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Gartaganis PS, Natsi PD, Gartaganis SP, Koutsoukos PG, Helbig H. A unique late-onset intraocular lens opacification 23 years after implantation: a clinical and laboratory case report. Ther Adv Ophthalmol 2024; 16:25158414241237713. [PMID: 38533488 PMCID: PMC10964437 DOI: 10.1177/25158414241237713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/19/2024] [Indexed: 03/28/2024] Open
Abstract
We report an unusual, rare case of opacification of the hydrophilic acrylic intraocular lens (IOL) 23 years after the initial surgery with significant visual deterioration. Opacification of the hydrophilic acrylic IOL was primarily due to the formation of folds on the surface of the lens material, and less so due to calcium phosphate deposits. Calcification opacification can be attributed to recent events, as evidenced by deposits of dicalcium phosphate dihydrate (CaHPO42H2O) and octacalcium phosphate (Ca8H2(PO4)65H2O), both of which are transient calcium phosphate phases, converting hydrolytically to the thermodynamically most stable hydroxyapatite (Ca10(PO4)6(OH)2). To our knowledge, this case of hydrophilic acrylic IOL opacification is the only one that has been described so late, 23 years after cataract surgery.
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Affiliation(s)
- Panos S. Gartaganis
- Department of Ophthalmology, 251 Hellenic Air Force General Hospital, 3 Kanellopoulou Ave., Athens 11525, Greece
| | - Panagiota D. Natsi
- Laboratory of Inorganic and Analytical Chemistry, Department of Chemical Engineering, University of Patras and FORTH-ICEHT, Patras, Greece
| | | | - Petros G. Koutsoukos
- Laboratory of Inorganic and Analytical Chemistry, Department of Chemical Engineering, University of Patras and FORTH-ICEHT, Patras, Greece
| | - Horst Helbig
- Department of Ophthalmology, University Hospital of Regensburg, Regensburg, Germany
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Märker DA, Radeck V, Barth T, Helbig H, Scherer NCD. Long-Term Outcome and Complications of IOL-Exchange. Clin Ophthalmol 2023; 17:3243-3248. [PMID: 37927577 PMCID: PMC10625384 DOI: 10.2147/opth.s436963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose To describe the long-term outcome after intraocular lens (IOL) exchange for IOL-opacification with a focus on any occurring complications. Patients and Methods Patients with an IOL exchange for opacified IOLs (Lentis LS-502-1) were identified. Medical records and information from the treating ophthalmologists were reviewed. Visual outcomes and any occurring complications after the IOL exchange were analyzed. Results IOL exchange was performed in 48 eyes of 46 patients and significantly improved best-corrected distance visual acuity from 0.42 ± 0.32 logMar (mean ± SD) in opacified lenses to 0.25 ± 0.28 logMar after IOL exchange. Nine of the 48 eyes (19%) underwent 11 further surgical procedures for complications due to four indications: IOL dislocation (n = 2, 4%), retinal detachment (RD) (n = 6, 12%), epiretinal membrane (n = 2, 4%), and pupillary block (n = 1, 2%). Three eyes (6%) developed a temporarily elevated intraocular pressure. Temporary postoperative cystoid macular edema was found in 2 eyes (4%). Conclusion IOL exchange can restore vision owing to IOL opacification in most cases. Nonetheless, IOL exchange is not an easy or risk-free procedure. This may lead to sight-threatening complications, even in eyes without predisposing ocular comorbidities.
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Affiliation(s)
- David A Märker
- Department of Ophthalmology, Universitätsklinikum Regensburg, University of Regensburg, Regensburg, Bavaria, Germany
| | - Viola Radeck
- Department of Ophthalmology, Universitätsklinikum Regensburg, University of Regensburg, Regensburg, Bavaria, Germany
| | - Teresa Barth
- Department of Ophthalmology, Universitätsklinikum Regensburg, University of Regensburg, Regensburg, Bavaria, Germany
| | - Horst Helbig
- Department of Ophthalmology, Universitätsklinikum Regensburg, University of Regensburg, Regensburg, Bavaria, Germany
| | - Nicolas C D Scherer
- Department of Ophthalmology, Universitätsklinikum Regensburg, University of Regensburg, Regensburg, Bavaria, Germany
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Bavaria, Germany
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Britz L, Schickhardt SK, Yildirim TM, Auffarth GU, Lieberwirth I, Khoramnia R. [Hydrophobic surface properties of hydrophilic acrylic lenses do not protect against calcification]. DIE OPHTHALMOLOGIE 2023; 120:1022-1028. [PMID: 37171476 DOI: 10.1007/s00347-023-01862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Opacification through calcification of hydrophilic acrylic intraocular lenses is a serious complication of cataract surgery, which usually results in explantation of the lens. In the process of calcification, the intraocular lens material plays a crucial role: calcification only occurs in hydrophilic acrylic lenses. Hydrophobic acrylic lenses show no crystal formation within the polymer. Hydrophilic acrylic lenses from some manufacturers have hydrophobic surface properties. The question arises as to what influence these surface properties have on the risk of calcification. OBJECTIVE The present study investigated whether the hydrophobic surface properties of hydrophilic acrylic lenses can prevent calcification. MATERIAL AND METHODS Using an electrophoretic in vitro model of calcification, two hydrophilic lenses with hydrophobic surface properties were compared to two hydrophilic lenses and a hydrophobic negative control to determine the risk of calcification. The lenses were then analyzed by optical microscopy, Alizarin Red and Von Kossa staining, scanning electron microscopy (SEM) and energy dispersive X‑ray spectroscopy (EDX). RESULTS All four hydrophilic lens models showed calcification within the polymer. No difference was found between the hydrophilic lenses and the hydrophilic lenses with hydrophobic surface properties in terms of crystal formation. The hydrophobic negative control showed no calcification. CONCLUSION The investigation conducted in this study under standardized conditions could show that hydrophobic surface properties of hydrophilic acrylic lenses do not protect against calcium phosphate crystal formation within the polymer. There also is a risk of calcification in these lens models.
