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Zhu P, Yuan G, Wan L, Chen S, Zhu W, Jiang H, Liu X, Zhang J. LONG-TERM OUTCOME OF TRANSSCLERAL FOUR-POINT FIXATION OF AKREOS INTRAOCULAR LENS WITH CLOSED CONTINUOUS-LOOP SUTURE. Retina 2024; 44:1015-1020. [PMID: 38295391 DOI: 10.1097/iae.0000000000004058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE To report the long-term clinical outcomes of transscleral four-point fixation of Akreos intraocular lens using a closed continuous-loop suture technique. METHODS This was a retrospective, multicenter, interventional case series. Primary outcome measures were best-corrected visual acuity, intraocular pressure, corneal endothelial cell density, and complications with a minimum of 1-year follow-up. RESULTS One hundred and ninety-two eyes of 177 patients from two surgical hospital sites were identified. The mean best-corrected visual acuity improved from 0.88 ± 0.74 logarithm of the minimum angle of resolution (Snellen 20/152) preoperatively to 0.42 ± 0.52 logarithm of the minimum angle of resolution (Snellen 20/53) postoperatively ( P < 0.001). The mean preoperative intraocular pressure was 17.51 ± 8.67 mmHg, and the mean postoperative intraocular pressure at final follow-up was 15.08 ± 4.18 mmHg ( P = 0.001). The mean corneal endothelial cell density significantly reduced from 2,259 ± 729 cells/mm 2 to 2077 ± 659 cells/mm 2 , representing a cell loss of 5.73% ( P < 0.001). The intraocular lens was fixed well during follow-up. There were no intraoperative complications noted. Postoperative complications included transient ocular hypertension in 15 eyes (7.81%), hypotony in two eyes (1.04%), retinal detachment in one eye (0.52%), and macular edema in one eye (0.52%). CONCLUSION The transscleral four-point fixation Akreos intraocular lens using the closed continuous-loop suture technique was effective and safe with satisfactory visual acuity with a minimum of 1-year follow-up.
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Affiliation(s)
- Pingfan Zhu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, Shandong, China
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and
| | - Gongqiang Yuan
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and
| | - Lei Wan
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China
| | - Shijiu Chen
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, Shandong, China
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and
| | - Wenting Zhu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and
| | - Han Jiang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, Shandong, China
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and
| | - Xiaoyan Liu
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and
| | - Jingjing Zhang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, Shandong, China
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and
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Renschler A, Kelkar N, Eid K, Hawn V, Bundogji N, Werner L, Mamalis N. Complications of foldable intraocular lenses requiring explantation or secondary intervention: 2022 survey with update of long-term trends. J Cataract Refract Surg 2024; 50:394-400. [PMID: 37994083 DOI: 10.1097/j.jcrs.0000000000001371] [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: 08/02/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE To assess the complications that resulted in the explantation or secondary intervention with foldable intraocular lenses (IOLs). SETTING University setting, Salt Lake City, Utah. DESIGN Survey study. METHODS For the 25th consecutive year, surgeons were surveyed regarding complications associated with foldable IOLs requiring explantation or secondary intervention over the 2022 calendar year. These forms were made available online using the ASCRS and ESCRS websites and a fax-on-demand service. Surgeons completed 1 survey for each foldable IOL requiring explantation or secondary intervention. Further analysis determined complication trends related to specific IOL styles, materials, and types over the past 16 years (2007 to 2022). RESULTS 103 completed surveys were returned in 2022 contributing to a total of 1627 tabulated surveys since 2007. In the 2022 survey, dislocation/decentration continued to be the most common complication overall. Glare/optical aberrations was a common complication associated with multifocal IOLs continuing a 16-year trend. In addition, hydrophilic acrylic IOLs as well as some silicone lenses in eyes with asteroid hyalosis demonstrated calcification as the most common complication necessitating explantation. CONCLUSIONS Dislocation/decentration remains the leading cause of explantation in most IOL types. Glare/optical aberrations continue to be an associated complication of multifocal IOLs suggesting this ongoing issue has yet to be resolved with this type of IOL. In addition, calcification of hydrophilic acrylic lenses and silicone lenses is a rare event but continues to occur.
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Affiliation(s)
- Andy Renschler
- From the University of Utah School of Medicine, Salt Lake City, Utah (Renschler, Kelkar, Eid, Hawn, Bundogji, Werner, Mamalis); Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Kelkar, Eid, Hawn, Bundogji, Werner, Mamalis)
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Chychko L, Khoramnia R, Son HS, Schickhardt SK, Lieberwirth I, Auffarth GU, Yildirim TM. Material Analysis of Explanted Calcified Silicone Intraocular Lenses in Association with Asteroid Hyalosis. Ophthalmol Ther 2024; 13:791-800. [PMID: 38244181 PMCID: PMC10853093 DOI: 10.1007/s40123-023-00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The aim of this study was to analyze posterior surface opacification in explanted silicone intraocular lenses (IOLs) with clinicopathologic correlation to asteroid hyalosis. METHODS In a laboratory setup, 12 explanted silicone IOLs underwent laboratory analyses, including light microscopy, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy for elemental composition (EDX). Relevant clinical data were obtained for each case, including gender, age at IOL implantation, dates of implantation and explantation, as well as history of neodymium-dopped yttrium aluminum garnet (Nd:YAG) laser treatments or other opacification removal attempts. High-resolution optical coherence tomography (OCT) images were obtained in vitro with an anterior segment OCT device (Anterion, Heidelberg Engineering, Heidelberg, Germany). RESULTS Calcification located at the posterior optic surface of each lens was identified through SEM and EDX analyses, revealing deposits composed of hydroxyapatite. In all cases, IOL polishing using Nd:YAG laser had been attempted prior to IOL exchange. The clinical functional data showed that this type of IOL opacity led to increase in straylight and subjective symptoms of glare. CONCLUSIONS Silicone IOLs can develop posterior surface calcification in eyes with asteroid hyalosis. There are mechanical techniques of cleaning the IOL surface but in many cases, IOL explantation is the only sustainable way to reduce the patients' straylight levels and glare symptoms. Due to the risk of posterior surface calcification, silicone IOL implantation should be avoided in eyes with asteroid hyalosis.
