Recurrent iritis after implantation of an iris-fixated phakic intraocular lens for the correction of myopia

The iris-claw intraocular lens (IOL) was recently approved by the U.S. Food and Drug Administration for the correction of refractive disorders. Previous reports are not uniform regarding its potential to induce inflammatory reaction. We report the case of a young healthy patient who experienced persistent and intolerable iritis after implantation of an iris-claw IOL. The iritis was resolved only after explantation of the IOL.

Two opacification patterns of the same hydrophilic acrylic polymer: case reports and clinicopathological correlation

We report 2 intraocular lenses (IOLs) manufactured from the same hydrophilic acrylic polymer by Ioltech that developed optic opacification. In both cases, the postoperative course after implantation of the IOLs was complicated by significant inflammatory reaction with fibrin formation in the anterior chamber. Pathologic analyses of the explanted IOLs were consistent with dystrophic calcification leading to optic opacification, but the pattern was different between the 2 IOL designs. Patient-related factors might have been responsible for this complication.

Hydrophilic acrylic intraocular lens as a drug-delivery system: Pilot study

PURPOSE

To evaluate the ability of a hydrophilic acrylic intraocular lens (IOL) to serve as a drug-delivery system for commercially available gatifloxacin and moxifloxacin.

SETTING

David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

Hydrophilic acrylic IOLs (C-flex, Rayner Ltd.), presoaked for 24 hours in commercially available solutions of gatifloxacin (Zymar) or moxifloxacin (Vigamox), were implanted in the capsular bag of 6 rabbits for a total of 12 eyes (6 in each group). Aqueous humor samples were taken 2, 4, and 6 hours after implantation. One rabbit served as a control and had nonpresoaked C-flex IOLs implanted. At the end of the operation, 1 drop of Vigamox was applied to the right eye and 1 drop of Zymar was applied to the left eye of the control rabbit.

RESULTS

High concentrations of both antibiotics were found in all the samples of the eyes implanted with the presoaked IOLs. The concentrations of the antibiotics decreased over time, but even the 6-hour sample concentrations were markedly higher than the concentrations found in the control rabbit after 4 hours.

CONCLUSION

The results suggest that the Rayner C-flex IOL can be effective as a drug-delivery system for fourth-generation fluoroquinolones.

New Endoscopic Technique to Analyze Various Modern Specialized Intraocular Lenses in Research Eyes and Human Eyes Obtained Postmortem

PURPOSE

To describe a new modification of the Miyake-Apple posterior video photographic technique and its 2 variations. We have developed a new endoscopic technique that is especially amenable for observation of modern specialized intraocular lenses (IOLs).

DESIGN

Laboratory study.

PARTICIPANT

Three cadaver eyes obtained postmortem.

METHODS

Human eyes obtained postmortem were prepared according to our modified preparation technique used for analyses of whole globes. An intraocular endoscope was utilized to demonstrate all aspects of the interior of an experimentally implanted IOL, with specialized reference to anterior segment structures, obtaining posterior, oblique, and side view images.

MAIN OUTCOME MEASURES

Different interior dynamic views of the anterior segment structures before and after implantation of an IOL.

RESULTS

High-magnification images of different intraocular structures both before and after device insertion as well as the device itself were obtained. Oblique and side view images from different locations were also available and informative. These images helped to create a 3-dimensional view of these objects and their relations to the surrounding structures.

CONCLUSION

The combination of the intraocular endoscope with the closed-system technique is a useful addition to our 3 previously described techniques: (1) the original Miyake-Apple posterior video/photograph technique and the (2) closed system and (3) side/oblique view (keyhole technique) modifications.

Suturing a tear of the anterior capsulorhexis

AIM

To describe a new technique of suturing a tear in the anterior capsulorhexis.

METHODS

Continuous curvilinear capsulorhexis (CCC) with lens removal was done in five fresh cadaver eyes. The diameter of the CCC was measured with a calliper. Using the same calliper a tear of the CCC was created while opening the calliper's arms. The distance between the calliper's arms needed to tear the CCC was documented. Using 9-0 Ethilon 9011, CS 160-6 sutures in two eyes, 9-0 Prolene, D-8229, CTC-6L sutures in two eyes, and 10-0 Prolene, 9090, CTC-6 suture in one eye, the tears were sutured. A tear in the CCC was created again in the same way as the first tear. The distance between the calliper's arms needed to tear the CCC was documented again.