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Affiliation(s)
- Leoni Britz
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Sonja Katrin Schickhardt
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Timur Mert Yildirim
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Gerd Uwe Auffarth
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Deutschland
| | - Ramin Khoramnia
- David J. Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, INF 400, 69120, Heidelberg, Deutschland.
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Chamerski K, Filipecki J, Balińska A, Jeleń P, Sitarz M. Spectroscopic characterization of calcium phosphate precipitated under human eye conditions: An in vitro study. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2023; 297:122716. [PMID: 37062117 DOI: 10.1016/j.saa.2023.122716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 05/14/2023]
Abstract
Calcification is a well-known process of calcium phosphate mineralization observed in intraocular lenses. Despite the many works conducted in this field, there is no strict explanation of the mechanisms of this process. In order to better understand the phenomenon, i.e., the mechanisms and structural conditions that promote calcification, any research observations should be conducted under conditions that best reflect those of the human eye. Taking into account the specific anatomy and physicochemical conditions of the human eye, the problem under discussion becomes difficult to solve in vitro. In the present study, calcium phosphates formed under conditions similar to those in the human eye were characterized using SEM/EDS and infrared spectroscopy. Conducted study showed the formation of white spherical precipitates, which are unstable when extracted from solution. Such precipitates were characteristic of solutions containing 1.5-3.0 mM2 of solutes. Elemental analysis showed a Ca/P ratio of 1.64-1.65, which is similar to the ratio for hydroxyapatite (1.67). Chemical structure analysis revealed the presence of broad bending and stretching bands at 475-830 cm-1 and 880-1250 cm-1, respectively, which are characteristic of PO43- groups in apatite calcium phosphates. In further analysis involving numerical fitting the bands corresponding to apatitic PO43- and indicating the presence of calcium phosphates hydration were found. The results allow the selection of immersion media for further studies involving the incubation of hydrogel intraocular lenses.
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Affiliation(s)
- Kordian Chamerski
- Department of Experimental and Applied Physics, Faculty of Science and Technology, Jan Dlugosz University in Czestochowa, Al. Armii Krajowej 13/15, 42-200 Czestochowa, Poland.
| | - Jacek Filipecki
- Department of Experimental and Applied Physics, Faculty of Science and Technology, Jan Dlugosz University in Czestochowa, Al. Armii Krajowej 13/15, 42-200 Czestochowa, Poland
| | - Agnieszka Balińska
- Institute of Chemistry, Faculty of Science and Technology, Jan Dlugosz University in Czestochowa, Al. Armii Krajowej 13/15, 42-200 Czestochowa, Poland
| | - Piotr Jeleń
- Department of Silicate Chemistry and Macromolecular Compounds, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Al. Mickiewicza 30, 30-059 Krakow, Poland
| | - Maciej Sitarz
- Department of Silicate Chemistry and Macromolecular Compounds, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Al. Mickiewicza 30, 30-059 Krakow, Poland
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Liu X, Dai Y, Huang Y, Zheng S, Wei Y, Teng Y, Wu X. New exploration of ions and fatty acids in hydrophilic acrylic intraocular lens calcification. J Cataract Refract Surg 2023; 49:970-975. [PMID: 37184462 DOI: 10.1097/j.jcrs.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To conduct a new exploration and analysis of the ion and fatty acid levels of a medium in which calcified hydrophilic intraocular lenses (IOLs) are present. SETTING Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. DESIGN Retrospective, laboratory observational case series. METHODS 11 patients (11 eyes) who had implantation of foldable hydrophilic acrylic posterior IOLs were found to have opacification of the IOLs. In vivo and in vitro analyses included the evaluation of patients' clinical characteristics, microscopy, histological staining, energy dispersive X-ray spectroscopy (EDS), the ion level of the aqueous humor (AH) and preserving fluid (PF), and the fatty acid content of AH. RESULTS 10 of 11 cases were female with unilateral opacification, and 7 cases had both-eye cataract surgery, including 1 first eye and 6 second eyes with IOL opacification. 4 types of similar serial numbers were counted. The analysis of AH showed that the concentrations of phosphorus and silicon were elevated but that of calcium decreased, and an increased level of silicon was detected in 3 random PFs. The palmitic (C16:0) and stearic (C18:0) fatty acids were higher than the others in the AH. The EDS confirmed that the IOL surface deposits were composed of calcium, phosphate, and a small amount of silicon. CONCLUSIONS More silicon and higher C16:0 and C18:0 were found in the AH of patients with IOL opacification. New ideas and avenues have been proposed in the study of IOL opacification.
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Affiliation(s)
- Xiaomin Liu
- From the Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu); State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu); Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu)
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Gartaganis PS, Natsi PD, Gartaganis SP, Koutsoukos PG, Manousakis E, Karmiris E. Explantation of a sutureless scleral fixated Carlevale intraocular lens due to calcification: a clinical and laboratory report. BMC Ophthalmol 2023; 23:359. [PMID: 37587408 PMCID: PMC10433584 DOI: 10.1186/s12886-023-03102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Hydrophilic intraocular lens opacification is a rare complication due to calcification. With current new surgical techniques, including lamellar endothelial keratoplasty and vitrectomies, this irreversible complication is becoming more common. In this case study, we present clinical and laboratory features of a case of Carlevale hydrophilic acrylic IOL calcification. CASE PRESENTATION Observational case report of a single incident case. An 83-year-old man was referred to our ophthalmic department complaining of right eye vision blurring for six months. Slit-lamp biomicroscopy revealed IOL opacification. Deposits of calcium phosphate were found both on the IOL's surface and inside it, according to thorough investigation using optical, scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX) spectrometry. CONCLUSIONS To the best of our knowledge, this is the first case to describe the laboratory evidence of Carlevale hydrophilic IOL calcification, suggesting possible explanation mechanisms based on underlying pathology and surgical technique. It reminds us that these findings suggest that physicians should be aware of possible hydrophilic IOL calcification.
