduces glistening by optimising temperature control and humidity conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">IOL design</span><p id="par0045" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Edges&#58; The square-edged design of the IOL has been shown to have a lower incidence of posterior capsule opacification&#44; which is a determining factor in fibrosis proliferation&#46; However&#44; it does not play a relevant role in glistening proliferation&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Preservative medium&#58; the osmolarity of the aqueous medium surrounding the IOL influences the formation of glistening&#44; so that lenses preserved in 10&#37; saline induce an osmotic pressure difference after implantation&#44; which may increase glistening&#46; Studies with the EnVista IOL &#40;Bausch &#38; Lomb&#44; Inc&#44; Rochester&#44; NY&#44; USA&#41; have shown that by varying the saline concentration from 10&#37; to 0&#46;9&#37; the formation of MVs disappears&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Temperature&#58; Temperature changes are largely responsible for the mechanism of glistening formation&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;24</span></a> Small changes in the temperature surrounding the lens induce the breakdown of the polymer network&#44; altering the water balance and promoting the formation of glistening&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Contact with the lens capsule and the presence of anterior capsule opacity have been described as another possible cause&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pathologies</span><p id="par0070" class="elsevierStylePara elsevierViewall">There is a direct relationship between glistening and alteration of the blood-aqueous barrier&#46; This can be altered in multiple situations such as diabetes mellitus&#44; anterior uveitis&#44; glaucoma &#40;as a consequence of the pathology itself or associated with the use of topical hypotensive drugs&#41;&#44; post-surgical inflammatory reactions or inflammatory diseases&#59; so it is relevant in the formation of these VMs&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;17&#44;20&#44;24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#8211;29</span></a> In addition&#44; longer intraoperative times or more complex surgeries may also have the same effect&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dioptric power</span><p id="par0075" class="elsevierStylePara elsevierViewall">IOL power and IOL-derived thickness have been studied in relation to glistening&#44; although most of the published results concur in the independence of IOL formation in relation to the dioptric power of the IOLs&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> However&#44; there are other studies that find a greater correlation in IOLs with greater dioptric power and&#44; therefore&#44; greater thickness&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;26&#44;31</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">IOL material</span><p id="par0080" class="elsevierStylePara elsevierViewall">Although glistening has been observed in a wide variety of materials&#44; including silicone&#44; hydrogel and polymethylmethacrylate &#40;PMMA&#41; IOLs&#44; it is particularly common in hydrophobic acrylic IOLs&#46; <a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#44;32&#8211;34</span></a> These lenses repel water&#44; and are designed from different monomers&#46; These monomers combined in different proportions in various polymer chains produce multiple combinations in terms of IOL composition&#44; which represent different characteristics and propensity of IOLs to develop glistening&#46; Due to their versatility and characteristics&#44; hydrophobic acrylic IOLs have become the most widely used IOLs today&#44; allowing implantation through smaller incisions due to the flexibility of the material&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">One of the first IOLs in which the presence of glistening was described was the Acrysof lens &#40;Alcon&#44; Fort Worth&#44; Texas&#44; USA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> In particular&#44; one of the most widely implanted hydrophobic lens models worldwide is the AcrySof SN60WF &#40;Alcon&#44; Fort Worth&#44; Texas&#44; USA&#41;&#44; considered to have one of the lowest rates of posterior capsular opacification &#40;PCO&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and has been one of the most studied IOLs in relation to glistening&#46; In 2012&#44; Colin et al&#46; included in their study 111 eyes in which AcrySof SN60WF was implanted&#44; and found glistening in 86&#46;5&#37; of them&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Later&#44; Johansson conducted a prospective&#44; randomised&#44; intraindividual clinical trial in which he observed a high number of glistening in most of the implanted SN60WF IOLs&#44; which increased between the second and third year of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Some other hydrophobic acrylic IOLs have also shown glistening&#44; but generally at lower rates&#46; As published by Yildirim et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> their analysis revealed that the SN60WF and CT Lucia 611&#8239;P IOL &#40;Zeiss&#44; Oberkochen&#44; Germany&#41; showed the highest number of MV&#47;mm<span class="elsevierStyleSup">2</span>&#44; being 66&#46;0&#8239;&#177;&#8239;45&#46;5 and 30&#46;7&#8239;&#177;&#8239;8&#46;4&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> respectively&#46; The 800C &#40;Rayner&#44; Worthing&#44; UK&#41; and Vivinex XY1 &#40;Hoya Inc&#44; Chino Hills&#44; CA&#44; USA&#41; showed similar values with 2&#46;0&#8239;&#177;&#8239;3&#46;6 and 2&#46;7&#8239;&#177;&#8239;2&#46;4&#8239;MVs&#47;mm<span class="elsevierStyleSup">2</span>&#44; respectively&#44; with the Tecnis ZCB00 &#40;Johnson &#38; Johnson Vision Care&#44; Santa Ana&#44; USA&#41; showing the lowest number&#44; being 0&#46;9&#8239;&#177;&#8239;0&#46;6 MVs&#47;mm<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The reasons why some lenses are more prone to develop glistening than others remain unclear&#46; In the meantime&#44; different IOL manufacturers have tried to improve their manufacturing process to provide lenses that are more resistant to material changes and reduce glistening&#46; This manufacturing progress was noted in 2013 by Thomes and Callaghan&#44; who compared AcrySof IOLs &#40;Alcon&#44; Fort Worth&#44; Texas&#44; USA&#41; manufactured in 2003 with those manufactured in 2012&#44; observing a large decrease from 315&#46;7&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> to 39&#46;9&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In 2021&#44; Yildirim et al&#46; published a reduction also in glistening in Lucia 611&#8239;P lenses &#40;Zeiss&#44; Oberkochen&#44; Germany&#41; &#40;30&#46;7&#8239;&#177;&#8239;8&#46;4&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#41; compared to their predecessors CT Lucia 601&#8239;P &#40;85&#8239;&#177;&#8239;86&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#44; which had been analysed in a previous study&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Recently&#44; Stanojcic et al&#46; compared two hydrophobic acrylic aspheric monofocal IOLs &#8211; Clareon&#44; &#40;Alcon&#44; Fort Worth&#44; Texas&#44; USA&#41; and Tecnis PCB00 &#40;Johnson &#38; Johnson Vision Care&#44; Santa Ana&#44; USA&#41; &#8211; in terms of glistening occurrence&#44; observing that at 12 months they were minimal &#40;median grade 0&#41;&#44; with no difference in grades between the groups &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In addition to improving the IOL manufacturing process&#44; modification of the IOL polymer itself is becoming increasingly important&#46; Thus&#44; the term &#39;hygroscopy&#39; refers to the ability of a material to retain water in its interior&#46; By adding monomers with a large number of hydrophilic groups to IOLs&#44; water entering the material binds to these groups instead of accumulating in vacuoles&#46; Therefore&#44; the more hygroscopic a material is&#44; the higher its equilibrium in water content &#40;EWC&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Hydrophobic acrylic lenses considered standard have a very low EWC &#40;&#60;0&#46;5&#37;&#41;&#44; unlike new models such as the Clareon CNA0T0 &#40;Alcon&#44; Fort Worth&#44; Texas&#44; USA&#41;&#44; Eternity W-60 &#40;Santen Inc&#44; CA&#44; USA&#41; and enVista MX60 &#40;Bausch &#38; Lomb&#44; Inc&#44; Rochester&#44; NY&#44; USA&#41; IOLs&#44; with an EWC ranging from 1&#46;5&#37; to 4&#37;&#46; These new materials exhibit hydrophobic characteristics&#44; but at the same time are considered to be glistening-free&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In 2019&#44; Werner et al&#46; objectified these findings&#44; as their results showed significantly lower MV density and size in Clareon CNA0T0 &#40;Alcon&#44; Fort Worth&#44; Texas&#44; USA&#41; compared to Tecnis ZCB00&#44; ZCB00&#8239;V &#40;Johnson &#38; Johnson Vision Care&#44; Santa Ana&#44; USA&#41;&#44; and Vivinex XY1 &#40;Hoya Surgical Optics&#44; Inc&#46; Chino Hills&#44; CA&#44; USA&#41;&#44; while no significant differences were found between Clareon CNA0T0 &#40;Alcon&#44; Fort Worth&#44; Texas&#44; USA&#41; versus Eternity W-60 &#40;Santen Inc&#44; CA&#44; USA&#41; &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;413 for density and <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;565 for size&#41; and inVista MX60 &#40;Bausch &#38; Lomb&#44; Inc&#44; Rochester&#44; NY&#44; USA&#41; &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;516 for density and <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;642 for size&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In diffractive multifocal lenses the presence of glistening would be more significant due to the lens geometry&#46; Thus&#44; in IOLs with Acrysof material&#44; a higher incidence of glistening has been described in multifocal geometry compared to monofocal lenses&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9&#44;13&#44;40</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the main studies that have been carried out in the evaluation of glistening in different IOL models&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Occurrence and evolution of IOL glistening</span><p id="par0115" class="elsevierStylePara elsevierViewall">It has been reported that their presence can be detected as early as one week after IOL implantation&#46; There are studies that report its appearance one month or several months after the intervention&#44; and it may remain stable over time in number and size after reaching a plateau phase according to some authors<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;41</span></a> or it may evolve and increase over time according to others&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;42</span></a> It has been reported that the incidence of glistening tends to increase 90 days after implantation in most cases&#44; with the exception of Acrysoft&#44; where there are published cases of an increase even 15 years after surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;44</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Recently&#44; by means of OCT&#44; our group has also found that glistening increases with lens implantation time&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> and may affect different visual parameters as will be seen later&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> Glistening usually starts in the centre of the lens and extends towards the periphery&#44; while the rim and haptic surfaces are usually free of vacuoles&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Evaluation methods</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">In vitro</span><p id="par0125" class="elsevierStylePara elsevierViewall">One of the main methods for the assessment of glistening or VMs in the IOL is in vitro study in the laboratory using a microscope&#46; This allows direct observation and analysis of the size and density of the VMs at a given temperature and location&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Different methodologies have been applied for the assessment of glistening in vitro&#44; such as the one proposed by Yildirim et al&#46; in which the number of MVs in the central area and in four peripheral IOL sections were assessed&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> For image analysis one of the most commonly used methodologies is to apply an automated thresholding system&#44; in which the image contrast and glistening are optimised to create a binary &#40;black and white&#41; image&#46; The software can then automatically calculate the number of MVs&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There are different laboratory techniques to induce the appearance of glistening by introducing the IOL into an aqueous medium with certain characteristics and temperature&#46; In this way&#44; it is possible to simulate what happens under physiological conditions and to predict the evolution of glistening over time&#46; Although the appearance or appearance of glistening may be somewhat exaggerated with respect to the real clinical situation&#44; these techniques are really interesting for investigating IOL materials that are going to be implanted&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Slit lamp photography</span><p id="par0140" class="elsevierStylePara elsevierViewall">Slit lamp &#40;SL&#41; photography is considered the standard reference technique in clinical practice for the evaluation of glistening&#44; which