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Affiliation(s)
- Lizaveta Chychko
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Hyeck-Soo Son
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Sonja K Schickhardt
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Germany
| | - Gerd U Auffarth
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
- Department of Ophthalmology, International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Timur M Yildirim
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Álvarez-García MT, Rivera-Ruiz E, Alió JL, Piñero DP. Long-term Prevalence of Opacification of a Hydrophylic Acrylic Rotationally Asymmetric Refractive Multifocal Intraocular Lens. J Refract Surg 2024; 40:e98-e107. [PMID: 38346118 DOI: 10.3928/1081597x-20240115-01] [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: 02/15/2024]
Abstract
PURPOSE To determine the prevalence of opacification of a hydrophylic intraocular lens (IOL) with hydrophobic coverage and the percentage of explantations required, determining possible risk factors associated with these opacifications. METHODS This ambispective study enrolled 575 eyes of 296 patients (age 36 to 87 years) that underwent cataract surgery between 2010 and 2017 with implantation of different models of Lentis Mplus IOLs: LS-312-MF30, LS-313-MF15, LS-313-MF30, LU-313-MF30, and LU-313-MF30T (Oculentis GmbH). Visual, refractive, and slit-lamp biomicroscopic changes were evaluated in a long-term follow-up. The percentage of cases with IOL opacification and the percentage of cases in which IOL explantation was required due to such opacifications were calculated at each visit. Five of the explanted IOLs from this series could be analyzed by scanning electron microscopy (SEM-EDX). RESULTS IOL opacification developed in 63 eyes (11.0%). With 95% confidence, the prevalence of IOL opacification was between 842 and 1,401 cases per 10,000 eyes. The time elapsed between surgery and the presence of IOL opacification ranged between 0 and 9.3 years (mean: 4.7 ± 2.2 years). No significant differences in terms of IOL opacification rate were found according to gender (P = .378). No significant differences were found in arterial hypertension, diabetes, hypothyroidism, or hyperthyroidism rates between eyes with or without IOL opacification (P ≥ .053). IOL explantation was needed in 9 eyes (1.57%). SEM-EDX analysis confirmed the presence of rough areas on the IOL surface containing different components, such as calcium, phosphorous, copper, or nitrogen. CONCLUSIONS The prevalence of opacification with time in Lentis Mplus IOLs is high, with no systemic risk factors associated with this complication, suggesting that it may be attributable to the material and/or the manufacturing process. [J Refract Surg. 2024;40(2):e98-e107.].
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Tripodi S, Toro MD, Rejdak R, Costagliola C, Avitabile T, Carnevali A, Bruzzichessi D, Gambaro S, Porta A. Qualitative and quantitative analysis of an explanted opacified hydrophilic IOL after over two years from cataract surgery. Eur J Ophthalmol 2023; 33:NP28-NP34. [PMID: 36866563 PMCID: PMC10590018 DOI: 10.1177/11206721221145744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/20/2022] [Indexed: 03/04/2023]
Abstract
Opacification of hydrophilic intraocular lenses (IOLs) is an uncommon complication, that can appear after uneventful cataract surgery. We report a case of opacified Hydroview® IOL in a 76-year-old woman, with a previous history of pars plana vitrectomy with silicon oil tamponade in her right eye for a proliferative diabetic retinopathy, who developed an opacification of the IOL after over two years from a silicon oil/BSS exchange in combination with an uneventful phacoemulsification. The patient complained about a progressive decrease in her visual acuity. The slit-lamp examination confirmed the opacification of the IOL. Therefore, because of blurred vision, a combined procedure of explant and exchange of the IOL was performed in the same eye. Qualitative (Optic microscope, X-Ray powder Diffraction (XRD), Scanning Electron Microscopy (SEM)) and quantitative (Instrumental Neutron Activation Analysis (INAA)) analysis of the IOL material were performed. Here, our aim is to report the acquired data of the explanted Hydroview® H60M IOL.
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Affiliation(s)
- Sarah Tripodi
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Mario Damiano Toro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, Naples, Italy
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, Naples, Italy
| | | | - Adriano Carnevali
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Stefano Gambaro
- Department of Ophthalmology, Hospital C. Cantù, Abbiategrasso, Italy
| | - Alessandro Porta
- Department of Ophthalmology, Hospital C. Cantù, Abbiategrasso, Italy
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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, 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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Yildirim TM, Auffarth GU, Henningsen N, Łabuz G, Augustin VA, Son HS, Mackenbrock LHB, Khoramnia R. Differential Diagnosis of Changes in Intraocular Lenses. Klin Monbl Augenheilkd 2023; 240:952-959. [PMID: 37567234 DOI: 10.1055/a-2130-6944] [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: 08/13/2023]
Abstract
Differentiating between various intraocular lens (IOL) changes can be a challenge. In particular, certain IOL models carry the risk of late postoperative calcification. A major cause of IOL exchange surgery could be avoided if appropriate modifications were made during the IOL manufacturing process. The use of a hydrophilic acrylate carries the risk of IOL calcification, especially when a secondary procedure, such as a pars plana vitrectomy or other procedures using gas or air, is performed. In secondary IOL calcification, there is a wide range of opacification patterns, which are usually located in the centre on the anterior surface of the IOL or sometimes elsewhere. Often, granular deposits accumulate just below or on the surface of the IOL, leading to significant deterioration in visual quality and eventually requiring IOL exchange surgery. Therefore, in the case of eyes requiring secondary surgical intraocular intervention in the future, the use of hydrophilic IOLs should be critically evaluated. With regard to hydrophobic IOL materials, there are clear differences in the susceptibility to the formation of glistenings. Over time, there has been a significant decrease in glistening formation over the past 30 years due to optimisation of the material. With hydrophobic IOLs, special care should also be taken to avoid mechanical damage. In general, the only treatment option for functionally-impairing IOL opacification is surgical lens exchange, which carries potential risks of complications. In cases with a low degree of functional impairment, and especially in eyes with additional ocular diseases, it may be difficult to weigh the risk of additional surgery against the potential benefit. In some cases, it may be more appropriate not to perform an IOL exchange despite the IOL opacification. Recent visualisation methods that allow high-resolution analysis of the opacities in vivo and in vitro may be used in the future to estimate the functional effects of various IOL material changes on the optical quality.
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Affiliation(s)
| | | | | | - Grzegorz Łabuz
- Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
| | | | - Hyeck-Soo Son
- Augenklinik, UniversitätsKlinikum Heidelberg, Deutschland
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Sharon T, Naftali Ben Haim L, Rabinowicz N, Kidron D, Kidron A, Ton Y, Einan-Lifshitz A, Assia EI, Belkin A. The effect of hypotensive drugs on intraocular lenses clarity. Eye (Lond) 2023; 37:1696-1703. [PMID: 36071178 PMCID: PMC10219955 DOI: 10.1038/s41433-022-02225-w] [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: 10/16/2021] [Revised: 05/19/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To assess the effect of hypotensive drugs on light absorbance, discoloration, opacification and precipitate formation of IOLs. METHODS In this laboratory study, four types of IOLs (two hydrophilic-acrylic-L1 and L2, and two hydrophobic-acrylic-B1 and B2) were soaked in solutions containing Timolol-maleate 0.5%, Dorzolamide 2%, Brimonidine-tartrate 0.2%, Latanoprost 0.005%, Brimonidine-tartrate/Timolol-maleate 0.2%/0.5% and Dorzolamide/Timolol-maleate 2%/0.5%. Non-treated IOLs and IOLs soaked in balanced salt solution (BSS) served as controls. All Treated lenses were sealed in containers and placed in an oven at 82 degrees Celsius for 120 days. Each IOL was examined using four different techniques: light microscopy imaging, light absorbance measurements at 550 nanometers through the optic's center, assessment of by a scanning electron microscope (SEM), and energy dispersive Xray spectrometry (EDX). RESULTS Ninety-eight IOLs were included. All BSS-soaked IOLs appeared clear with no significant discoloration or precipitate-formation. Light absorbance in these lenses was comparable to that of non-soaked, non-heated IOLs. No calcium or phosphate were detected in either of these groups. Light absorbance differed significantly between the four treated IOL types. The drops most affecting light absorbance differed between IOLs. Gross examination revealed brown and yellow discoloration of all IOLs soaked in Dorzolamide and Brimonidine-tartrate solutions, respectively. SEM demonstrated precipitates that differed in size, morphology and distribution, between different IOL-solution combinations. EDX's demonstrated the presence calcium and phosphor in the majority of precipitates and the presence of sulfur in brown discolored IOLs. CONCLUSIONS In vitro, interactions between hypotensive drugs and IOLs induce changes in light absorbance, discoloration and precipitate formation.