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Affiliation(s)
- Panos S Gartaganis
- Department of Ophthalmology, 251 Hellenic Air Force General Hospital, 16 Avras Str, 166 73, Athens, Greece.
| | - Panagiota D Natsi
- Department of Chemical Engineering, Laboratory of Inorganic and Analytical Chemistry, University of Patras and FORTH/ICE-HT, Patras, Greece
| | | | - Petros G Koutsoukos
- Department of Chemical Engineering, Laboratory of Inorganic and Analytical Chemistry, University of Patras and FORTH/ICE-HT, Patras, Greece
| | - Evangelos Manousakis
- Department of Ophthalmology, 251 Hellenic Air Force General Hospital, 16 Avras Str, 166 73, Athens, Greece
| | - Efthymios Karmiris
- Department of Ophthalmology, 251 Hellenic Air Force General Hospital, 16 Avras Str, 166 73, Athens, Greece
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Britz L, Schickhardt SK, Auffarth GU, Khoramnia R. Opacification of Hydrophilic Acrylic Intraocular Lenses: Overview of Laboratory Methods for Histological Analysis and Replication of IOL Calcification. Klin Monbl Augenheilkd 2023; 240:960-970. [PMID: 37391183 DOI: 10.1055/a-2073-8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Opacification of intraocular lenses (IOLs) due to material changes is a serious complication that can compromise the good visual outcomes of uncomplicated cataract surgery. In hydrophobic acrylic IOLs, opacification can result from glistening formation, while in hydrophilic acrylic IOLs, there is a risk of calcification due to the formation of calcium phosphates within the polymer. Over time, various methods have been developed to investigate calcification in hydrophilic acrylic IOLs. The aim of this article is to provide an overview of standard histological staining and models used to simulate IOL calcification. Histological staining can be used to detect calcification and assess the extent of crystal formation. The development of in vivo and in vitro replication models has helped to identify the underlying pathomechanisms of calcification. In vivo models are suitable for assessing the biocompatibility of IOL materials. Bioreactors as an in vitro model can be used to investigate the kinetics of crystal formation within the polymer. The replication of IOL calcification under standardized conditions using electrophoresis allows for the comparison of different lens materials with respect to the risk of calcification. The combination of different analytical and replication methods can be used in the future to further investigate the pathomechanisms of calcium phosphate crystal formation and the influence of risk factors. This may help to prevent calcification of hydrophilic acrylic IOLs and associated explantation and complications.
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Affiliation(s)
- Leoni Britz
- Universitäts-Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
| | | | - Gerd U Auffarth
- Universitäts-Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Univ.-Augenklinik Heidelberg, Deutschland
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8
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Naujokaitis T, Khoramnia R, Łabuz G, Choi CY, Auffarth GU, Tandogan T. Imaging Function and Relative Light Transmission of Explanted Opacified Hydrophilic Acrylic Intraocular Lenses. Diagnostics (Basel) 2023; 13:diagnostics13101804. [PMID: 37238287 DOI: 10.3390/diagnostics13101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
We evaluated the influence of intraocular lens (IOL) opacification on the optical performance of explanted hydrophilic acrylic IOLs. We performed a laboratory analysis of 32 Lentis LS-502-1 (Oculentis GmbH, Berlin, Germany) IOLs, explanted due to opacification, in comparison with six clear unused samples of the same IOL model. Using an optical bench setup, we obtained modulation transfer function (MTF), Strehl ratio, two-dimensional MTF, and United States Air Force (USAF) chart images. In addition, we assessed light transmission through the IOLs. The MTF values of opacified IOLs at 3-mm aperture were similar to those of clear lenses, with the median (interquartile range) values of 0.74 (0.01) vs. 0.76 (0.03) at the spatial frequency of 50 line pairs per millimeter in clear and opacified IOLs, respectively. The Strehl ratio of opacified lenses was not lower than that of clear lenses. The USAF-chart analysis showed a considerable reduction in brightness in opacified IOLs. The median (interquartile range) relative light transmission of opacified IOLs in comparison to clear lenses was 55.6% (20.8%) at the aperture size of 3 mm. In conclusion, the explanted opacified IOLs had comparable MTF values to those of clear lenses but significantly reduced light transmission.
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Affiliation(s)
- Tadas Naujokaitis
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Ramin Khoramnia
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Grzegorz Łabuz
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Chul Young Choi
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Gerd U Auffarth
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Tamer Tandogan
- The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
- Augenklinik Pallas, 4600 Olten, Switzerland
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Ní Dhubhghaill S, Janssen C, Dragnea DC, Van Os L, Rozema J, Werner L, Van Dyck D, Tassignon MJ. Wave-like calcification on the posterior surface of an acrylic hydrophilic bag-in-the-lens (BIL) implant. Am J Ophthalmol Case Rep 2022; 28:101693. [PMID: 36090304 PMCID: PMC9449740 DOI: 10.1016/j.ajoc.2022.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose To report secondary opacification of a hydrophilic bag-in-the-lens (BIL) which is a rare manifestation that can happen years after initial surgery. Observations We describe a case of a prominent wave-like, rippled opacification on the posterior surface of the BIL. The opacification was composed of calcium deposits and seems to start in the periphery as a ring and progresses to the centre of the posterior surface. Due to the specific design of the BIL, there is direct contact between the BIL and the posterior chamber, both with the space of Berger, and the anterior hyaloid, particularly in this very hyperopic eye. Conclusions and importance: Abnormal fluid flow and stagnation in an unusual retrolenticular space is a possible explanation for this unusual pattern of posterior surface opacification.