is detected as small bright spots inside the IOL&#46; Its main advantage is its direct visualisation in clinical practice &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; Most authors quantify them subjectively&#44; based on a grading scale&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">However&#44; said technique has several drawbacks&#46; Firstly&#44; it requires an expert examiner with great photographic skill to obtain quality images of the IOL and to be able to assess glistening in a completely standardised way&#46; This is because photography can be hampered by numerous factors such as lighting conditions &#40;flash or backlight&#41;&#44; the plane or angle of the photograph&#44; size of the slit&#44; pupillary dilation&#44; transparency of the media and the brightness of the screen on which it is analysed&#46; In addition&#44; areas of the photograph that are slightly out of focus are not accurately displayed and the lighting on the different planes due to the thickness of the lens is not completely homogeneous&#44; so that some glistening may go unnoticed and will not be taken into account&#46; Therefore&#44; although it is done in a standardised way&#44; there is some variability depending on the criteria of the person taking the photo and the examiner who evaluates and quantifies the brightness&#46; Finally&#44; it is a time-consuming technique as complex post-processing of the images is required to assess and quantify glistening&#46; Thus&#44; it is not a fast method where quantification can be done on the fly during a clinical visit&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The lack of an objective and independent examiner and a reproducible method for the assessment of glistening in vivo is a common problem&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Thus&#44; we find that each study applies its own protocol when taking LH microscopic images for analysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;12&#44;14&#44;15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> Furthermore&#44; there is no consensus on the size of the IOL region to be assessed&#44; the magnification&#44; the plane along the thickness of the lens to be examined&#44; the number of regions studied within the IOL or the number of photographs of each sample to be taken&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Scheimpflug chamber</span><p id="par0155" class="elsevierStylePara elsevierViewall">Recently&#44; several authors have proposed the use of devices based on the Scheimpflug camera to assess and classify glistening in the IOL&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> This technology uses a rotational camera to analyse and reconstruct the structures of the ocular anterior segment&#44; allowing measurements to be taken&#46; It typically captures 25 images per scan&#46; However&#44; this technology does not provide images of sufficient resolution to perform automated glistening counting and classification&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and D&#41;&#46; This technology has been proposed for glistening assessment because it is more objective and less scanner-dependent than LH photography&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In 2015&#44; Biwer et al&#46; used a specially designed digital image analysis programme &#40;Matlab&#44; Mathworks&#44; CA&#44; USA&#41; to automatically count MVs or visible glistening in Scheimpflug images&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> They encountered two main difficulties&#58; firstly&#44; the exported Scheimpflug images did not have sufficient resolution for the digital analysis programme&#59; and secondly&#44; the manifestation of glistening was lower in the Scheimpflug images than in the slit-lamp examination&#44; which made them difficult to distinguish from different image artefacts&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Optical coherence tomography &#40;OCT&#41;</span><p id="par0165" class="elsevierStylePara elsevierViewall">To date&#44; no objective&#44; rapid and reproducible method has been described for the assessment of IOL glistening in clinical practice&#46; However&#44; in recent years some authors have used OCT for this purpose&#46; Werner et al&#46; were the first authors to observe glistening using anterior segment OCT &#40;AS-OCT&#41; by <span class="elsevierStyleItalic">ex vivo</span> analysis of hydrophobic acrylic IOLs explanted due to various complications&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> They stated that this technique was useful for analysing the location and density of glistening&#44; observing that glistening was homogeneously distributed within the entire optic&#44; although sometimes it was absent in a small area&#46; Subsequently&#44; in 2019&#44; Tripathy and Sridhar published an image of IOL glistening via OCT in a patient&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Very recently&#44; our group has proposed the usefulness of OCT in the evaluation of IOL glistening&#44; in a simple and objective way&#44; observed as hyper-reflective spots within the lens optics&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; High reproducibility of this method and high correlation between horizontal and vertical scans was observed&#46; In addition&#44; one of the main advantages of OCT is that it assesses almost the entire optic in an OCT-scan&#44; which is approximately 3&#8239;mm<span class="elsevierStyleSup">2</span> &#40;6&#8239;mm length and 0&#46;5&#8239;mm IOL thickness&#41;&#44; and does not analyse only a small area of 1&#8239;mm<span class="elsevierStyleSup">2</span> as is usually the case with LH-based photography&#46; Another advantage is that it allows a cube or sweep to be made in just a few seconds&#44; so that multiple slices covering the entire optical zone can be assessed&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">In contrast to glistening VMs&#44; pigment deposits or pseudo-exfoliative materials are easily distinguishable as these are deposits on the surface of the IOL&#44; as well as OCP or mass remnants that are clearly visible between the posterior aspect of the IOL and the posterior capsule of the saccule &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">One of the main limitations of this technique is the image resolution &#40;usually 5&#8211;8 microns axial&#44; and 20 microns transverse&#41;&#44; which allows the detection of VMs above this size&#44; thus underestimating the number of VMs detected in vitro&#46; However&#44; the influence of the detection of the smallest VMs is debated&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In addition&#44; it would be interesting to have some comparative study between OCT and LH photography for glistening assessment&#46; However&#44; a direct comparison of quantification and grading