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Affiliation(s)
- Tal Sharon
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Ein-Tal Eye Center, Tel Aviv, Israel.
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rabinowicz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine E-Research Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Debora Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Arnon Kidron
- Department of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ein-Tal Eye Center, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ein-Tal Eye Center, Tel Aviv, Israel
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10
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Bopp S, Özdemir HB, Aktaş Z, Khoramnia R, Yildirim TM, Schickhardt S, Auffarth GU, Özdek Ş. Clinical Characteristics of Patients with Intraocular Lens Calcification after Pars Plana Vitrectomy. Diagnostics (Basel) 2023; 13:diagnostics13111943. [PMID: 37296795 DOI: 10.3390/diagnostics13111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/21/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
AIM To determine the clinical risk factors that may increase the occurrence of intraocular lens (IOL) calcification in patients who had undergone pars plana vitrectomy (PPV). METHODS The medical records of 14 patients who underwent IOL explantation due to clinically significant IOL opacification after PPV were reviewed. The date of primary cataract surgery, technique and implanted IOL characteristics; the time, cause and technique of PPV; tamponade used; additional surgeries; the time of IOL calcification and explantation; and IOL explantation technique were investigated. RESULTS PPV had been performed as a combined procedure with cataract surgery in eight eyes and solely in six pseudophakic eyes. The IOL material was hydrophilic in six eyes, hydrophilic with a hydrophobic surface in seven eyes and undetermined in one eye. The endotamponades used during primary PPV were C2F6 in eight eyes, C3F8 in one eye, air in two eyes and silicone oil in three eyes. Two of three eyes underwent subsequent silicone oil removal and gas tamponade exchange. Gas in the anterior chamber was detected in six eyes after PPV or silicone oil removal. The mean interval between PPV and IOL opacification was 20.5 ± 18.6 months. The mean BCVA in logMAR was 0.43 ± 0.42 after PPV, which significantly decreased to 0.67 ± 0.68 before IOL explantation for IOL opacification (p = 0.007) and increased to 0.48 ± 0.59 after the IOL exchange (p = 0.015). CONCLUSIONS PPV with endotamponades in pseudophakic eyes, particularly gas, seems to increase the risk for secondary IOL calcification, especially in hydrophilic IOLs. IOL exchange seems to solve this problem when clinically significant vision loss occurs.
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Affiliation(s)
- Silvia Bopp
- Capio Augenklinik Universitätsallee, 28213 Bremen, Germany
| | - Hüseyin Baran Özdemir
- Department of Ophthalmology, Gazi University School of Medicine, Ankara 06570, Turkey
| | - Zeynep Aktaş
- Department of Ophthalmology, Atilim University School of Medicine, Ankara 06830, Turkey
| | - Ramin Khoramnia
- The David J Apple International Laboratory for Ocular Pathology, University of Heidelberg, 69117 Heidelberg, Germany
| | - Timur M Yildirim
- The David J Apple International Laboratory for Ocular Pathology, University of Heidelberg, 69117 Heidelberg, Germany
| | - Sonja Schickhardt
- The David J Apple International Laboratory for Ocular Pathology, University of Heidelberg, 69117 Heidelberg, Germany
| | - Gerd U Auffarth
- The David J Apple International Laboratory for Ocular Pathology, University of Heidelberg, 69117 Heidelberg, Germany
| | - Şengül Özdek
- Department of Ophthalmology, Gazi University School of Medicine, Ankara 06570, Turkey
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11
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Amon T, Goldblum D, Meyer P, Maloca PM, Garweg J, Pruente C, Sachers F, Signer T, Thumann G, Hasler PW. 674 Cases of Late Postoperative Intraocular Lens Opacification of a Hydrophilic-Hydrophobic Acryl Intraocular Lens in Switzerland and Retrospective Opacification Risk Factor Assessment of 212 Cases. Klin Monbl Augenheilkd 2023; 240:440-445. [PMID: 37164403 DOI: 10.1055/a-2013-1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To report the prevalence of late postoperative opacification of a hydrophilic and hydrophobic acrylic intraocular lens (IOL) and to assess the risk factors in a subset of 212 eyes of patients referred to the University Eye Department in Basel, Switzerland. DESIGN Retrospective case series. METHODS A survey was performed at all large ophthalmological clinics in Switzerland regarding exchanged Lentis LS-502-1 lenses, and the number of affected eyes was counted. Moreover, consecutive patients who were referred to a tertiary clinic between September 2015 and November 2016 with Lentis LS-502-1 opacification were investigated. Peri- and postoperative charts, medical history, and topical and systemic medications were assessed. RESULTS A total of 674 opacified Lentis LS-502-1 lenses have been reported in Switzerland, and 212 consecutive eyes of 182 patients were included in the study. All IOLs had a similar pattern of opacification with a yellowish, diffuse appearance, and most of them showed a small, paracentral, roundish area that was less affected or not at all. Arterial hypertension (73%), hypercholesterolemia (34%), and diabetes (21%) were the main associated systemic diseases, and statins (34%) and betablockers (34%) were the main treatments used. CONCLUSIONS The prevalence of IOL opacification was 9.9%. No associated systemic eye disease or medications could be detected, which was implicated in the opacification process. The reason for opacification remains unclear, but it seems to be unrelated to the patient's state; therefore, it is attributed to primary calcification.
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Affiliation(s)
- Tabea Amon
- Eye Clinic, University Hospital Basel, Basel, Switzerland
| | - David Goldblum
- Department of Ophthalmology, Pallas Clinic, Olten, Switzerland
| | - Peter Meyer
- Eye Clinic, University Hospital Basel, Basel, Switzerland
| | | | - Justus Garweg
- Berner Augenklinik, Bern, Switzerland
- Swiss Eye Institute AG, Rotkreuz, Switzerland
| | | | | | | | - Gabriele Thumann
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
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12
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Dyrda A, Rey A, Pighin MS, Jürgens I. Transient intraoperative opacification of a Carlevale intraocular lens. J Fr Ophtalmol 2023; 46:e28-e29. [PMID: 36470751 DOI: 10.1016/j.jfo.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022]
Affiliation(s)
- A Dyrda
- Institut Català de Retina, C/de Ganduxer, 117, 08022 Barcelona, Spain.
| | - A Rey
- Institut Català de Retina, C/de Ganduxer, 117, 08022 Barcelona, Spain
| | - M S Pighin
- Institut Català de Retina, C/de Ganduxer, 117, 08022 Barcelona, Spain
| | - I Jürgens
- Institut Català de Retina, C/de Ganduxer, 117, 08022 Barcelona, Spain
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13
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Unexpected Poor Vision within 24 h of Uneventful Phacoemulsification Surgery-A Review. J Clin Med 2022; 12:jcm12010048. [PMID: 36614846 PMCID: PMC9820923 DOI: 10.3390/jcm12010048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Review on day one post uneventful phacoemulsification surgery is no longer standard practice due to the infrequency of complications when using modern cataract removal techniques. Clinicians are therefore likely to be unfamiliar with the potential causes of reduced vision when presented with a patient in the immediate postoperative period. The purpose of this review is to discuss the various differential causes of early visual loss, for the benefit of clinicians presented with similar patients in emergency care, with the use of an illustrative clinical case of paracentral acute middle maculopathy (PAMM), which recently presented to the authors. A thorough literature search on Google Scholar was conducted, and only causes of visual loss that would manifest within 24 h postoperatively were included. Complications are inherently rare in this period; however, various optical, anterior segment, lens-related and posterior segment causes have been identified and discussed. Front-line clinicians should be aware of these differentials with different mechanisms. PAMM remains to be the only cause of unexpected visual loss within this time frame that may have no abnormal findings on clinical examination.