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Affiliation(s)
- Sorcha Ní Dhubhghaill
- Antwerp University Hospital, Edegem, Belgium
- Faculty of Health Sciences, University of Antwerp, Belgium
- Corresponding author. Antwerp University Hospital, Edegem, Belgium.
| | | | | | - Luc Van Os
- Antwerp University Hospital, Edegem, Belgium
- Faculty of Health Sciences, University of Antwerp, Belgium
| | - Jos Rozema
- Antwerp University Hospital, Edegem, Belgium
- Faculty of Health Sciences, University of Antwerp, Belgium
| | - Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, United States
| | - Dirk Van Dyck
- Faculty of Physics, Antwerp University, Wilrijk, Belgium
| | - Marie-José Tassignon
- Antwerp University Hospital, Edegem, Belgium
- Faculty of Health Sciences, University of Antwerp, Belgium
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Britz L, Schickhardt SK, Yildirim TM, Auffarth GU, Lieberwirth I, Khoramnia R. Development of a standardized in vitro model to reproduce hydrophilic acrylic intraocular lens calcification. Sci Rep 2022; 12:7685. [PMID: 35538104 PMCID: PMC9090772 DOI: 10.1038/s41598-022-11486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Opacification through calcification of hydrophilic acrylic intraocular lenses (IOL) is a severe complication after cataract surgery. Causing symptoms that range from glare through to severe vision loss, the only effective therapy is explantation of the opacified IOL so far. Although IOL calcification is a well-described phenomenon, its pathogenesis is not fully understood yet. The purpose of the current study was to develop a laboratory model to replicate IOL calcification. Calcification could be reproduced using a horizontal electrophoresis and aqueous solutions of calcium chloride and disodium hydrogen phosphate. The analysis of the in vitro calcified IOLs was performed using light microscopy, Alizarin Red and Von Kossa staining, scanning electron microscopy, energy dispersive x-ray spectroscopy and electron crystallography using transmission electron microscopy and electron diffraction. The presented laboratory model could be used to identify hydrophilic IOLs that are at risk to develop calcification and to assess the influence of associated risk factors. In addition, it can serve as a research tool to further understand this pathology.
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Affiliation(s)
- Leoni Britz
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Sonja Katrin Schickhardt
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Timur Mert Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University Eye Clinic Heidelberg, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
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Kanclerz P, Yildirim TM, Khoramnia R. Microscopic Characteristics of Late Intraocular Lens Opacifications. Arch Pathol Lab Med 2021; 145:759-767. [PMID: 33091924 DOI: 10.5858/arpa.2019-0626-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The increases in overall life expectancy and in lens surgeries performed on younger patients have resulted in a significant increase in the anticipated duration of artificial intraocular lenses (IOLs) in the eye. Thus, the physicochemical properties of the IOL become a critical issue, and several types of postoperative IOL opacifications have been reported. OBJECTIVE.— To describe the microscopic characteristics of opacified IOLs. Glistenings and subsurface nanoglistenings are fluid-related phenomena developing mainly in hydrophobic acrylic IOLs and are associated with aqueous influx into the IOL matrix. Calcification presents in hydrophilic acrylic or silicone IOLs as deposits of hydroxyapatite or other phases of calcium. Snowflake degeneration is less common, and it manifests in older polymethyl methacrylate IOLs. DATA SOURCES.— PubMed and ScienceDirect databases were searched for the following keywords: intraocular lens, IOL, cataract surgery, phacoemulsification, opacification, glistening, subsurface nanoglistenings, calcification, snowflake degeneration. English-language articles published up to October 15, 2019 were included in the study. The manuscript contains mainly a literature review; however, it was supplemented with original investigations from the David J. Apple International Laboratory for Ocular Pathology. CONCLUSIONS.— Glistenings and subsurface nanoglistenings should be evaluated in a hydrated state and at room temperature; they manifest as microvacuoles sized from 1.0 to greater than 25.0 μm and less than 200 nm, respectively. Calcification deposits are situated on or underneath the surface of the IOL and can be stained with a 1% alizarin red solution or with the von Kossa method. Snowflake degeneration manifests as "particles" or "crystals," causing whitish IOL discoloration. Scanning electron microscopy or energy dispersive X-ray spectroscopy may improve the diagnostic accuracy.