RESULTS

Suturing of the tear restored some of the strength/elasticity of the CCC. Better results were found while using the 9-0 Prolene, D-8229, CTC-6L sutures than with the two others sutures.

CONCLUSIONS

Suturing of a broken CCC can restore at least some of the strength/elasticity of the CCC. This can be important before intraocular lens (IOL) implantation for the safety of the implantation or after the implantation to ensure proper fixation of the IOL.

"Special" intraocular lens designs: why do they sometimes fail?

A variety of new "special" intraocular lens models to optimize the visual performance after cataract surgery have been introduced. The majority of these new intraocular lens designs require a good centration within the capsular bag and/or capsular elasticity. Today, the main post-operative complications after cataract surgery still arise from retained lens epithelial cells within the capsular bag, resulting mainly in anterior and posterior capsule opacification. Some special intraocular lenses are not designed to be effective against proliferating lens epithelial cells. Although lens epithelial cells can never be completely removed from the capsular bag, surgical quality is a major factor for success or failure of these intraocular lens designs.

Histology of AlphaCor skirts: evaluation of biointegration

PURPOSE

To report histologic findings in 14 AlphaCor artificial corneas implanted during clinical trials and subsequently explanted from human subjects following complications, so as to evaluate biointegration within the device skirt.

METHODS

Explants were fixed and sectioned in paraffin. Histologic findings related to the device skirt were compared with earlier histologic results from animal studies and correlated with clinical histories.

RESULTS

Two devices had been removed due to complications related to the optic alone, 11 following stromal melting overlying the biointegratable sponge skirt and 1 due to a retroprosthetic membrane. All devices demonstrated normal skirt porosity. Biointegration was similar to that found in animal studies but qualitatively appeared reduced in the affected areas in patients with overlying stromal melting prior to explantation. Patients with a longer history of melting prior to explantation demonstrated presence of inflammatory cells around the device.

CONCLUSIONS

Histologic findings of the AlphaCor skirt in humans are consistent with earlier animal studies. This study confirms that biointegration by host fibroblastic cells, with collagen deposition occurs after AlphaCor implantation in humans. In cases in which stromal melting had occurred, biointegration is seen to be reduced. On correlating preoperative clinical factors with biointegration observed histologically, preoperative vascularization appears not to be required for AlphaCor biointegration.

Linear deposits on the surfaces of intraocular lenses implanted through a hexagonal cartridge which mimic scratches/cracks on the lenses

AIM

To describe unique linear deposits on the surface of posterior chamber intraocular lenses (IOLs) occurring after implantation through a hexagonal cartridge.

METHODS

Five ACR6D SE IOLs (Corneal Laboratories, Pringy, France) were injected/implanted through hexagonal cartridges. Two of these were injected into a petri dish and the remaining three were inserted into the evacuated capsular bag of cadaver eyes. In addition, three other ACR6D SE IOLs were injected into a petri dish through round cartridges. The latter served as controls.

RESULTS

All lenses that were injected/implanted through the hexagonal cartridges demonstrated linear deposits on the posterior surface of the IOL optic component. The IOLs that were injected through the round cartridges had no deposits. All the hexagonal cartridges showed signs of internal cracking. None of the round cartridges were cracked.

CONCLUSION

Implantation of at least one IOL model, the ACR6D SE IOL, through a hexagonal cartridge can result in linear deposits on the posterior optical surface of the IOL. The shape of the cartridge appears to be a significant factor in causing the depositions.

Cocooning of an iris-fixated intraocular lens in a 3-year-old child after perforating injury: Clinicopathologic correlation

We present a 3-year-old patient who developed extensive noninflammatory fibrous membrane formation in the anterior chamber involving the present iris-fixated intraocular lens (IOL), with subsequent need for explantation. The child had had repair of a corneal injury, crystalline lens extraction and Artisan iris-claw IOL (Ophthec) implantation after a penetrating injury 2 months before. Histopathologic analyses were consistent with a retrocorneal membrane that originated from the corneal stroma and formed a "cocoon" membrane on the iris-claw IOL.