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14
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Specifying Risk of Intraocular Lens Opacification After Endothelial Keratoplasty for Different Intraocular Lens Models: A Retrospective Monocentric Cohort Study. Cornea 2022:00003226-990000000-00119. [PMID: 36633939 DOI: 10.1097/ico.0000000000003087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE The aims of this study were to calculate the specific risk of opacification for different intraocular lens (IOL) models and to determine whether differences exist, even between lenses made of similar acrylic materials. METHODS This is a retrospective cohort study of all patients who underwent endothelial keratoplasty (EK), either after or in conjunction with cataract surgery, from June 2009 to October 2020 at Fundación Jiménez Díaz Hospital. RESULTS Three hundred seventy-two eyes of 308 patients with a median follow-up of 856 days [interquartile range (IQR): 384-1570] were included, of which 128 IOLs were hydrophobic, 120 hydrophilic, and 124 unknown. 12.9% of IOLs opacified after a median of 466 days (IQR: 255-743). Visual acuity (VA) was significantly lower in the opacified IOL group [0.51 (IQR: 0.36-1.13)] compared with the nonopacified group [0.22 (IQR: 0.11-0.65)] ( P < 0.001). IOL explantation and exchange was performed in 10 eyes, in which VA improved markedly, from 1.75 (IQR: 0.99-3.00) to 0.60 (IQR: 0.36-0.86) ( P = 0.004). IOL material and opacification events were not independent ( P < 0.001). Significant differences were found between the Akreos ADAPT AO and MI60P models and the Asphina 409M model ( P = 0.022). No significant differences were found in the opacification ratio for hydrophilic IOLs in the clinical diagnosis ( P = 0.11), the type of EK ( P = 0.25), the rebubbling rate ( P = 0.44), or the tamponade used ( P = 0.36). CONCLUSIONS Hydrophilic lenses should be avoided in patients at risk of requiring EK. It is important to know the probability of opacification of each IOL model to balance risk and benefits when planning an EK procedure because not all lenses opacify equally. Opacification is an unwanted event with a negative impact on VA, making IOL explantation and exchange the only viable treatment, although one that is not without risks.
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15
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Stewart SA, McNeely RN, Chan WC, Moore JE. Visual and Refractive Outcomes Following Exchange of an Opacified Multifocal Intraocular Lens. Clin Ophthalmol 2022; 16:1883-1891. [PMID: 35706684 PMCID: PMC9191835 DOI: 10.2147/opth.s362930] [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: 02/26/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the visual and refractive outcomes following exchange of an opacified multifocal intraocular lens (IOL). Patients and Methods A consecutive series of 37 eyes (31 patients) that underwent IOL exchange between November 2015 and May 2021 were included in this study. The indication for surgery in all cases was opacification of a multifocal IOL. Outcome measures included design and anatomical location of the secondary IOL, intraoperative and postoperative complications, visual acuity and refractive accuracy. Results An opacified Lentis Mplus multifocal IOL was explanted from all eyes and replaced with a monofocal IOL in 21 eyes (57%) and multifocal IOL in 16 eyes (43%). Secondary IOLs were implanted in the capsular bag or sulcus or were iris-fixated. IOL exchange was performed at a mean interval of 7 years after the primary surgery. Anterior vitrectomy was required for vitreous prolapse in 9 eyes (24%). Mean corrected distance visual acuity (CDVA) postoperatively was −0.02 ± 0.08 logMAR for eyes with a monofocal secondary IOL and 0.02 ± 0.08 logMAR for eyes with a multifocal secondary IOL. Mean refractive prediction error was −0.57 ± 0.67 D in the multifocal-monofocal group and −0.33 ± 0.59 D in the multifocal–multifocal group. Conclusion An opacified multifocal IOL can be exchanged for a monofocal or multifocal IOL, depending on available capsular support and the patient’s desired refractive outcome. Vitreous prolapse requiring anterior vitrectomy is the most common intraoperative complication. An improvement in visual acuity and a low postoperative complication rate were achieved in this cohort of patients.
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Affiliation(s)
- Stephen A Stewart
- Cathedral Eye Clinic, Belfast, Northern Ireland, UK
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Correspondence: Stephen A Stewart, Cathedral Eye Clinic, Belfast, Northern Ireland, UK, Tel +44 28 9032 2020, Email
| | | | - Wing C Chan
- Cathedral Eye Clinic, Belfast, Northern Ireland, UK
| | - Jonathan E Moore
- Cathedral Eye Clinic, Belfast, Northern Ireland, UK
- Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland, UK
- Department of Ophthalmology, Tianjin Medical University, Tianjin, People’s Republic of China
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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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Balakrishnan H, Muthukrishnan G, Moorthy P. Seeing through the mist: An unusual case of tertiary cataract. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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18
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Intraoperative and Postoperative Intraocular Lens Opacifications: Analysis of 42545 Cases. J Ophthalmol 2021; 2021:1285947. [PMID: 34912573 PMCID: PMC8668301 DOI: 10.1155/2021/1285947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/26/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the types and causes of intraocular lens (IOL) turbidity in a tertiary eye center. Setting. Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. Design Retrospective case series. Methods Patients who underwent uncomplicated phacoemulsification and IOL implantation for cataract between January 2015 and December 2019 were included. Medical records were reviewed of participants with intraoperative or postoperative IOL opacification for clinical data, artificial crystal materials, and causes of the opacification. Results A total of 42545 IOLs were implanted in the five years, comprising 25471 (66.0%) hydrophilic IOLs, 11881 (27.9%) hydrophobic IOLs, and 2601 (6.1%) hydrophilic-hydrophobic acrylic IOLs. Among the operated eyes, 14 eyes (13 patients) experienced IOL opacification, which was permanent for 10 IOLs, including 7 (0.6%) hydrophilic IOLs (860UV) and 3 (0.2%) hydrophilic-hydrophobic acrylic IOLs (L-312). The mean interval between surgery and diagnosis of permanent opacification was 34.4 ± 18.4 (SD) months (range, 12 to 59 months). Permanent IOL clouding led to a statistically significant reduction in best corrected visual acuity (mean, 0.64 ± 0.4 logMAR; P < 0.004). Acute IOL clouding occurred in four eyes during the implantation of a hydrophilic-hydrophobic acrylic IOL of L-312, 809M, or 839M and returned to transparency several hours later. All four procedures were performed in winter, with the mean outside temperature being −5.75°C. Conclusions The rate of IOL opacification was 0.03%. Both delayed postoperative and acute intraoperative opacifications occurred with various characteristics in IOLs made of different materials and designs. Clinicians should be aware of this risk for cataract surgery.