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Affiliation(s)
- Piotr Kanclerz
- From the Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland (Kanclerz)
| | - Timur Mert Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany (Yildirim, Khoramnia)
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany (Yildirim, Khoramnia)
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Serial opacification of a hydrophilic–hydrophobic acrylic intraocular lens: analysis of potential risk factors. J Cataract Refract Surg 2020; 46:1624-1629. [DOI: 10.1097/j.jcrs.0000000000000342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tarnawska D, Balin K, Jastrzębska M, Talik A, Wrzalik R. Physicochemical Analysis of Sediments Formed on the Surface of Hydrophilic Intraocular Lens after Descemet's Stripping Endothelial Keratoplasty. MATERIALS 2020; 13:ma13184145. [PMID: 32957729 PMCID: PMC7560278 DOI: 10.3390/ma13184145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
An intraocular lens (IOL) is a synthetic, artificial lens placed inside the eye that replaces a natural lens that is surgically removed, usually as part of cataract surgery. The opacification of the artificial lens can be related to the formation of the sediments on its surface and could seriously impair vision. The physicochemical analysis was performed on an explanted hydrophilic IOL and compared to the unused one, considered as a reference IOL. The studies were carried out using surface sensitive techniques, which can contribute to a better understanding of the sedimentation process on hydrophilic IOLs’ surfaces. The microscopic studies allowed us to determine the morphology of sediments observed on explanted IOL. The photoelectron spectroscopy measurements revealed the presence of organic and inorganic compounds at the lens surface. Mass spectroscopy measurements confirmed the chemical composition of deposits and allowed for chemical imaging of the IOL surface. Applied techniques allowed to obtain a new set of information approximating the origin of the sediments’ formation on the surface of the hydrophilic IOLs after Descemet’s stripping endothelial keratoplasty.
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Affiliation(s)
- Dorota Tarnawska
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, 41-200 Sosnowiec, Poland;
- Department of Ophthalmology, District Railway Hospital, Panewnicka 65, 40-760 Katowice, Poland
| | - Katarzyna Balin
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
- Correspondence:
| | - Maria Jastrzębska
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
| | - Agnieszka Talik
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
| | - Roman Wrzalik
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
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Variation in intraocular lens calcification under different environmental conditions in eyes with supplementary sulcus-supported lenses. Am J Ophthalmol Case Rep 2020; 19:100797. [PMID: 32760851 PMCID: PMC7390754 DOI: 10.1016/j.ajoc.2020.100797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose Analysis of explanted intraocular lenses (IOLs) from pseudophakic eyes with supplementary sulcus-supported IOLs. Methods In this laboratory investigation, ten supplementary and capsular bag IOLs were analyzed. All lenses were received between January 2012 and March 2018. Explants were examined morphologically with histological and electron microscopic techniques and patients’ medical history was evaluated. Additionally, we used a technique new to this field: Transmission Electron Microscopy and electron diffraction pattern analysis was performed to investigate the structure of the opacifying crystals in detail. Results Eleven lenses were explanted due to IOL opacification from seven polypseudophakic eyes: In three cases the supplementary lens calcified, in three cases the capsular bag IOL (both lenses analyzed) and in one case both IOLs (only the supplementary was received). Additional surgical procedures and comorbidities included pars plana vitrectomy or Descemet stripping endothelial keratoplasty and diabetes mellitus. For each opacified lens, a varying layer of a Calcium phosphate beneath the optic surface was apparent. Crystal characterization revealed its composition to be Hydroxyapatite. Conclusions and Importance We report on a series of secondary calcification in lenses explanted from polypseudophakic eyes. In some cases, calcification occurred in the capsular bag lens, in other cases in the supplementary lens, or in both. The severity of the morphological change could be related to the comorbidities and the presence of surgery subsequent to the lens implantations. Detailed morphology of the opacifying crystals was revealed. Intraocular lenses exhibited calcification in a series of polypseudophakic eyes. Pathology occurred in the capsular bag lens, the supplementary lens, or in both. Calcification was associated with different environmental factors. Depending on the factor, morphology and pattern of the opacity differed. Transmission Electron Microscopy revealed the opacifying crystals' ultrastructure.
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15
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Fernández J, Sánchez‐García A, Rodríguez‐Vallejo M, Piñero DP. Systematic review of potential causes of intraocular lens opacification. Clin Exp Ophthalmol 2019; 48:89-97. [DOI: 10.1111/ceo.13650] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/02/2019] [Accepted: 09/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision)Vithas Virgen del Mar Hospital Almería Spain
- Department of OphthalmologyTorrecárdenas Hospital Complex Almería Spain
| | - Alicia Sánchez‐García
- Department of Ophthalmology (Qvision)Vithas Virgen del Mar Hospital Almería Spain
- Department of Optics, Pharmacology and AnatomyUniversity of Alicante Alicante Spain
| | | | - David P. Piñero
- Department of Optics, Pharmacology and AnatomyUniversity of Alicante Alicante Spain
- Department of OphthalmologyVithas Medimar International Hospital Alicante Spain
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16
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Costa JF, Bompastor-Ramos P, Marques M, Henriques J, Póvoa J, Lobo C, Alió JL, Werner L, Murta J. Large-scale opacification of a hydrophilic/hydrophobic intraocular lens. Eur J Ophthalmol 2019; 30:307-314. [PMID: 30782006 DOI: 10.1177/1120672119830581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the prevalence and risk factors related to the opacification of the LS-502-1 intraocular lens. METHODS Cross-sectional study including patients submitted to cataract surgery between January 2010 and March 2012, with implantation of the LS-502-1 intraocular lens. Past medical history was registered and a complete ophthalmologic evaluation, that included best-corrected visual acuity, slit-lamp examination and fundoscopy, was performed. Anterior segment photographs were taken whenever intraocular lens opacification was present. RESULTS One hundred and sixty-nine eyes of 154 patients were included, mean age 78.5 ± 7.9 years. The average follow-up after intraocular lens implantation was 65.6 ± 10.0 months. Intraocular lens opacification was seen in 53.3% (n = 90) and presented as one of four different patterns: peripheral (15.6%, n = 14), central (4.4%, n = 4), diffuse (71.1%, n = 64) and superficial white deposits (8.9%, n = 8). There was no statistically significant association with systemic or ophthalmic conditions. In patients with bilateral implantation, intraocular lens opacification in one eye was significantly related to intraocular lens opacification in the fellow eye. A significant variability in opacification was found across intraocular lens serial numbers: the odds ratio for opacification in intraocular lens with serial number beginning with 200003 was 6.0 when comparing with the remaining lenses. CONCLUSION The opacification prevalence of the LS-502-1 intraocular lens was 53.3%, which is the highest ever described for any intraocular lens model. Our results suggest that this occurrence is secondary to an interaction between unknown patient variables and problems related to intraocular lens manufacturing and storage procedures.
