Influence Of Capsular Bag Morphology On Intraocular Lens Performance In An Ex Vivo Model

Published 2026 - 44th Congress of the ESCRS

Reference: POCAT552 | Type: Poster | DOI: 10.82333/ahjy-j153

Authors: Dr Grzegorz Labuz* ¹ , Ms Margarita Karaivanova ¹ , Dr Agnieszka Zielińska ² , Dr Zhiyi Wu ³ , Dr Leoni Britz ¹ , Dr Sabrina Wohlfart ¹ , A/Prof. Philipp Uhl ⁴ , Dr Sabrina Wohlfart ¹ , A/Prof. Gerd Auffarth ¹ , Dr Maximilian Hammer ⁵

¹Department of Ophthalmology, David J. Apple Center for Vision Research,University Hospital Heidelberg,Heidelberg ,Germany, ²Department of Ophthalmology, David J. Apple Center for Vision Research,University Hospital Heidelberg,Heidelberg ,Germany; Institute of Physics, Faculty of Physics, Astronomy and Informatics,Nicolaus Copernicus University,Toruń,Poland, ³Department of Ophthalmology, David J. Apple Center for Vision Research,University Hospital Heidelberg,Heidelberg ,Germany;Eye Center,The Second Affiliated Hospital, Zhejiang University,Hangzhou,China, ⁴Institute of Pharmacy and Molecular Biotechnology,Heidelberg University,Heidelberg ,Germany, ⁵Department of Ophthalmology, David J. Apple Center for Vision Research,University Hospital Heidelberg,Heidelberg ,Germany; Faculty of Biosciences,Heidelberg University,Heidelberg,Germany

Purpose

To investigate how the human capsular bag influences the performance of contemporary intraocular lens (IOL) designs using an ex vivo human capsular bag model that enables quantitative optical assessment under anatomically and biomechanically relevant conditions, and to link optical bench metrics with capsular bag morphology to better understand their impact on clinical visual outcomes.

Setting

David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Germany.

Methods

Human cadaver eyes (n=11) were prepared with a modified Choi‑Apple technique to isolate the intact uveolenticular complex, which was stabilized in custom 3D‑printed rings to preserve zonular tension. After lens extraction, five IOL models, including a monofocal‑plus, refractive and diffractive extended‑depth‑of‑focus (EDoF) designs, and two diffractive trifocals, were sequentially implanted. Optical quality was quantified ex vivo on an optical‑bench system using objective image‑quality parameters, and simulated visual acuity was derived from these measurements to estimate potential functional impact.

Results

The model enabled stable, repeatable optical measurements within human capsular bags. Implantation reduced optical quality for all IOLs compared with control measurements, with more pronounced losses at a 4.5‑mm pupil. Refractive designs (monofocal‑plus and EDoF) showed relatively preserved optical quality and simulated visual acuity across defocus, whereas diffractive EDoF and trifocal IOLs exhibited greater degradation of intermediate and near performance and higher sensitivity to capsular bag irregularities. Defocus‑curve simulations revealed lens‑specific far, intermediate, and near profiles that closely reflected reported clinical outcomes.

Conclusions

We demonstrated that IOLs can be assessed in an ex vivo human capsular bag model, providing a translational platform for closer prediction of postoperative outcomes and for reproducing the variability of non‑ideal morphological conditions in which IOLs function after implantation. Our findings show that complex diffractive presbyopia‑correcting IOLs are more prone to capsular bag‑induced degradation of optical quality than refractive designs. This model may support future studies on capsular changes and their interaction with IOL geometry and optical design.