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19
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Kern C, Priglinger S, Mackert MJ. [Intraocular lens opacification after combined cataract and minimally invasive glaucoma surgery (MIGS)]. Ophthalmologe 2021; 118:724-727. [PMID: 32681299 PMCID: PMC8260514 DOI: 10.1007/s00347-020-01176-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drei Wochen nach komplikationsloser kombinierter minimal-invasiver Glaukom- und Kataraktoperation kam es zu einer Sehverschlechterung durch die Eintrübung der Intraokularlinse. Durch die Nichtanwendung der postoperativen antiinflammatorischen Lokaltherapie kam es zu einer homogenen Fibrinbildung auf der Linsenvorderfläche sowie einer beginnenden Vernarbung des Sickerkissens. Wir führten ein Needling mit 5‑Fluorouracil sowie eine Linsenpolitur mit dem Nd:YAG-Laser durch und erreichten so eine suffiziente Druckkontrolle und Sehverbesserung.
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Affiliation(s)
- Christoph Kern
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland
| | - Siegfried Priglinger
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland
| | - Marc J Mackert
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland.
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20
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Bhattacharjee H, Buragohain S, Javeri H, Das D, Bhattacharjee K. Delayed postoperative opacification of three hydrophobic acrylic intraocular lens: A scanning electron microscopic and energy dispersive spectroscopic study. Indian J Ophthalmol 2021; 69:1103-1107. [PMID: 33913842 PMCID: PMC8186658 DOI: 10.4103/ijo.ijo_2749_20] [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] [Indexed: 11/29/2022] Open
Abstract
Purpose: The aim of this study was to report scanning electron microscopic (SEM) and energy dispersive spectroscopic (EDS) findings of three specimens of opaque hydrophobic acrylic intraocular lens (IOL) explanted in delayed postoperative period for visual indications. Methods: Clinical data and photographs from each subject were obtained. Explanted IOLs were examined under gross and light microscopy followed by SEM coupled with EDS. Results: All three subjects underwent IOL implantation following senile cataract extraction at an average age of 64.3 ± 0.3 years, and the IOLs were in situ for a duration of 11.3 ± 4.04 years. The IOL explantation and exchange were done due to late postoperative opacification of the IOL and significant visual deterioration. The milky iridescent opacity affected the full thickness of IOL optics in the first two specimens and in the third only two surfaces were involved. SEM detected surface cracks in the first specimen, typical conglumated surface, pores and accumulation of crystals with surface deposit of nano-particles on the second specimen and uneven surface erosion in the third specimen. SEM detected mainly sodium (Na) and chloride (Cl) spikes. All patients recovered normal vision following IOL exchange. Conclusion: SEM features of the IOL optics and absence of calcium and phosphate spikes in EDS and other findings were consistent and suggestive of hydrolytic biodegradation of hydrophobic acrylic IOL polymer in ocular media and was responsible for delayed postoperative opacification of the hydrophobic IOLs and visual loss.
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Affiliation(s)
| | | | - Henal Javeri
- Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Dipankar Das
- Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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21
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Mackert M, Muth DR, Vounotrypidis E, Deger C, Goldblum D, Shajari M, Hasler PW, Priglinger S, Wolf A. Analysis of opacification patterns in intraocular lenses (IOL). BMJ Open Ophthalmol 2021; 6:e000589. [PMID: 33634210 PMCID: PMC7880112 DOI: 10.1136/bmjophth-2020-000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022] Open
Abstract
Objective Intraocular lens (IOL) opacification may cause severe visual impairment. The pathogenesis remains unclear. The aim of this study was to analyse opacification patterns in different IOLs. Therefore, this multicentre, retrospective, observational study was conducted at Ludwig-Maximilians-University, Munich, Germany and University-Hospital Basel, Switzerland. Methods and analysis In this study, 75 opacified IOLs were identified and classified after extraction. Macroscopical photo documentation, light and electron microscopic analysis were done. Results 68 acrylic-hydrophilic single-piece-IOLs, 1 acrylic-hydrophilic 3-piece-IOL, 6 acrylic-hydrophobic 3-piece-IOLs were extracted. The dataset comprised IOLs known for opacification and IOLs not having been reported yet. 67 IOLs showed a fine-granular and 8 IOLs a crust-like opacification pattern. According to literature, 62 of the fine-granular opacified IOLs were graded into type 1 (processing/packaging-induced primary opacification) and 13 into type 2 (secondary opacification of unknown aetiology). The anterior surface of the IOLs was affected in all 75 IOLs, the posterior surface only in 23 cases. Of all 67 fine-granular IOLs, 43 had a central defect and 21 had a zone without opacification (clear islet). Conclusion In our series, the morphology of IOL opacification did not follow the existing pathogenetic classification that strictly discriminates between primary and secondary causes. Fine-granular IOL opacification occurs with similar patterns in both type 1 and type 2 IOL opacification, while a crust-like pattern was only detected in type 2 IOL opacifications. Consequently, susceptibility of an IOL to opacification is caused by a multifactorial combination of material and processing properties as well as individual (pathological) conditions of the patient.
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Affiliation(s)
- Marc Mackert
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | | | - Constanze Deger
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - David Goldblum
- Department of Ophthalmology, University Hospital Basel, Universitatsspital Basel Augenklinik, Basel, Switzerland
| | - Mehdi Shajari
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Pascal Willy Hasler
- Department of Ophthalmology, University Hospital Basel, Universitatsspital Basel Augenklinik, Basel, Switzerland
| | - Siegfried Priglinger
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Armin Wolf
- Ophthalmology, Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
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Li C, Lu P. A rare intraocular lens surface foreign body during phacoemulsification surgery: A case report. Medicine (Baltimore) 2021; 100:e24391. [PMID: 33546080 PMCID: PMC7837886 DOI: 10.1097/md.0000000000024391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Only a few cases of intraocular lens (IOL) opacification during phacoemulsification surgery have been reported in the literature; intraoperative emergency due to IOL surface foreign body is even rarer. PATIENT CONCERNS A 76-year-old woman underwent uncomplicated cataract surgery in her right eye. A triangular transparent seemingly foreign body tightly attached to the posterior surface of the IOL was found during IOL implantation; the IOL surface foreign body prevented the patient from obtaining satisfactory visual acuity after surgery. DIAGNOSIS IOL surface foreign body. INTERVENTIONS After confirmation of the surface foreign body by swept-source optical coherence tomography (IOL Master 700), the surface foreign body was removed in a second surgery. After surgery, the IOL was still well centered. OUTCOMES Fortunately, the patient achieved distinctly improved vision without any visual disturbances in her right eye. To identify the material of the foreign body, it was examined by Fourier-transform infrared spectroscopy (FTIR). LESSONS This case suggests that surgeons should carefully observe IOLs before implantation. In addition, effective preoperative planning and skillful surgery can remove foreign bodies smoothly and improve patient vision.
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23
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Balendiran V, MacLean K, Mamalis N, Tetz M, Werner L. Localized calcification of hydrophilic acrylic intraocular lenses after posterior segment procedures. J Cataract Refract Surg 2021; 45:1801-1807. [PMID: 31856993 DOI: 10.1016/j.jcrs.2019.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the clinical and laboratory findings in a series of cases of hydrophilic acrylic intraocular lens (IOL) opacification after posterior segment procedures. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Experimental study. METHODS Thirty hydrophilic acrylic IOLs were explanted after various posterior segment procedures (pars plana vitrectomy, intravitreal anti-vascular endothelial growth factor injections) because of localized central anterior surface and subsurface optic opacification associated with decreased visual function. Once received by the laboratory in the dry state or in fixative by the explanting surgeons, microscopic, histochemical (alizarin red), and surface analysis (scanning electron microscopy [SEM], energy-dispersive X-ray spectroscopy [EDS]) evaluations were performed on the IOLs. The surgeons were sent a questionnaire to obtain information pertinent to each case. RESULTS Of the 30 explanted IOLs, 9 hydrophilic acrylic designs from 7 different manufacturers were identified. Gross microscopy and light microscopy showed granular deposits in a dense round pattern of distribution within the margins of the capsulorhexis or pupil on the anterior surface/subsurface of the IOLs. The granules stained positive for calcium with alizarin red. On SEM coupled with EDS, the granular deposits were found to comprise calcium and phosphate. CONCLUSIONS A localized pattern of anterior surface/subsurface calcification was seen on hydrophilic acrylic IOLs from various manufacturers. The calcification resembled the pattern seen on calcified IOLs after anterior segment procedures using intracameral injections of air or gas. This calcification of hydrophilic acrylic IOLs is likely the result of blood-aqueous barrier breakdown from repeated intraocular procedures.