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Affiliation(s)
- José F Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Paula Bompastor-Ramos
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Marco Marques
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Jorge Henriques
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - João Póvoa
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Conceição Lobo
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Jorge L Alió
- Research & Development Department, Ophthalmic Explants Biobank, VISSUM Alicante, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Liliana Werner
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Joaquim Murta
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
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Roland S, Khoramnia R, Auffarth GU, Son HS, Yildirim TM, Schoenherr U. Eintrübung einer hydrophilen Intraokularlinse nach multiplen Bevacizumab-Injektionen. Ophthalmologe 2018; 116:882-886. [DOI: 10.1007/s00347-018-0829-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Bompastor-Ramos P, Póvoa J, Lobo C, Rodriguez AE, Alió JL, Werner L, Murta JN. Late postoperative opacification of a hydrophilic-hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2018; 42:1324-1331. [PMID: 27697251 DOI: 10.1016/j.jcrs.2016.06.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To report late postoperative opacification of a model of hydrophilic-hydrophobic acrylic intraocular lens (IOL) as well as the clinical consequences and laboratory characteristics. SETTING Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. DESIGN Retrospective case series. METHODS Medical records were reviewed of patients with Lentis LS-502-1 IOL opacification reporting visual loss who had IOL explantation between November 2013 and March 2015. Patients were identified in the emergency room or during regular follow-up visits. Explanted IOLs were analyzed at the Ophthalmic Explants Biobank, Vissum, Spain, or at the John A. Moran Eye Center, University of Utah, USA. RESULTS Twenty opacified IOLs were explanted from 19 patients. The mean interval between cataract surgery and diagnosis of opacification was 29.15 months ± 9.57 (SD) (range 6 to 45 months). Opacification led to a statistically significant reduction in corrected distance visual acuity (mean 0.86 ± 0.76 logMAR; P < .001) and occurred in 5.1% of the hydrophilic-hydrophobic acrylic IOLs implanted at the department. The most frequently associated medical conditions were arterial hypertension, diabetes, and glaucoma. All IOLs but 1 had a similar pattern of opacification, with yellowish diffuse opacification uniformly distributed and calcium deposits on the surface and/or subsurface of the optic and haptics and within the IOL material. CONCLUSIONS Opacification of the hydrophilic-hydrophobic acrylic IOL was found in a significant number of patients and had a significant effect on their vision. The opacification was attributed to primary calcification. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Paula Bompastor-Ramos
- From the Department of Ophthalmology (Bompastor-Ramos, Póvoa, Lobo, Murta), Centro Hospitalar e Universitário de Coimbra, and the Faculty of Medicine (Lobo, Murta), University of Coimbra, Coimbra, Portugal; the Research and Development Department (Rodriguez, Alió), Ophthalmic Explants Biobank, Vissum Alicante, and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; the John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - João Póvoa
- From the Department of Ophthalmology (Bompastor-Ramos, Póvoa, Lobo, Murta), Centro Hospitalar e Universitário de Coimbra, and the Faculty of Medicine (Lobo, Murta), University of Coimbra, Coimbra, Portugal; the Research and Development Department (Rodriguez, Alió), Ophthalmic Explants Biobank, Vissum Alicante, and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; the John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Conceição Lobo
- From the Department of Ophthalmology (Bompastor-Ramos, Póvoa, Lobo, Murta), Centro Hospitalar e Universitário de Coimbra, and the Faculty of Medicine (Lobo, Murta), University of Coimbra, Coimbra, Portugal; the Research and Development Department (Rodriguez, Alió), Ophthalmic Explants Biobank, Vissum Alicante, and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; the John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Alejandra E Rodriguez
- From the Department of Ophthalmology (Bompastor-Ramos, Póvoa, Lobo, Murta), Centro Hospitalar e Universitário de Coimbra, and the Faculty of Medicine (Lobo, Murta), University of Coimbra, Coimbra, Portugal; the Research and Development Department (Rodriguez, Alió), Ophthalmic Explants Biobank, Vissum Alicante, and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; the John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Jorge L Alió
- From the Department of Ophthalmology (Bompastor-Ramos, Póvoa, Lobo, Murta), Centro Hospitalar e Universitário de Coimbra, and the Faculty of Medicine (Lobo, Murta), University of Coimbra, Coimbra, Portugal; the Research and Development Department (Rodriguez, Alió), Ophthalmic Explants Biobank, Vissum Alicante, and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; the John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Liliana Werner
- From the Department of Ophthalmology (Bompastor-Ramos, Póvoa, Lobo, Murta), Centro Hospitalar e Universitário de Coimbra, and the Faculty of Medicine (Lobo, Murta), University of Coimbra, Coimbra, Portugal; the Research and Development Department (Rodriguez, Alió), Ophthalmic Explants Biobank, Vissum Alicante, and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; the John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Joaquim N Murta
- From the Department of Ophthalmology (Bompastor-Ramos, Póvoa, Lobo, Murta), Centro Hospitalar e Universitário de Coimbra, and the Faculty of Medicine (Lobo, Murta), University of Coimbra, Coimbra, Portugal; the Research and Development Department (Rodriguez, Alió), Ophthalmic Explants Biobank, Vissum Alicante, and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; the John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA.