Professor Peter Choyce: an early pioneer of intraocular lenses and corneal/refractive surgery

Professor Peter Choyce, FRCS, DOMS, MS, was one of the pioneers of intraocular lens implant surgery. He developed an interest in artificial lens implantation following cataract surgery, a procedure that was widely criticized by the ophthalmic establishment in the UK, Europe, North America and other countries. Owing to the opposition to the intraocular lenses, Peter Choyce together with Sir Harold Ridley co-founded the International Intraocular Implant Club in 1966, which was responsible for the gradual acceptance of artificial lens implantation. Peter Choyce developed several models of intraocular lens, but did not patent the majority of them. The Choyce Mark IX, manufactured by Rayner Intraocular Lenses, became the first US Food and Drug Administration-approved intraocular lens in 1981. A review of Peter Choyce's record confirms a significant number of original innovations in the field of anterior segment surgery, including many procedures taken for granted today, but not associated with his name. These include early work on both kerato- and intraocular lens-refractive procedures, keratoprosthesis, pioneering paediatric implant procedures and others. Unfortunately his tenacious adherence to anterior chamber lens technology, while in general clinically sound, caused many to question his influence and hence he remained poorly understood even until after his death. He passed away on 8 August 2001 after a long fight with colon cancer. In this article, we provide evidence and elaborate Peter Choyce's accomplishments, which places him as one of the most innovative ophthalmologist in his surgical field in the twentieth century.

Posterior capsule opacification in rabbit eyes implanted with 1-piece and 3-piece hydrophobic acrylic intraocular lenses

PURPOSE

To evaluate the outcome of posterior capsule opacification (PCO) after implantation in rabbit eyes of currently available 3-piece and 1-piece hydrophobic acrylic intraocular lenses (IOLs) with square optic edges.

SETTING

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

METHODS

The 3-piece designs evaluated were the AR40e (Advanced Medical Optics Inc.) and the MA60AC (Alcon, Inc.); the 1-piece designs were the SA60AT and the SA30AT (Alcon, Inc.). Nine lenses of each type were implanted in a randomized manner by the same surgeon in 18 Dutch Belted pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and analyses of the enucleated eyes were performed from the posterior or Miyake-Apple view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was scored from 0 to 4. The area of Soemmering's ring formation was also scored from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL anterior surface, IOL centration, fixation, and presence of striae. Results from the posterior view were complemented by histopathologic evaluation of the eyes.

RESULTS

No statistically significant difference was found between the 4 groups of IOLs in the parameters analyzed from the posterior view. When cell ingrowth occurred with the 1-piece designs, causing peripheral and central PCO formation, it was more likely to start at the optic-haptic junctions, as observed during the clinical follow-up with slitlamp examination and confirmed by gross and histopathologic analyses of the enucleated eyes.

CONCLUSIONS

The square, truncated optic edge is the most important IOL design feature for PCO prevention. The optic-haptic junctions of the 1-piece designs appear to be sites where the barrier effect of the truncated optic edge is less effective.

Analysis of the capsule edge after Fugo plasma blade capsulotomy, continuous curvilinear capsulorhexis, and can-opener capsulotomy

PURPOSE

To compare the quality of the edges of anterior capsulotomies performed in porcine eyes using 3 different techniques.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA.

METHODS

Four porcine eyes were submitted to the center in 10% neutral buffered formalin. The cornea of the eyes had been removed, and a continuous capsulotomy had been performed in each eye using the Fugo plasma blade. To provide morphologic correlation, 4 additional porcine eyes were used in the study. In 2, a manual continuous curvilinear capsulorhexis (CCC) was performed after the cornea or cornea/iris was removed and in the other 2, a can-opener capsulotomy (COC) was performed. The eyes were then placed in 10% neutral buffered formalin. Gross (macroscopic) and microscopic analysis of each eye was performed, and photographs were taken. One eye in each group was also prepared and analyzed under scanning electron microscopy (SEM).