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Affiliation(s)
- Vaishnavi Balendiran
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Kyle MacLean
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Nick Mamalis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | | | - Liliana Werner
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Berlin Eye Research Institute, Berlin, Germany.
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Oner FH, Ozturk T, Yaman A, Werner L. Intraocular Lens Opacification Following Silicone Oil Endotamponade. Ophthalmic Surg Lasers Imaging Retina 2021; 52:37-43. [PMID: 33471913 DOI: 10.3928/23258160-20201223-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report cases with intraocular lens (IOL) opacification following silicone oil (SO) endotamponade. PATIENTS AND METHODS Medical charts of 32 eyes with IOL opacification were evaluated retrospectively. All eyes had rhegmatogenous retinal detachment and had a history of previous hydrophilic acrylic IOL implantation. All patients underwent vitrectomy with SO endotamponade. Clinical features of all cases and the results of histochemical evaluation of explanted IOLs were reported. RESULTS The mean duration of SO endotamponade was 4.6 ± 2.0 months. The mean follow-up was 67.0 ± 23.5 months. The interval between phacoemulsification surgery and IOL opacification was 27.4 ± 18.3 months. With the exception of two eyes, all IOL opacification was detected during the follow-up period after SO removal. IOL exchange was performed in 12 eyes (37.5%). Histochemical analysis revealed significant calcification mostly on the surface of explanted IOL optics. CONCLUSION Vitreoretinal surgeons should be aware of that some hydrophilic IOLs may have the potential of opacification following SO endotamponade. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:37-43.].
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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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26
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Poleva RP, Ermolaev AP, Hderi K, Levitskiy YV. [Functional rehabilitation of a patient with central opacification of the intraocular lens optic (clinical case)]. Vestn Oftalmol 2020; 136:237-240. [PMID: 33063971 DOI: 10.17116/oftalma2020136052237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors present a clinical case of central opacification of the intraocular lens (IOL) optic associated with a significant uncorrectable visual acuity decrease. Due to high surgical risks of IOL exchange, corectopia was achieved through sectoral laser photomydriasis. Stable dilation of the lower nasal sector of the pupil enabled the optical zone to be shifted outside the opaque area of the IOL. As shown by the perimetry results, the visual field borders enlarged through sectoral laser photomydriasis were comparable with the topography of the asymmetrically dilated pupil.
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Affiliation(s)
- R P Poleva
- Research Institute of Eye Diseases, Moscow, Russia
| | - A P Ermolaev
- Research Institute of Eye Diseases, Moscow, Russia
| | - K Hderi
- Research Institute of Eye Diseases, Moscow, Russia
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Jo YC, Park JM. Late Opacification of a Hydrophilic Acrylic Monofocal Intraocular Lens with Hydrophobic Surface after Vitrectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.10.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Ng JY, Ting DSJ, Thomas S, Auffarth GU, Merz P. Opacification of hydrophilic acrylic intraocular lens following vitreoretinal surgery: a clinicopathological report. Can J Ophthalmol 2020; 56:e9-e11. [PMID: 32771328 DOI: 10.1016/j.jcjo.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jia Yu Ng
- Sunderland Eye Infirmary, Sunderland, U.K..
| | - Darren Shu Jeng Ting
- University of Nottingham, Nottingham, U.K.; Queen's Medical Centre, Nottingham, U.K
| | - Saju Thomas
- Darlington Memorial Hospital, Darlington, U.K
| | | | - Patrick Merz
- Heidelberg University Clinic, Heidelberg, Germany
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29
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August consultation #5. J Cataract Refract Surg 2020; 46:1204-1205. [DOI: 10.1097/01.j.jcrs.0000696744.42126.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Durr GM, Ahmed IIK. Intraocular Lens Complications: Decentration, Uveitis-Glaucoma-Hyphema Syndrome, Opacification, and Refractive Surprises. Ophthalmology 2020; 128:e186-e194. [PMID: 32652203 DOI: 10.1016/j.ophtha.2020.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
As cataract surgery has evolved, intraocular lens (IOL) complications are rare. The purpose of this review was to report the incidence, diagnosis, and management of IOL decentrations, uveitis-glaucoma-hyphema (UGH) syndrome, IOL opacifications, and refractive surprises. Literature review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Controlled Trial Database and the reference lists of original studies as well as reviews. Intraocular lens decentrations and dislocations can appear at any time, particularly in patients with predisposing factors such as pseudoexfoliation, prior vitreoretinal surgery, or trauma. Recognizing when they require surgical intervention for UGH or to improve visual function is critical in limiting long-term sequela. Intraocular lens opacifications such as glistenings rarely require intervention, but others, such as subsurface nanoglistenings, calcifications, or discolorations, may require IOL exchange. Finally, despite our best efforts to enhance measurements and IOL calculations, refractive surprises still occur. Intraocular lens complications are uncommon with modern cataract surgery. A number of these complications require proper identification and care to optimize patient outcomes.
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Affiliation(s)
- Georges M Durr
- Department of Ophthalmology, Université de Montréal, Montréal, Canada; Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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31
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Werner L. Intraocular Lenses: Overview of Designs, Materials, and Pathophysiologic Features. Ophthalmology 2020; 128:e74-e93. [PMID: 32619547 DOI: 10.1016/j.ophtha.2020.06.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
This article provides an overview of intraocular lenses (IOLs) currently used in cataract surgery. Aspects presented include design features related to IOL construction and sites of fixation; optic, filter, and haptic materials; as well as pathophysiologic features of uveal biocompatibility, capsular biocompatibility, and postoperative IOL opacification. This overview also includes supplementary (add-on; piggyback) lenses implanted in eyes that are already pseudophakic and considerations on IOLs used in the pediatric population. Different IOLs are made available to surgeons each year, including lenses with increasingly complex design characteristics owing to advancements in manufacturing and surgical techniques.