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19
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Gurabardhi M, Häberle H, Aurich H, Werner L, Pham DT. Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases. J Cataract Refract Surg 2018; 44:1326-1332. [PMID: 30279087 DOI: 10.1016/j.jcrs.2018.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To report clinical findings and light microscopic results of 71 opacified hydrophilic acrylic intraocular lenses (IOLs). SETTING Vivantes Klinikum Neukoelln, Ophthalmology Department, Berlin, Germany. DESIGN Retrospective case series. METHODS Sixty-three patients (71 eyes) were referred to the clinic because of vision-impairing IOL opacification between December 2012 and September 2016 after routine cataract surgery elsewhere. The explanted IOLs were analyzed with light microscopy at the John A. Moran Eye Center (University of Utah, Salt Lake City, Utah, USA). Medical records were reviewed for visual acuity, comorbidities, and complications. Clinical follow up was 6 months. RESULTS Seventy-one opacified 1-piece or 3-piece hydrophilic acrylic IOLs (Lentis) of different designs from 2009 to 2012 (LS-502-1, LS-402-1Y, LS 312-1Y, LS-313-1Y, L-402, L-312) were found. Morphological findings were surface, subsurface, or deep calcifications of the IOL material. Explantation was performed 4 years ± 1.2 (SD) after initial phacoemulsification. The mean patient age was 78.6 ± 8.2 years. Ocular and systemic comorbidities were found without statistical correlation: the most frequent were diabetes, uveitis, and glaucoma. The preoperative mean corrected distance visual acuity changed from 0.63 ± 0.47 logarithm of the minimum angle of resolution (logMAR) to 0.20 ± 0.28 logMAR postoperatively (P < .001). CONCLUSIONS Different designs of IOLs by the same manufacturer, implanted between 2009 and 2012, developed late calcification with significant visual loss after routine cataract surgery. No medical, surgical, or ophthalmologic trigger could be determined. A manufacture issue might be the reason for the opacification.
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Affiliation(s)
- Maceda Gurabardhi
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA.
| | - Heike Häberle
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Henning Aurich
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Liliana Werner
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
| | - Duy-Thoai Pham
- From the Vivantes Klinikum Neukoelln (Gurabardhi, Häberle, Aurich, Pham), Ophthalmology Department, Berlin, Germany; John A. Moran Eye Center (Werner), University of Utah, Salt Lake City, Utah, USA
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20
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Rosca C, Munteanu M, Tamasoi I, Petrovic Z, Balica N, Nicula C, Cretu O. Calcification of hydrophilic acrylic intraocular lens in eyes with silicone oil tamponade - an interventional case series report. Acta Ophthalmol 2016; 94:625-7. [PMID: 26507103 DOI: 10.1111/aos.12887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 08/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Cosmin Rosca
- Department of Ophthalmology; ‘Victor Babes’ University of Medicine and Pharmacy Timisoara; Timisoara Timis Romania
| | - Mihnea Munteanu
- Department of Ophthalmology; ‘Victor Babes’ University of Medicine and Pharmacy Timisoara; Timisoara Timis Romania
| | - Irina Tamasoi
- Department of Ophthalmology; ‘Victor Babes’ University of Medicine and Pharmacy Timisoara; Timisoara Timis Romania
| | - Zarko Petrovic
- Department of Ophthalmology; “Đorđe Joanović” General Hospital Zrenjanin; Zrenjanin Vojvodina Serbia
| | - Nicolae Balica
- Department of ENT; ‘Victor Babes’ University of Medicine and Pharmacy Timisoara; Timisoara Timis Romania
| | - Cristina Nicula
- Department of Ophthalmology; ‘Iuliu Hatieganu’ University of Medicine and Pharmacy; Cluj-Napoca Cluj Romania
| | - Octavian Cretu
- Department of Surgery; ‘Victor Babes’ University of Medicine and Pharmacy Timisoara; Timisoara Timis Romania
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21
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Gartaganis SP, Prahs P, Lazari ED, Gartaganis PS, Helbig H, Koutsoukos PG. Calcification of Hydrophilic Acrylic Intraocular Lenses With a Hydrophobic Surface: Laboratory Analysis of 6 Cases. Am J Ophthalmol 2016; 168:68-77. [PMID: 27130371 DOI: 10.1016/j.ajo.2016.04.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the nature and characteristic features of deposits causing opacification of intraocular lenses (IOLs) based on the examination of clinical findings using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDX) analysis. DESIGN Retrospective, observational case series. METHODS This is a multicenter study of 6 hydrophilic acrylic IOLs (Lentis LS-502-1; Oculentis GmbH, Berlin, Germany) with a hydrophobic surface that were explanted from 5 patients because of opacification. Three patients had an uncomplicated phacoemulsification. One patient underwent combined phacoemulsification and pars plana vitrectomy for retinal detachment and later silicone oil endotamponade owing to redetachment. The last patient had a pars plana vitrectomy and silicone oil instillation combined with phacoemulsification for tractive retinal detachment and diabetic retinopathy. The explanted lenses were submitted to our laboratory and were examined by SEM and EDX in order to identify the morphologic features and the composition of the deposits. RESULTS SEM and EDX analyses confirmed the presence of calcific deposits in the interior of the opacified hydrophilic IOLs, with a pattern showing the formation of lumps on the surface. The lumps were due to subsurface formation of calcium phosphate crystalline deposits. The crystallite clusters seemed to diffuse from the IOL interior to the surface. CONCLUSIONS We demonstrated the calcification pattern of the hydrophilic IOL (Lentis LS-502-1) with a hydrophobic surface. Although hydrophilic acrylic lenses have a hydrophobic surface, the development of calcification is a possible threat initiating from the hydrophilic subsurface of the IOLs.