RESULTS

The capsulotomy margin in the Fugo blade group presented some regularly spaced tags directed centrally with smooth edges at the base. Such a configuration would not interfere with the dynamics of the capsulorhexis sphincter and would generally not lead to radial tears. The smooth and regular nature of the capsulotomy margin in the CCC group was confirmed by gross and microscopic examinations of the eyes. The capsulotomy margin in the COC group presented some sharp notches directed outward, irregularly spaced, and irregular in shape. These are known to have a tendency to extend and form radial tears.

CONCLUSION

Although performance of an anterior capsulotomy with the Fugo blade was associated with some margin irregularities, the geometry of the centrally directed tags prevented them from becoming the site of radial tear formation. The base of the capsulotomy performed with the Fugo blade appeared to be almost as smooth and regular as in the CCC under SEM evaluation.

Removal times for a dispersive and a cohesive ophthalmic viscosurgical device correlated with intraocular lens material

PURPOSE

To investigate the removal times of ophthalmic viscosurgical devices (OVDs) with different intraocular lens (IOL) designs and materials.

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA, and Heidelberg IOL & Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.

METHODS

In a standardized laboratory setup, the Miyake-Apple posterior view video technique was used to evaluate OVD removal from capsular bags in human autopsy eyes implanted with poly(methyl methacrylate) (PMMA), silicone, and acrylic IOLs. The cohesive OVD ProVisc (sodium hyaluronate 1.0%) and the dispersive OVD Viscoat (sodium hyaluronate 3.0% and chondroitin sulfate 4.0%) were stained with fluorescein for better visualization. The open-sky preparation and an Alcon Series 20000 Legacy phaco machine with a flow rate of 25 mL/min and a vacuum setting of +500 mm Hg (maximum irrigation/aspiration) were used. The time needed for complete removal of the cohesive and dispersive OVDs with each IOL type was measured and analyzed statistically.

RESULTS

The mean removal times for both OVDs were as follows: Alcon MZ60BD PMMA IOL-25.0 seconds +/- 3.7 (SD) (Viscoat), 15.9 +/- 6.9 seconds (ProVisc); Alcon AcrySof MA60BM IOL-35.5 +/- 10.0 seconds (Viscoat), 25.6 +/- 4.7 seconds (ProVisc); Chiron/Bausch & Lomb C1043 silicone IOL-46.5 +/- 10.5 seconds (Viscoat), 17.3 +/- 2.1 seconds (ProVisc); AMO SI-30 silicone IOL-33.5 +/- 3.1 seconds (Viscoat), 15.3 +/- 6.3 seconds (ProVisc); and Pharmacia 912 silicone IOL-18.3 +/- 5.8 seconds (Viscoat), 19.8 +/- 4.3 seconds (ProVisc).

CONCLUSIONS

Differences in OVD removal times were detected. The removal time for the cohesive OVD correlated with the IOL material. Overall, the time needed for complete removal was significantly longer for the dispersive OVD than for the cohesive OVD.

Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants

PURPOSE

To report clinical, pathologic, histochemical, ultrastructural, and spectroscopic analyses of MemoryLens intraocular lenses (IOLs) explanted from patients who had visual disturbances caused by postoperative opacification of the lens optic.

DESIGN

Noncomparative, large case series with clinicopathologic correlation.

PARTICIPANTS

A total of 106 hydrophilic acrylic IOLs of the same design explanted from 106 different patients. All patients had decreased visual acuity at presentation approximately 2 years after cataract surgery, associated with a whitish fine granularity on the optical surfaces of the IOLs.

METHODS

The explanted IOLs were submitted to the John A. Moran Eye Center and were examined under light microscopy, histochemically, and with scanning electron microscopy (SEM) equipped with an energy dispersive x-ray spectroscopy detector with light element capabilities (EDS).

MAIN OUTCOME MEASURES

The IOLs were examined for distribution, structure, and composition of the deposits causing opacification of their optic components.

RESULTS

The average interval between lens implantation and opacification was 25.8+/-11.9 months. The most frequently associated medical and ophthalmic conditions were diabetes and glaucoma. However, some patients did not have any preexisting medical or ophthalmic conditions. Most of the IOLs had been implanted in 1999 and 2000. Microscopic analyses revealed the presence of multiple fine, granular deposits of variable sizes on the anterior and posterior optic surfaces, especially on the anterior surface. The deposits stained positive for calcium. The EDS confirmed the presence of calcium and phosphate within the deposits.