systems between LH photography &#40;based on a frontal plane of the IOL&#41; and the proposed OCT &#40;based on a transverse plane of the IOL&#41; is methodologically difficult&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Classification proposals&#58; glistening scale</span><p id="par0190" class="elsevierStylePara elsevierViewall">The quantification of IOL glistenings has been a matter of debate in different studies in order to find a reproducible&#44; objective and examiner-independent method for in vivo examinations&#46; Scales have typically been used to subjectively assess the degree of glistening observed through an IOL&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;46&#44;53&#44;54</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">At present&#44; one of the most popular glistening classification systems is the Miyata scale&#44; which is based on LH images and ranges from grade 0&#58; no glistening&#44; grade 1&#58; up to 50&#47;mm<span class="elsevierStyleSup">2</span>&#44; grade 2&#58; up to 100&#47;mm<span class="elsevierStyleSup">2</span> and grade 3&#58; 200&#47;mm<span class="elsevierStyleSup">2</span> &#40;considered severe glistening&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> Different authors consider that by biomicroscopic or LH scanning MVs smaller than 2&#8239;&#181;m would not be detectable&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;42</span></a> Colin and Origna designed an automatic programme to measure the density of VMs formed in an IOL from images taken with LH&#44; showing a high correlation with the subjective method&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Specifically&#44; they analysed a core area of 0&#46;75&#8211;2&#8239;mm using Image J&#44; a digital image processing programme&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Sizes between 0 and 0&#46;001&#8239;mm<span class="elsevierStyleSup">2</span> were set as limits for the Image J programme to recognise the VMs&#46; Mean values for objective glistening grading were&#58; 26&#8239;&#177;&#8239;43&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> for grade 0&#44; 152&#8239;&#177;&#8239;142&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> for grade 1 and 261&#8239;&#177;&#8239;139&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> for grade 2&#46; Interestingly&#44; in their study&#44; only 4 lenses had &#62;400&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#59; the maximum observed density was 597&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Stanojcic et al&#46; carried out a similar approach to glistenings quantification by proposing the Saint Thomas scale&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> The methodology used to classify glistenings was based on 10&#8239;&#215;&#8239;2&#8239;mm central vertical LH images obtained at a 40-degree angle&#46; The images were processed by adjusting the pupil&#44; identifying its centre and superimposing a 1&#8239;&#215;&#8239;3&#8239;mm grid divided into 1&#8239;mm areas<span class="elsevierStyleSup">2</span>&#46; Three ophthalmologists independently assessed and graded the images within the 3 defined 1&#8239;mm grids<span class="elsevierStyleSup">2</span> by counting the number of MVs&#46; Grades of glistenings density were assigned to each 1&#8239;mm area<span class="elsevierStyleSup">2</span> according to an 8-point ordinal scale based on increments of 10 glistenings&#47;mm<span class="elsevierStyleSup">2</span> from 0 &#40;grade 0&#41; to more than 60 &#40;grade 7&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">To quantify the degree of glistening in an IOL&#44; both the number and diameter of the VMs should be taken into account&#46; Thus&#44; Henriksen et al&#46;&#44; also using photography&#44; proposed that instead of classifying glistening based on the number of VMs&#44; glistening should be classified into two groups according to the size of the VMs &#40;6&#8722;25&#8239;&#181;m and more than 25&#8239;&#181;m&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">In an in vitro analysis using binarisation and automatic quantification&#44; Yildirim et al&#46; proposed a modification of the Miyata scale&#44; establishing&#58; Grade 0 &#40;&#60;25&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#44; grade 1 &#40;25&#8722;100&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#44; grade 2 &#40;100&#8722;200&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#41; and grade 3 &#40;&#62;200&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> Relevantly&#44; they observed that the central section was the region with the highest glistening density&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">More recently&#44; Fernandez-Vigo et al&#46; classified the degree of glistening detected on the central pupillary OCT scan into four categories&#58; 0&#58; &#8804;5 MV&#59; 1&#58; 6&#8211;15&#8239;MV&#59; 2&#58; 16&#8211;30&#8239;MV&#59; and 3&#58; &#62;30&#8239;MV&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> Therefore&#44; glistening was described as the absolute number of MV and a degree of severity was established&#46; In this study&#44; the mean number of VM in grade 0 was 1&#46;0&#8239;&#177;&#8239;1&#46;4&#59; in grade 1 it was 9&#46;6&#8239;&#177;&#8239;2&#46;5&#59; in grade 2 it was 20&#46;7&#8239;&#177;&#8239;4&#46;6 and in grade 3 it was 74&#46;5&#8239;&#177;&#8239;46&#46;2&#44; with the highest number observed being 239&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Impact on visual function and clinical relevance</span><p id="par0220" class="elsevierStylePara elsevierViewall">Although symptoms of glistening may include glare&#44; blurred vision or difficulties in dynamic light conditions&#44; most studies report no apparent effect of glistening&#39;s influence on VA&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7</span></a> For these reasons&#44; along with others&#44; IOL explantation has rarely been described in the literature as a consequence of glistening&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> However&#44; the full impact of glistening on postoperative visual function&#44; and its long-term changes&#44; has not yet been fully elucidated&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">What seems clear is that&#44; considering that cataract surgery is being performed on younger and younger patients with increasing life expectancy&#44; it is highly recommended that IOLs with minimal risk of changes in optical quality or transparency over time be implanted&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> Based on this concern&#44; the impact of IOL glistening on visual quality has long been a topic of debate&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The main effect of glistening on vision appears to be an increase in intraocular light