[Subluxation of hydrophilic acrylate intraocular lenses due to massive capsular fibrosis]

Impact of intraocular lens characteristics on intraocular lens dislocation after cataract surgery

Background

To assess the influence of intraocular lens (IOL) characteristics on IOL dislocations after cataract surgery.

Methods

Patients who underwent cataract surgery at the Department of Ophthalmology Graz, Austria, between 1996 and 2017 were included and medical records were reviewed. Cox proportional-hazard regression models were used to assess the influence of IOL characteristics on IOL dislocation.

Results

From 68 199 eyes out of 46 632 patients (60.2% women, mean age: 73.71 SD±10.82 years), 111 (0.16%) had an in-the-bag (ITB) disloaction and 35 (0.05%) had an out-of-the-bag (OTB) dislocation. The HRs adjusted for predisposing factors significantly associated with a higher risk for an ITB dislocation were 2.35 (95% CI, 1.45 to 3.8) for hydrophilic IOLs, 2.01 for quadripode IOLs (95% CI, 1.04 to 3.86) and 1.61 (95% CI, 1.04 to 2.48) for haptic angulation. A lower risk was observed for three-piece IOLs (HR=0.58, 95% CI, 0.34 to 0.98) and larger overall IOL diameter (HR=0.79, 95% CI, 0.66 to 0.95). For an OTB dislocation, the HR associated with a higher risk was 18.81 (95% CI, 5.84 to 60.58) for silicone IOLs and 2.12 (95% CI, 0.62 to 7.29) for hydrophilic IOLs. Larger overall IOL diameter (HR 0.40, 95% CI; 0.25 to 0.63) showed a lower risk.

Conclusion

Hydrophilic IOLs, quadripode IOLs and haptic angulation were associated with a higher risk for an ITB dislocation, whereas three-piece IOLs and a larger overall diameter were associated with a lower risk. Risk factors for OTB dislocation were silicone IOLs, hydrophilic IOLs and a smaller overall IOL diameter.

Attenuation of human lens epithelial cell spreading, migration and contraction via downregulation of the PI3K/Akt pathway

BACKGROUND

Posterior capsule opacification (PCO) represents a major challenge in the postoperative management of cataract patients. Spreading, migration and contraction of residual human lens epithelial cells play a pivotal role in the pathogenesis of PCO. Therefore, we analyzed the effect of the alkylphosphocholine (APC) erufosine on these cellular features as well as on PI3K/Akt, a crucial pathway in PCO pathogenesis.

METHODS

Human lens epithelial cells were cultured under standard cell culture conditions. Cell spreading was analyzed on fibronectin-coated wells and chemokinetic migration was assessed by time-lapse microscopy. For evaluation of cell-mediated collagen matrix contraction, the cells were seeded into collagen gels and incubated with an APC in different non-toxic concentrations before the surface area was measured on day 6. The activity of PI3K/Akt was assessed by an ELISA kit after incubation of the cells with different APC concentrations.

RESULTS

Human lens epithelial cell spreading and migration were attenuated by APCs as follows: 7 % spreading, 48 % migration (0.1 μM APC), and 32 % spreading, 68 % migration (1.0 μM APC). APC concentrations of 0.1 μM reduced collagen gel diameter by 5 %, and 1.0 μM by less than 1 %, compared to untreated, cell-populated gels that resulted in a cell diameter contraction of 36 %. PI3K was downregulated in a concentration-dependent manner.

CONCLUSIONS

The crucial cellular features of PCO pathogenesis are attenuated by the APC erufosine via downregulation of the PI3K pathway. Thus, erufosine might become a valuable tool for pharmacologic PCO prophylaxis in the future.

[Early in-the-bag spontaneous intraocular lens dislocation of hydrophilic acryl single piece lenses following uncomplicated phacoemulsification]

BACKGROUND

As techniques for cataract surgery have evolved, spontaneous intraocular lens (IOL) dislocation in patients with no ocular pathology arises less frequently. We present seven consecutive cases of uncomplicated cataract surgery with early in-the-bag spontaneous intraocular lens dislocation for which the same type of hydrophilic single piece lens was used.

MATERIAL AND METHODS

A retrospective analysis was conducted on seven cases involving patients with IOL dislocation who underwent uncomplicated cataract surgery within a period of 4 months (October 2010 to January 2011) using the same type of single piece IOL. The median age of the 7 patients was 73 years and IOL repositioning was performed after an average of 10 weeks.

RESULTS

Sulcus repositioning could be carried out in only five of the seven patients and IOL repositioning within the capsule was achieved in one patient. A second patient exhibited IOL dislocation after yttrium aluminium garnet (YAG) laser capsulotomy. Explantation of the IOL and sulcus implantation of another IOL type (Acrysof MA50 MB) was necessary for a third patient. A fourth case presented an angled IOL haptic and dislocation of the IOL in the sulcus position.

DISCUSSION

Even after uncomplicated cataract surgery, spontaneous in-the-bag IOL dislocation in patients with no ocular pathology may occur due to a hydrophilic lens material which induces stronger anterior capsular phimosis (ACP) in comparison to alternative materials. In combination with a thin lens design this may result in angled IOL haptics and IOL dislocation.

CONCLUSIONS

Careful selection of suitable lens design and material according to individual predisposing factors is necessary. This retrospective case study demonstrates that the combination of hydrophilic lens material and a thin lens design may result in early spontaneous IOL dislocation. Furthermore, as established in one case, YAG laser capsulotomy may induce IOL dislocation if the lens design cannot withstand capsular fibrosis.

Delayed dislocation of an injectable hydrophilic acrylic lens after Nd:YAG capsulotomy in anterior capsular contraction syndrome

Posterior dislocation of IOLs has been reported following Nd:YAG laser for anterior capsule contraction in only 3 cases and these involved plate haptic silicone lenses; while the dislocation of IOLs into the vitreous cavity following posterior Nd:YAG laser capsulotomy have been reported in plate haptic silicone lenses and single piece hydrophilic acrylic (polymacon) lenses. We report a patient who suffered the delayed dislocation of an injectable hydrophilic acylic IOL (SlimFlex-m 123 IOL, PhysIOL, Liège, Belgium) following combined Nd:YAG laser anterior and posterior capsulotomy. We also explore the factors that may predispose to anterior capsular contraction syndrome and IOL dislocation.