CONCLUSIONS

The results obtained suggest the surface deposits to be composed, at least in part, by calcium and phosphate. A special polishing technique used in the manufacture of most of these IOLs may have caused changes in the lens surface leading to deposit formation. Further studies should be undertaken to confirm this hypothesis.

Correlation between different measurements within the eye relative to phakic intraocular lens implantation

PURPOSE

To obtain measurements of the white-to-white distance and the anterior chamber and ciliary sulcus diameters in phakic human eyes obtained post-mortem to find a correlation between these measurements.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

Twenty-two phakic human eyes obtained from eye banks within 24 hours of death were evaluated. The following measurements were performed: white-to-white distance, anterior chamber diameter with a plastic sizer after a small limbal incision, and anterior chamber and ciliary sulcus diameters after fixation and sagittal section of the eyes. The first 10 eyes were studied at the 6 o'clock to 12 o'clock meridian and the last 12 eyes, at the 3 o'clock to 9 o'clock meridian.

RESULTS

A positive correlation was found between the white-to-white measurements and the anterior chamber diameter in the 10 eyes studied at the 6 o'clock to 12 o'clock meridian but not in the 12 eyes studied at the 3 o'clock to 9 o'clock meridian. The latter is the meridian frequently used by surgeons to perform white-to-white measurements and thus choose the overall size of the phakic intraocular lens to be implanted. No correlation was found between the white-to-white measurements and the ciliary sulcus diameter in the 2 meridians.

CONCLUSION

Experimental studies using cadaver eyes are helpful in evaluating sizing techniques for phakic IOL implantation as well as in better understanding the anatomical relationships between ocular structures.

Posterior capsule opacification in rabbit eyes implanted with hydrophilic acrylic intraocular lenses with enhanced square edge

PURPOSE

To evaluate the development of posterior capsule opacification (PCO) after implantation of single-piece hydrophilic acrylic intraocular lenses (IOLs) with an enhanced square edge.

SETTING

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

METHODS

The standard 570H Centerflex (Rayner Ltd.) design was compared to 2 new designs with enhanced square edges: the 570E and the 570C. Ten IOLs of each type were implanted in a randomized manner by the same surgeon in 15 pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and the eyes were analyzed from the posterior view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was graded from 0 to 4. The area of Soemmering's ring was graded from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL edge and IOL centration and fixation. Results from the posterior view were complemented by histopathological evaluation.

RESULTS

Posterior capsule opacification was lowest in the 570C group, highest in the 570H group, and intermediate in the 570E group. There was a statistically significant difference between the 3 groups in peripheral PCO (P = .039). No significant difference was found between the groups in the other parameters analyzed. When cell ingrowth occurred with the 570H, it started at the optic-haptic junctions, as observed during the clinical follow-up and confirmed by gross and histopathological analyses.

CONCLUSIONS

The square optic edge is the most important IOL design feature for PCO prevention. However, it should be present for 360 degrees around the IOL optic to provide an effective barrier effect.

Capsulorhexis ovaling and capsular bag stretch after rigid and foldable intraocular lens implantation

PURPOSE

To compare the amount of capsulorhexis ovaling and capsular bag stretch produced by various intraocular lenses (IOLs) implanted in pediatric human eyes obtained post-mortem.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Salt Lake City, Utah, USA.

METHODS

In this nonrandomized comparative study, 16 pediatric human eyes obtained postmortem were divided into 2 groups: Eight eyes were obtained from children younger than 2 years (Group A), and 8 eyes were obtained from children older than 2 years (Group B). All eyes were prepared according to the Miyake-Apple posterior video technique. Six types of rigid and foldable posterior chamber IOLs manufactured from poly(methyl methacrylate) (single-piece), silicone (plate and loop haptics), and hydrophobic acrylic (single-piece and 3-piece AcrySof, Alcon Laboratories) biomaterials were implanted. The capsulorhexis opening and capsular bag diameters were measured before IOL implantation and after in-the-bag IOL fixation with the haptics (or the main axis) at the 3 to 9 o'clock meridian. The percentage of ovaling of the capsulorhexis opening was calculated by noting the difference in the opening's horizontal diameter before and after IOL implantation. The percentage of capsular bag stretch was also calculated by noting the difference in the horizontal capsular bag diameter before and after IOL implantation.