scatter&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a> which does not necessarily correlate with a decrease in VA or contrast sensitivity&#46; Some authors have reported that intraocular light scatter increases proportionally with respect to the number of VMs<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;31&#44;48</span></a> and that smaller glistenings seem to create more scatter even at equal percentages of obscured area&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> Thus&#44; it has been described that it is even possible that VMs not visible during the LH examination may have clinical significance&#44; also taking into account that the scatter of light entering the eye and perceived by the patient is 300 times stronger than the scatter that is reflected and seen by the external observer&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Regarding the clinical relevance of glistening&#44; it has been observed in different studies that the effect of glistening on the quality of vision &#40;measured by VA and contrast sensitivity&#41; was limited or non-existent&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">57&#44;58</span></a> In actual fact&#44; these parameters reflect subjectively <span class="elsevierStyleItalic">perceived</span> in vivo image quality&#59; but vision quality can also be measured objectively by the modulation transfer function &#40;MTF&#41;&#46; One study reported that only MVs larger than 10&#8239;&#181;m induce a worsening of the MTF&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Furthermore&#44; Weindler et al&#46; demonstrated that it takes a fairly large number of glistenings &#40;&#62;500&#47;mm<span class="elsevierStyleSup">2</span>&#41; to reduce the optical quality &#40;MTF and Strehl ratio&#41; and that&#44; even in those cases of severe glistenings&#44; the impact on the MTF and Strehl ratio remains low&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> Oshika et al&#46; also concluded that grade 4 glistening causes only a &#34;slight deterioration&#34; of the MTF&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56&#44;60</span></a> In this line of study&#44; other grading systems have been proposed&#46; Waite et al&#46; suggested the use of a severity index&#44; which was defined as the size of the flashes multiplied by the density of the flashes &#40;&#37; area&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> or by analysing size as a measure of area &#40;&#37; area&#47;size&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">46&#44;48</span></a> Henriksen et al&#46; concluded that the percentage glistening area&#44; from a key size&#44; correlated with random light scattering&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> In another study&#44; by evaluating the Strehl function&#44; it was found that higher order aberrations have more impact on visual image quality than the presence of glistening&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> The presence of glistening in grades 1&#8211;3 on the Miyata scale does not seem to affect post-surgical visual quality&#59; however&#44; IOLs with grade 4 do cause visual impairment&#44; especially with reference to contrast sensitivity&#44; light sensitivity and glare and glare phenomena&#46; Interestingly&#44; it has been reported that MTF function is decreased by glistening in multifocal IOLs due to the design of the lens itself compared to monofocal IOLs&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Finally&#44; in an analysis carried out by Neuhann et al&#46; on a sample of 200 explanted IOLs&#44; only 2 lenses were found to be glistened&#44; one from Alcon and one from Medennium&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a></p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Current limitations and future studies</span><p id="par0245" class="elsevierStylePara elsevierViewall">Although some recent proposals have been made to achieve an objective quantification of glistening&#44; the vast majority of studies are subjectively based on observations with LH&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Thus&#44; the different methods used to quantify glistening in the study materials may explain some of the differences observed in the results of different publications&#46; Accordingly&#44; until a consistent&#44; reproducible and examiner-independent method for glistening detection is available&#44; it will be difficult to correlate findings between different studies&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">In what concerns the OCT approach&#44; although it is a quick and easy&#44; highly reproducible and easily objectifiable examination&#44; its main limitation remains image resolution&#46; However&#44; this is an aspect that will most likely be overcome in the coming years with technology developments&#46; The potential usefulness of OCT models other than those published remains to be demonstrated to assess their ability to identify glistening&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">There is a need for tools that provide an objective classification&#44; allow prospective evaluation and can serve as a valid tool to study new IOL designs and materials&#46; In this way&#44; their resistance to glistening could be analysed in clinical trials prior to implantation of these lenses&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">In both LH and OCT imaging&#44; it is difficult to establish a cut-off point for determining the size at which a VM is considered to be correctly identified&#46; Recently developed materials focus on formulations that show minimal glistening&#44; such as Alcon&#39;s recently introduced Clareon&#44; an acrylic copolymer of 2-hydroxyethylmethacrylate combined with phenylethyl acrylate as a hydrophobic component to which a UV filter has been added&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;61</span></a> However&#44; there is still no consensus or strict criteria to determine how many MV can be &#34;tolerated&#34; to label a certain IOL model as &#34;glistening-free&#34;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> although traditionally most authors have used 50&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> as the cut-off point&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">Although much progress has been made in the assessment of glistening in recent years&#44;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#8211;66</span></a> future studies are needed to analyse whether glistening progresses over time in newer IOL models&#44; with prolonged follow-up&#44; ideally more than 20&#8722;25 years&#44; being necessary&#46; Cataract surgery is being performed on increasingly younger patients&#44; a fact which&#44; together with increasing life expectancy&#44; means that newer implanted IOLs must maintain optical clarity or transparency for