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Ní Mhéalóid Á, Fulcher T, O'Keefe M. Anterior surface opacification of intraocular lenses after Descemet's stripping automated endothelial keratoplasty. BMJ Case Rep 2015; 2015:bcr-2015-213216. [PMID: 26677158 DOI: 10.1136/bcr-2015-213216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Descemet's stripping automated endothelial keratoplasty (DSAEK) is today recognised as the surgical procedure of choice for corneal endothelial dysfunction. The triple procedure (either staged or combined), whereby cataract surgery can be performed at the same time as endothelial keratoplasty, is well suited for patients with Fuch's endothelial dystrophy with decreased vision due to endothelial guttata, early stromal oedema and cataract formation. Recognised complications of DSAEK include donor graft detachment/dislocation, primary graft failure and pupillary block by air. Intraocular lens (IOL) opacification is a complication that is becoming apparent in patients who have undergone DSAEK and, to date, no definitive mechanism of such opacification has been discovered. Primary postoperative optic opacification of hydrophilic acrylic IOL designs has been attributed to the formation of calcium phosphate deposits. This has led to changes in lens designs, manufacturing processes and packaging. Secondary calcification is thought to be caused by environmental factors unrelated to the IOL model, such as breakdown of the blood-aqueous barrier. In this report, four cases of IOL anterior surface opacification are described in patients who required both cataract surgery and DSAEK. Only one case had cataract surgery and DSAEK performed concurrently, with the remainder having DSAEK performed at variable timeframes after cataract surgery.
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Affiliation(s)
- Áine Ní Mhéalóid
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Tim Fulcher
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Michael O'Keefe
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Dhubhghaill SN, Van Os L, De Keizer RJ, Taal M, Zakaria N, Tassignon MJ. Intraocular lens exchange technique for an opacified bag-in-the-lens. J Cataract Refract Surg 2015; 41:924-8. [DOI: 10.1016/j.jcrs.2015.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/08/2015] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
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Intraocular Lens Opacification following Intracameral Injection of Recombinant Tissue Plasminogen Activator to Treat Inflammatory Membranes after Cataract Surgery. J Ophthalmol 2015; 2015:975075. [PMID: 25861464 PMCID: PMC4378335 DOI: 10.1155/2015/975075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/02/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To report 7 cases of intraocular lens (IOL) opacification following treatment of postoperative anterior chamber fibrin with recombinant tissue plasminogen activator (rtPA) after cataract surgery. Methods. Retrospective case series of 7 eyes in 7 patients who developed IOL opacification after receiving rtPA for anterior chamber inflammatory membrane formation resulting from phacoemulsification cataract surgery. Three explanted IOLs were investigated with light microscopy, histochemical analysis, scanning electron microscopy, and X-ray spectrometry. Results. All patients underwent uncomplicated cataract surgery and posterior chamber hydrophilic IOL implantation. Anterior chamber inflammatory membranes developed between 1 and 4 weeks of surgery and were treated with intracameral rtPA. IOL opacification was noted between 4 weeks and 6 years after rtPA treatment with reduced visual acuity, and IOL exchange was carried out in 3 patients. Light microscopy evaluation revealed diffuse fine granular deposits on the anterior surface/subsurface of IOL optic that stained positive for calcium salts. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS) confirmed the presence of calcium and phosphate on the IOL. Conclusions. Intracameral rtPA, though rapidly effective in the treatment of anterior chamber inflammatory membranes following cataract surgery, may be associated with IOL opacification.
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Gambrelle J, Robinet A, Le Loir M. [Secondary opacification of a hydrophilic acrylic multifocal intraocular lens with a hydrophobic surface]. J Fr Ophtalmol 2015; 38:e27-8. [PMID: 25595631 DOI: 10.1016/j.jfo.2014.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J Gambrelle
- Ophtasiam, 5, bis rue Amiral-Linois, 29200 Brest, France; Clinique Pasteur, 83, rue Auguste-Kervern, 29200 Brest, France.
| | - A Robinet
- Ophtasiam, 5, bis rue Amiral-Linois, 29200 Brest, France; Clinique Pasteur, 83, rue Auguste-Kervern, 29200 Brest, France
| | - M Le Loir
- Centre ophtalmologique genevois, 17, avenue Mendes-France, 74100 Annemasse, France
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Schmidinger G, Pemp B, Werner L. [Opacification of an intraocular lens: calcification of hydrophilic intraocular lenses after gas tamponade of the anterior chamber]. Ophthalmologe 2014; 110:1066-8. [PMID: 23552856 DOI: 10.1007/s00347-013-2793-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient with endothelial dystrophy was treated with Descemet stripping automated endothelial keratoplasty (DSAEK) combined with cataract extraction and implantation of a hydrophilic intraocular lens (IOL, Lentis-L312, Oculentis) but visual acuity dropped from 0.15 logMAR to 0.52 logMAR 18 months later due to calcification of the IOL. With new methods of lamellar corneal transplantation being used more frequently the number of necessary anterior chamber tamponades with air/gas are increasing. In cataract cases in which a gas tamponade and transplantation might be necessary later on (cornea guttata), hydrophilic IOLs should be avoided.
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Affiliation(s)
- G Schmidinger
- Abteilung für Augenheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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Huang XD, Li HY, Lin L, Yao K. Reduced Silicone Oil Adherence to Silicone Intraocular Lens by Surface Modification with 2-Methacryloyloxyethyl Phosphoryl-Choline. Curr Eye Res 2012; 38:91-6. [DOI: 10.3109/02713683.2012.704477] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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