Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas.

Liliana Werner, Garth Wilbanks, Carla P Nieuwendaal, Anish Dhital, Aaron Waite, Gerald Schmidinger, William B Lee, Nick Mamalis

Journal: Journal of cataract and refractive surgery 2015;41(1):199-207

PMID: 25465216

Full Text on Elsevier Science View on PubMed

Abstract

PURPOSE

To describe clinical and laboratory findings in a series of cases of intraocular lens (IOL) opacification after procedures involving intracameral injections of air or gas.

SETTING

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN

Experimental study.

METHODS

Seven hydrophilic acrylic IOLs explanted after Descemet-stripping endothelial keratoplasty (DSEK) or Descemet-stripping automated endothelial keratoplasty (DSAEK) because of a localized central optic opacification associated with decrease in visual acuity and complaints of foggy vision were analyzed. The explanted IOLs were sent to our laboratory in the dry state or in fixative by the explanting surgeons. They underwent pathological and histochemical evaluation (alizarin red and von Kossa method). Light scattering measurements were also performed on the surface of 1 explant using Scheimpflug photography. A questionnaire was sent to the surgeons to obtain information pertinent to each case.

RESULTS

The 7 explanted IOLs were represented by 6 hydrophilic acrylic designs from 5 manufacturers. Gross and light microscopy showed that granular deposits were densely distributed in an overall round pattern within the margins of the capsulorhexis or the pupil on the anterior surface/subsurface of the IOLs. The granules stained positive for calcium (alizarin red and von Kossa method). Light scattering on the anterior optic surface was very high (228 versus 13 computer-compatible tapes on a control IOL).

CONCLUSIONS

A localized pattern of calcification was seen on the anterior surface/subsurface of various hydrophilic acrylic IOLs. Surgeons should be aware of this phenomenon following DSEK/DSAEK procedures in pseudophakic patients with hydrophilic acrylic IOLs.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Address: From the John A. Moran Eye Center (Werner, Mamalis), University of Utah, Salt Lake City, Utah; Eastern Maine Eye Associates (Wilbanks), Bangor, Maine, the Hamilton Eye Institute (Waite), University of Tennessee Health Science Center, Memphis, Tennessee, and Eye Consultants of Atlanta (Lee), Atlanta, Georgia, USA; the Department of Ophthalmology (Nieuwendaal), Academic Medical Center, Amsterdam, the Netherlands; the Department of Ophthalmology (Dhital), St Thomas' Hospital, London, United Kingdom; the Department of Ophthalmology (Schmidinger), Medical University of Vienna, Vienna, Austria. Electronic address: [email protected].; From the John A. Moran Eye Center (Werner, Mamalis), University of Utah, Salt Lake City, Utah; Eastern Maine Eye Associates (Wilbanks), Bangor, Maine, the Hamilton Eye Institute (Waite), University of Tennessee Health Science Center, Memphis, Tennessee, and Eye Consultants of Atlanta (Lee), Atlanta, Georgia, USA; the Department of Ophthalmology (Nieuwendaal), Academic Medical Center, Amsterdam, the Netherlands; the Department of Ophthalmology (Dhital), St Thomas' Hospital, London, United Kingdom; the Department of Ophthalmology (Schmidinger), Medical University of Vienna, Vienna, Austria.

DOI: 10.1016/j.jcrs.2014.10.025

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MeSH Terms: Acrylic Resins, Aged, Aged, 80 and over, Air, Calcinosis, Calcium, Descemet Stripping Endothelial Keratoplasty, Device Removal, Endotamponade, Female, Fluorocarbons, Humans, Hydrophobic and Hydrophilic Interactions, Lenses, Intraocular, Light, Male, Middle Aged, Prosthesis Failure, Scattering, Radiation, Surveys and Questionnaires, Vision Disorders, Visual Acuity