several decades&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;54</span></a> In fact&#44; it has been reported that the presence of glistening increased up to 15 years post-operatively&#44; with an increase in surface light scattering on the IOL surface&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;44&#44;67</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">Finally&#44; studies applying artificial intelligence such as deep learning-based algorithms that could provide an automatic description and classification of glistening in both LH and OCT&#44; which could even predict its stability or progression&#44; will be very relevant&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0275" class="elsevierStylePara elsevierViewall">IOL glistening is common&#44; especially in hydrophobic acrylic lenses&#44; and there are numerous risk factors that facilitate its occurrence&#46; In addition to their analysis and quantification in vitro and by slit-lamp photography&#44; quantification techniques based on the Scheimpflug chamber&#44; and more recently optical coherence tomography&#44; have been described in the past few years and may be useful alternatives in routine clinical practice&#46; In recent years&#44; with improvements in lens material&#44; design and manufacture&#44; this phenomenon has been greatly reduced&#46; However&#44; since it is a progressive phenomenon and its clinical relevance is only detectable in severe stages&#44; follow-up and long-term evaluation is required in these patients&#46;</p></span><span id="sec0091" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0111">Conflict of interests</span><p id="par0271" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The glistening in intraocular lenses &#40;IOLs&#41; is a phenomenon in which tiny water-filled microvacuoles &#40;MVs&#41; form within the IOL material&#44; causing light to scatter and create a sparkling or shimmering effect&#46; The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence&#44; risk factors&#44; evolution&#44; and possible clinical relevance&#46; Classically&#44; it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp&#44; but these were techniques that required either specific technology or an expert explorer&#44; complex image processing&#44; and required a lot of time&#46; In recent years&#44; proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs&#46; It has been described that the manufacturing process&#44; the hydrophobic acrylic material&#44; or the time since surgery are risk factors for the appearance of glistening&#46; In addition&#44; many issues related to this phenomenon are still unknown&#44; such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs&#46;</p></span>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El glistening en las lentes intraoculares &#40;LIO&#41; es un fen&#243;meno en el que se forman diminutas microvacuolas &#40;MV&#41; llenas de agua dentro del material de la LIO&#44; lo que hace que la luz se disperse y cree un efecto centelleante o reluciente&#46; La presencia del glistening es frecuente en muchos tipos de materiales y modelos de LIO&#44; y se ha estudiado ampliamente en los &#250;ltimos a&#241;os para conocer su incidencia&#44; factores de riesgo&#44; evoluci&#243;n y posible relevancia cl&#237;nica&#46; Cl&#225;sicamente se ha estudiado in vitro en laboratorio o mediante fotograf&#237;a obtenida con l&#225;mpara de hendidura&#46; Sin embargo&#44; eran t&#233;cnicas que requer&#237;an o tecnolog&#237;a espec&#237;fica o un explorador experto&#44; adem&#225;s de un complejo procesado de im&#225;genes y mucho tiempo&#46; En los &#250;ltimos a&#241;os&#44; han surgido propuestas basadas en la c&#225;mara de Scheimpflug y en la tomograf&#237;a de coherencia &#243;ptica como forma de simplificar el an&#225;lisis del glistening en las LIOs&#46; Se ha descrito que tanto el proceso de fabricaci&#243;n&#44; como el propio material acr&#237;lico hidrof&#243;bico&#44; y el tiempo desde la cirug&#237;a son factores de riesgo relacionados con la aparici&#243;n de glistening&#46; Adem&#225;s&#44; a&#250;n se desconocen numerosas cuestiones relacionadas con este fen&#243;meno&#44; como la cantidad de puntos o el tama&#241;o de los mismos&#44; necesarios para causar afectaci&#243;n de la funci&#243;n visual&#44; ya que se han descrito diferentes fen&#243;menos &#243;pticos relacionados con el glistening de las LIOs&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Top row&#58; Examples of intraocular lens &#40;IOL&#41; with a high number of microvacuoles or glistening in the lens optic as seen by slit-lamp photography&#46; Bottom row&#58; &#40;B&#41; Scheimpflug camera images of a patient with mild glistening &#40;left&#41;&#44; which is very difficult to see due to its limited resolution&#44; and a patient with an opacified lens &#40;bottom right&#41; and associated increased densitometry&#46;</p>"
        ]
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        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Different severity of glistening assessed by OCT from lesser to greater presence of glistening &#40;A&#8211;F&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          0 => array:3 [
            "identificador" => "at0015"
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            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography &#40;OCT&#41; images of intraocular lens &#40;IOL&#41; optics&#46; A&#41; Glistening&#46; B&#41; IOL opacification showing hyper-reflective bands on the anterior and posterior aspect of the lens&#46; C&#41; Crystalline lens masses between the posterior aspect of the IOL and the capsular bag in a patient with hyper-reflective spots or glistening inside the optic&#46; D&#41; Posterior capsular opacity is seen as the presence of hyperreflective material in the space between the capsular bag and the posterior aspect of the IOL&#46; It should be noted that the iris is inverted&#44; but the image of the posterior capsule of the sac is correct&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">VA &#40;Visual Acuity&#41;&#44; CS &#40;Contrast Sensitivity&#41;&#44; SL &#40;Slit Lamp&#41;&#44; IOL &#40;IntraOcular Lens&#41;&#44; MTF &#40;Modulation Transfer Function&#41;&#44; MVs &#40;MicroVacuoles&#41;&#44; N&#47;S &#40;Not Specified&#41;&#44; No&#46; &#40;numbers&#41;&#44; PMMA &#40;Polymethylmethacrylate&#41;&#44; SS-OCT &#40;Swept-Source Optical Coherence Tomography&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Studio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Iols assessed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IOL area assessed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evaluation conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions of the study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miyata et al&#44; 