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Affiliation(s)
- Liliana Werner
- Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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32
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Revaluating the relationship between keratoplasty and intraocular lenses. Eye (Lond) 2020; 34:1722-1725. [PMID: 32296129 PMCID: PMC7608366 DOI: 10.1038/s41433-020-0870-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 11/16/2022] Open
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Kawai K. An evaluation of glistening and stability of intraocular lens material manufactured by different methods. Eur J Ophthalmol 2020; 31:427-435. [PMID: 32000525 DOI: 10.1177/1120672120902038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate glistening and long-term stability of five commercially available intraocular lenses. METHODS This experimental study evaluated the SN60WF (Alcon), XY1 (Hoya), NS-60YG (NIDEK), ZCB00V (Johnson & Johnson Vision) and AN6KA (Kowa) intraocular lenses. To generate glistenings, intraocular lenses were immersed in physiological saline at 50°C for 2 h, then left in situ at 35°C and removed at regular intervals over 24 h. Stability of the intraocular lens material was assessed by immersing intraocular lenses into vials of purified water placed at 100°C for 115 days, which simulated 20-year ageing. Gas chromatography-mass spectrometry was used to detect leached compounds. RESULTS Almost no glistenings were observed for the AN6KA. Glistenings were observed in the remaining intraocular lenses after 3 h. The number of glistenings gradually disappeared by 6 h for all intraocular lenses except SN60WF (12 h). Only the NS-60YG and ZCB00V intraocular lenses had no changes in weight or dimensions. Gas chromatography-mass spectrometry detected phenethyl alcohol in XY1 and SN60WF, 2-phenoxyethanol in AN6K and no compounds in the remaining intraocular lenses. A peak shift due to the carbonyl group between 1600 and 1700 cm-1 was detected for the SN60WF and AN6K intraocular lenses only. CONCLUSION SN60WF had the most numerous glistenings that resolved over a longer duration. The long-term stability test confirmed elution of the intraocular lens material-derived compounds and signs of degradation for the XY1, SN60WF and AN6K intraocular lenses. NS-60YG and ZCB00V showed no signs of deterioration due to ageing. Differing manufacturing methods likely play a role in the stability of intraocular lenses.
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Affiliation(s)
- Kenji Kawai
- Department of Ophthalmology, School of Medicine, Tokai University, Oiso, Japan
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34
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Flushing Versus Pushing Technique for Graft Implantation in Descemet Membrane Endothelial Keratoplasty. Cornea 2019; 39:605-608. [DOI: 10.1097/ico.0000000000002239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Łabuz G, Reus NJ, van den Berg TJTP. Light scattering levels from intraocular lenses extracted from donor eyes. J Cataract Refract Surg 2019; 43:1207-1212. [PMID: 28991619 DOI: 10.1016/j.jcrs.2017.06.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/23/2017] [Accepted: 06/24/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess light scatter levels of intraocular lenses (IOLs) extracted from donor eyes to understand straylight elevation documented earlier in pseudophakic population studies and identify potential sources of light scattering in IOLs. SETTING Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands. DESIGN Experimental study. METHODS Light scattering in 74 donor IOLs was measured with the C-Quant device adapted for in vitro analysis of IOLs. Straylight was assessed at a 2.5-degree and 7.0-degree scatter angle, and results were compared with the straylight of a 20-year-old crystalline lens, a 70-year-old crystalline lens, and a lens with cataract. To identify potential changes to the IOL material, the IOLs were examined with a light microscope and a slitlamp. RESULTS At 2.5 degrees and 7.0 degrees, the straylight parameter was 5.78 deg2/steradian (sr) ± 4.70 (SD) and 5.06 ± 4.01 deg2/sr, respectively. Forty-one percent of IOLs showed lower straylight than the 20-year-old lens. In 14%, the scattering intensity was higher than in the 70-year-old lens; none showed straylight comparable to that of the cataractous lens. Increased straylight was associated with surface deposits, snowflake-like degeneration, and glistenings. The incidence of IOL-related complications differed between the IOL groups. CONCLUSIONS Microscopic structural alterations of IOLs play a major role in straylight elevations in pseudophakic eyes. A clear correlation with degeneration and/or alteration of implanted IOLs was found. Although these IOL-related complications would likely not affect visual acuity, they give rise to straylight and thus can cause disability glare and other symptoms.
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Affiliation(s)
- Grzegorz Łabuz
- From the Rotterdam Ophthalmic Institute (Łabuz), Rotterdam, the Department of Ophthalmology (Reus), Amphia Hospital, Breda, and the Netherlands Institute for Neuroscience (van den Berg), Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
| | - Nicolaas J Reus
- From the Rotterdam Ophthalmic Institute (Łabuz), Rotterdam, the Department of Ophthalmology (Reus), Amphia Hospital, Breda, and the Netherlands Institute for Neuroscience (van den Berg), Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Thomas J T P van den Berg
- From the Rotterdam Ophthalmic Institute (Łabuz), Rotterdam, the Department of Ophthalmology (Reus), Amphia Hospital, Breda, and the Netherlands Institute for Neuroscience (van den Berg), Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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36
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Platt SM, Iezzi R, Mahr MA, Erie JC. Surgical removal of dystrophic calcification on a silicone intraocular lens in association with asteroid hyalosis. J Cataract Refract Surg 2019; 43:1608-1610. [PMID: 29335107 DOI: 10.1016/j.jcrs.2017.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022]
Abstract
We present a case of successful removal of late calcium deposition on the posterior surface of a silicone intraocular lens (IOL) optic in association with asteroid hyalosis using a surgical technique that included pars plana vitrectomy, a lighted pick, and a modified silicone-tipped cannula. The lighted pick provided the most efficient and complete removal of calcium deposits. Postoperatively, the dystrophic calcification was removed and the IOL optic was clear at 6 months follow-up. The patient's symptoms resolved and uncorrected distance visual acuity returned to 20/20. This method can be considered in patients with dystrophic calcification of a silicone IOL in association with asteroid hyalosis and might avoid the need for IOL exchange and its associated complications and uncertain refractive outcomes.
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Affiliation(s)
- Sean M Platt
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymond Iezzi
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael A Mahr
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay C Erie
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
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37
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Bang SP, Moon K, Lee JH, Jun JH, Joo CK. Subsurface calcification of hydrophilic refractive multifocal intraocular lenses with a hydrophobic surface: A case series. Medicine (Baltimore) 2019; 98:e18379. [PMID: 31852151 PMCID: PMC6922436 DOI: 10.1097/md.0000000000018379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Opacification of monofocal intraocular lenses (IOLs) of various designs and materials has been reported. Hydrophilic acrylic IOLs are more prone to opacification than hydrophobic IOLs, but IOL surface modification by hydrophobic materials may improve biocompatibility, and few opacifications of such monofocal lenses have been reported to date. However, here we describe the characteristics of opacification of hydrophilic refractive multifocal IOLs with a hydrophobic surface modification in a cluster of patients who underwent uneventful cataract surgery. PATIENT CONCERNS In this retrospective observational case series, the medical records of 7 patients in whom opacification of the IOL was identified after implantation of LS-313 MF30 (Lentis M plus, Oculentis), from November 2017 to May 2019, were reviewed. DIAGNOSIS All patients had undergone bilateral implantation of LS-313 MF30 IOLs. Ten eyes of 7 patients showed significant opacification at a mean 49.1 ± 10.2 months postoperatively. INTERVENTIONS The IOLs of 4 cases were explanted. OUTCOMES All of the opacified cases had received LS-313 MF30 IOLs from February 2014 to August 2014 and experienced decreased visual acuity after 44.6 ± 10.5 months. The explanted IOLs of 4 cases were evaluated by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), Alizarin-red, and von Kossa staining. These explanted IOLs showed fine and evenly distributed, whitish deposits on the entire IOL, particularly below the surface. Although the constituent of the deposits was identified as calcium by Alizarin-red and von Kossa stain, SEM, and EDX analysis showed no surface deposits of calcium. Paraffin-embedded sections of the IOLs were prepared, and calcium deposition was confirmed by EDX analysis at the subsurface region of the IOL. LESSENS Significant opacification of these hydrophilic refractive multifocal IOLs with hydrophobic surface modification was found to be due to abnormal calcification of the subsurface of the IOL. Clinicians must be aware of the opacification of this IOL design, despite surface modification. In particular, it should be noted that there is a high likelihood that the patient may experience vision-related symptoms even with moderate opacity and that opacification may lead to a burdensome IOL exchange.