RESULTS

All IOLs produced ovaling of the capsulorhexis opening and stretching of the capsular bag parallel to the IOL haptics. There were significant differences in capsulorhexis ovaling and capsular bag stretch (P<.001, analysis of variance) between the 6 IOL types in each group of eyes. The postimplantation difference was significant only between the single-piece hydrophobic acrylic IOL (AcrySof) and the other IOLs. The single-piece hydrophobic acrylic IOL was associated with significantly less capsulorhexis ovaling and capsular bag stretch in both groups (mean 12.06% +/- 0.59% [SD] and 7.6% +/- 1.47%, respectively).

CONCLUSIONS

Modern rigid and foldable IOLs designed for the adult population implanted in the capsular bag of infants and children produced variable degrees of capsulorhexis ovaling and capsular bag stretch. The Miyake-Apple posterior video technique confirmed the well-maintained configuration of the capsular bag (with minimal ovaling) after implantation of a single-piece hydrophobic acrylic IOL because of its flexible haptic design.

Pathological evaluation of postmortem human eyes implanted with a new single-piece hydrophobic acrylic lens

PURPOSE

To report the pathological findings in 14 human cadaver eyes implanted with a single-piece AcrySof(Alcon Laboratories) posterior chamber intraocular lens (IOL).

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

METHODS

Fourteen human autopsy eyes implanted with a single-piece AcrySof (SA30AL) IOL were evaluated. The eyes were sectioned at the equatorial plane, and the anterior segment containing the IOL in the capsular bag was evaluated from a posterior perspective (Miyake-Apple view) and from an anterior perspective (surgeon's view) after removal of cornea and iris. They were then processed through paraffin, sectioned, and stained with hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome and examined under light microscopy.

RESULTS

All IOLs had symmetric in-the-bag fixation. Slight decentration was measured in 1 eye, which also had an anterior capsule tear. Grade 1 anterior capsule opacification was present in 9 eyes. No central posterior capsule opacification or posterior capsule folds were observed in any eye. Soemmering's ring formation was observed in 5 eyes. Zonular stretch caused by different degrees of capsular bag contraction was present in 4 eyes without decentration of the IOL.

CONCLUSIONS

Analyses of pseudophakic cadaver eyes from the posterior (Miyake-Apple) view, complemented by microscopic analyses, proved useful in the evaluation of IOL-capsular bag interaction. These studies are more important in cases of newly introduced lens designs.

Deposits in artificial corneas: risk factors and prevention

PURPOSE

To identify risk factors for calcium deposition and pigmented staining within AlphaCor artificial corneas.

METHODS

Retrospective analysis of data from 72 AlphaCor implantations was conducted. Histological analysis of explants was performed.

RESULTS

Eight cases of either intraoptic calcium or pigment deposition occurred in AlphaCor patients between 2.5 and 21 months after implantation. Four cases had diffuse white deposits, confirmed to be calcium and associated with prior coadministration of topical steroids and beta-blockers. The other four cases had brown deposits, associated with cigarette smoking and topical levobunolol.

CONCLUSION

These findings led to changes in patient management protocols, surgeon training and patient information so as to minimize the risk of further occurrences. No further cases of white deposition have occurred after warning surgeons of the risk associated with certain topical therapy combinations. The risk of brown staining may be difficult to remove completely as it appears that environmental exposure to chemicals may cause deposition in addition to personal smoking habits and topical medications.

Single-piece hydrophobic acrylic intraocular lens explanted within the capsular bag

A 74-year-old woman had uneventful phacoemulsification with implantation of a single-piece hydrophobic acrylic intraocular lens (IOL) (SA30AL) in her left eye. Two weeks after the surgery, the patient presented for ophthalmological consultation reporting pseudophakic dysphotopsia, which she had subjectively noted since surgery. Explantation/exchange of the IOL was performed 3 months after the surgery. The IOL was strongly attached to the capsule, which was fibrotic and contracted; explantation of the capsular bag complex in toto was done. To our knowledge, this is the first case of explantation of this IOL design with clinicopathological correlation.