2000<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 LIO &#40;MA60BM&#47;MA30BA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8722;20 months follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miyata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#37; of IOLs develop glistening within 2&#8722;16 months post-surgery&#46; Glistening stabilises within months of onset&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tognetto et al&#44; 2002<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 911A&#44; 36 ACR6D&#44; 37 AcrySof&#44; 41 SI-40NB&#44; 32 H60M&#44; 40 Sensar&#44; 30 Stabibag&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44; 30&#44; 90&#44; 180&#44; 180&#44; 360 and 720 days post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;3 &#40;I mild II moderate III severe&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glistening was observed in all IOLs but higher &#37; and density of MVs in AcrySof&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miyata et al&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 MA60BM&#44; 17 SA60AT&#44; 16 AR40&#44; 17 ClariFlex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scheimpflug in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8239;mm central IOL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&#44;12&#44;24&#44;36 months post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glistening at 3 years post-surgery higher in MA60BM and SA60AT than in AR60 and ClariFlex&#46; VA without significant differences&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colin et al&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 MA&#44; 15 SA60AT&#44; 41 SN60AT&#44; 37 SN60WF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;75&#8239;&#215;&#8239;2&#8239;mm central IOL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic counting&#46; 18&#8239; &#177;&#8239;13 months monitoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No correlation found between the degree of glistening and IOL&#47;VA power&#47;contrast sensitivity&#47;scattering&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hayashi et al&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 acrylics &#40;MA60BM&#41;&#44; 35 silicone&#44; 35 PMMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manual counting &#40;2 ophthalmologists&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miyata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Light scattering and glistening are not significantly related to visual function and optical aberrations&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thomes et al&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 SB30AL &#91;2003&#93;&#44; 270 SN60WF &#91;2012&#93;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8239;mm<span class="elsevierStyleSup">2</span>&#58; at 0&#46;6&#44; 1&#46;6 and 2&#46;6&#8239;mm from the edge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic counting &#40;zone with&#8239;&#43;&#8239;MVs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absolute numbers only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IOLs manufactured in 2012 show significantly less glistening compared to those manufactured in 2003&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biwer et al&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 monofocal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL&#8239;&#43;&#8239;Scheimpflug in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic&#8239;&#43;&#8239;manual counting&#46; 6 months post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;4 &#40;IV&#8239;&#62;&#8239;40&#8239;MV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manual and automatic counts at SL showed moderate correlation&#46; Scheimpflug images do not have sufficient resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Henriksen et al&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 SN60WF&#44; 36 SN60AT&#44; 4 SN60T5&#44; 1 SN60T4&#44; 1 SN60T3&#44; 1 SN6AD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&#8722;1&#8239;mm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic counting&#46; 1&#8722;4 years post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diameter MV 6&#8722;25 and &#62; 25 microns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The area affected by glistening correlates with light scatter&#46; IOL age affects both MVs size and VA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Labuz et al&#44; 2017<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 SN60WF&#44; 2 SN60AT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central zone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic&#8239;&#43;&#8239;manual counting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absolute numbers only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Light deflection is proportional to the number of MVs and IOL area affected&#46; Numerous glistenings are necessary to cause significant light deflection&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oshika et al&#44; 2018<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 hydrophobic &#40;MA30BA&#47;MA60BM&#41;&#44; 37 silicone&#44; 30 PMMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#8722;21 years of follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glistening is more frequent in hydrophobics than in silicone and PMMA&#46; However&#44; VA and CS with no significant differences&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Labuz et al&#44; 2018 <a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 601P&#44; 5 PY60AD&#44; 5 SN60WF&#44; 5 MA60AC&#44; 5 NS60YG&#44; 5 Avansee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central and&#47;or peripheral area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic counting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absolute numbers only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Greater glistening in PY60D &#40;3058&#8722;4061&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#46; No glistening was observed in Avansee&#46; Light scattering is related to the number of MV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Werner et al&#44; 2019<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 CNA0T0&#44; 30 ZCB00&#44; 30 ZCB00V&#44; 30 W-60&#44; 30 MX60&#44; 30 XY1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edge&#44; mid-periphery&#44; centre IOL and area with more glistening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absolute numbers only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CNA0T0&#44; W-60 and MX60&#58; IOLs with less glistening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weindler et al&#44; 2019<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 SA60AT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;4 &#40;IV&#8239;&#62;&#8239;500&#8239;MV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glistening &#60; 500&#8239;MV&#47;mm<span class="elsevierStyleSup">2</span> does not affect the quality of vision&#46; In glistening grade IV &#40;&#62;500&#41; FTM and Strehl radius are affected&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stanojcic et al&#44; 2019<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 SA60AT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8239;&#215;&#8239;1&#8239;mm&#44; central area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manual counting &#40;3 ophthalmologists&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;7 &#40;VII&#8239;&#62;&#8239;61&#8239;MV&#41;&#44; Miyata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glistening does not correlate with VA&#44; CS or light scattering&#46; New glistening quantification scale &#40;grades 0&#8722;7&#41; proposed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oshika et al&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 Clareon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Day 1&#44; week 1&#44; months 1&#44; 6 and 12 post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No glistening was observed in Clareon in the first 12 months after surgery&#46; At 9 years&#44; 20 were evaluated with no MVs found&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stanojcic et al&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140 Clareon&#44; 134 PCB00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 areas of 1mm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manual counting &#40;3 ophthalmologists&#41;&#46; 12 months post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 0&#8722;7 &#40;and Miyata&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Minimal glistening &#40;mean grade 0&#41; between Clareon and PCB00&#44; with no significant differences &#40;in glistening or VA&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borghesi et al&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basis V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&#8239;mm<span class="elsevierStyleSup">2</span>&#44; 30 photos &#40;one shot every 23 microns thickness&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic counting &#43; 2 observers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absolute numbers only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The density of MVs decreases near the edges of the IOL&#44; and follows normal distribution along the thickness of the IOL&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yildrim et al&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 ASHFY600&#44; 10 SN60WF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 sections of each IOL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miyata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">More frequent glistening in centre section&#46; ASHFY600 more resistant to glistening than SN60WF &#40;0&#46;52&#43;&#47;-0&#46;24&#8239;MVs VS 41&#46;84&#43;&#47;-27&#46;67&#8239;MVs&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yildrim et al&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 800C&#44; 5 SN60WF&#44; 5 ZCB00&#44; 5 XY1&#44; 5 611P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;63&#8239;mm<span class="elsevierStyleSup">2</span> central&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modified Miyata &#40;III&#8239;&#62;&#8239;200&#8239;MV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glistening in IOLs&#58; SN60WF &#40;66&#43;&#47;-45&#46;5&#41; &#62; 611&#8239;P &#40;30&#46;7&#43;&#47;-8&#46;4&#41; &#62; 800C &#40;2&#46;0&#43;&#47;-3&#46;6&#41; and XY1 &#40;2&#46;7&#43;&#47;-2&#46;4&#41; &#62; ZCB00 &#40;0&#46;9&#43;&#47;-0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wang et al&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 MA30BA&#47;MA60AC &#91;1990&#93;&#44; 5 MA60AC&#44; 5 SA60AT&#44; 5 TFNT00 and 5 SN60WF &#91;2014&#8722;2017&#93;&#44; 5 Clareon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central zone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic counting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modified Miyata &#40;III&#8239;&#62;&#8239;200&#8239;MV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IOLs manufactured in 1990 with significantly higher glistening compared to IOLs manufactured in 2014&#8722;2017&#46; Clareon minimum glistening &#40;grade 0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oshika et al&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">384 Clareon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 day&#44; 1 week&#44; 1&#44; 6 and 12 months post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modified Miyata &#40;III&#8239;&#62;&#8239;151&#8239;MV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clareon does not develop glistening in the first postoperative year&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kawai et al&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 SN60WF&#44; 5 XY1&#44; 5 NS60YG&#44; 5 ZCB00V&#44; 5 AN6KA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In vitro induction&#8239;&#43;&#8239;SL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Automatic counting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absolute numbers only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SN60WF showed higher glistening for a longer time&#46; XYI&#44; SN60WF and AN6K showed signs of degradation&#44; NS-60YG and ZCB00&#8239;V did not&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lehmann et al&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">350 SY60CL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SL in vivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8239;st day&#44; 1st week&#44; 1&#44; 6 and 12 months post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not quantify&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">At 12 months post-surgery&#44; no glistening was observed in any of the lenses&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fern&#225;ndez-Vigo et al&#44; 2023<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150 SN60WF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SS-OCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central zone IOL &#40;3&#8239;mm&#41;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manual counting &#40;2 ophthalmologists&#41;&#46; Minimum 600 days post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grades 0&#8722;3 &#40;III&#8239;&#62;&#8239;30&#8239;MVs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The use of SS-OCT facilitates the identification&#44; quantification and classification of the degree of glistening in an objective and reproducible manner&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of the main published studies on the occurrence of glistening in different lens models&#46;</p>"
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