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Affiliation(s)
- Seung Pil Bang
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | | | | | - Jong Hwa Jun
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea
- Catholic Institute for Visual Science, Catholic University of Korea, College of Medicine, Seoul, Korea
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38
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Agarwal R, Bhardwaj M, Chetan C, Sharma N. Optic shrinkage and retraction in opacified hydrophilic acrylic intraocular lens: an anterior segment optical CT-based observation. BMJ Case Rep 2019; 12:12/9/e231545. [PMID: 31537600 DOI: 10.1136/bcr-2019-231545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intraocular lens (IOL) opacification is a rare phenomenon noted with hydrophilic acrylic IOLs. We report a case of advanced IOL opacification appreciated on anterior segment optical CT (ASOCT)as a shrunken biconcave optic retracted away from the posterior capsule (PC), unlike the other eye which had a clear biconvex IOL of similar material abutting the PC. After IOL exchange, the affected eye was noted to have more folds and Elschnig's pearls on the PC when compared with the other eye. Our case points towards rare IOL changes seen in advanced cases of opacification, their association with posterior capsular changes and the aid of ASOCT as a non-invasive tool in diagnosing them correctly.
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Affiliation(s)
- Rinky Agarwal
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Mayank Bhardwaj
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Chetan Chetan
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Namrata Sharma
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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39
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Stanojcic N, Hull C, O'Brart DP. Clinical and material degradations of intraocular lenses: A review. Eur J Ophthalmol 2019; 30:823-839. [PMID: 31387387 DOI: 10.1177/1120672119867818] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To review the published scientific literature concerning clinical and material degradations of intraocular lenses after implantation in cataract surgery. METHODS A search was undertaken using the following databases: CENTRAL (including Cochrane Eyes and Vision Trials Register; The Cochrane Library: Issue 2 of 12 February 2019), Ovid MEDLINE (R) without Revisions (1996 to February week 2, 2019), Ovid MEDLINE (R) (1946 to February week 2, 2019), Ovid MEDLINE (R) Daily Update 19 February 2019, MEDLINE and MEDLINE non-indexed items, Embase (1980-2019, week 7), Embase (1974-2019, 19 February), Ovid MEDLINE (R) and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to 19 February 2019), Web of Science (all years), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and the WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Only published articles in English were selected. Search terms/keywords included 'IOL' or 'intraocular lens', combined with 'opacification', degradation, glistenings, nanoglistenings, whitening, transmittance, light scatter, discolouration/discoloration, performance, quality, material, biocompatibility, calcification, explantation and ultraviolet/UV radiation. Relevant in-article references not returned in our searches were also considered. RESULTS After review of the available articles, the authors included 122 publications in this review, based on the quality of their methodology and their originality. The studies included in this review were randomized controlled trials, cohort studies, case-controlled studies, case series, case reports, laboratory studies and review papers. Differing material degradations of intraocular lenses have been described and their associated pathophysiology studied. Reported anomalies include photochemical alterations, water vacuoles, internal and surface calcific deposits, surface coatings and discolouration. The nature of such changes has been shown to depend on the type of intraocular lenses material used and/or manufacturing processes and storage conditions employed. Changes in the intraocular lens can also be influenced by surgical technique, coexisting ocular pathologies and topical and systemic medications. The clinical significance of these degradations is variable, with some resulting in significant visual disturbance and the need for intraocular lens explantation and others producing only minimal visual impairments. Failure to recognize the precise nature of the problem may lead to unnecessary laser capsulotomy procedures. CONCLUSION Clinical degradations of intraocular lenses are uncommon but have been reported following the implantation of intraocular lenses made of differing biomaterials. Their correct identification and thorough investigation to determine the underlying cause is necessary for optimal patient management and the prevention of such problems. Choosing a lens made of a particular material may be important in patients with certain ocular conditions.
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Affiliation(s)
- Nick Stanojcic
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London Frost Eye Research Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Hull
- Division of Optometry and Visual Sciences, School of Health Science, City, University of London, London, UK
| | - David Ps O'Brart
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London Frost Eye Research Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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40
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Patel NA, Gangasani N, Yannuzzi NA, Melo G, Flynn HW, Smiddy WE. Indications and Outcomes for the Removal of Intraocular Lens Implants in a Retinal Surgery Practice. Ophthalmic Surg Lasers Imaging Retina 2019; 50:504-508. [PMID: 31415697 DOI: 10.3928/23258160-20190806-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the reasons for and clinical outcomes of intraocular lens (IOL) removal, with or without exchange, in the setting of retina surgery. PATIENTS AND METHODS This is a retrospective, noncomparative, consecutive, interventional case series of patients undergoing IOL removal at an academic referral center performed by a single surgeon between 2002 and 2013. Data collected included baseline patient characteristics, visual acuity (VA), type of IOL, reason for IOL removal, and postoperative complications. RESULTS The study cohort included 63 eyes with IOL removal. Of these, 51 (81%) were left aphakic. For cases of IOL opacification or dislocated IOL (56), the decision to remove was made for 35 (63%) during concurrent retinal surgery due to obstruction in visualization. Overall, the most common reason for removal of the IOL was IOL opacities in 42 eyes (67%), followed by nonspecific nature of opacities (n = 19; 45%), oil artifact (n = 17; 40%), opaque nonvascular membranes (n = 4; 10%), and fibrovascular proliferation (n = 2; 5%). Other causes for removal were IOL dislocation (n = 14; 22%), endophthalmitis (n = 7; 11%), and broken IOL haptic (n = 1; 2%). The composition of the 42 IOLs with opacification included 19 (45%) silicone, 14 (33%) unspecified, five (12%) polymethyl methacrylate, and four acrylic (10%). From the 17 IOLs removed due to oil opacification, 15 (83%) were silicone, and two (17%) were unspecified. Postoperative complications included recurrent retinal detachment (n = 13; 21%), hypotony (n = 8; 13%), phthisis bulbi (n = 8; 13%), corneal edema (n = 7; 11%), cystoid macular edema (n = 5; 8%), elevated intraocular pressure (n = 3; 5%), vitreous hemorrhage (n = 3; 5%), hyphema (1; 2%), anterior synechiae (1; 2%), and subretinal hemorrhage (1; 2%) The mean (SD) immediate, 3 months, and final best-corrected VA in logMAR were 2.18 (0.47), 1.85 (0.82), and 1.97 (0.85). CONCLUSION The vitreoretinal surgeon must be prepared for IOL removal, especially if IOL opacification and dislocation compromise the view or capability to achieve primary retinal reattachment objectives. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:504-508.].
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41
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Werner L, Wallace KJ, Balendiran V, Shumway C, Ellis N, Mamalis N. Surface deposits mimicking calcification on a hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2019; 45:1036-1039. [DOI: 10.1016/j.jcrs.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/15/2022]
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42
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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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Yoon MH, Kim SY, Chin HS. Late Postoperative Opacification of Multifocal Intraocular Lens after Vitrectomy in a Diabetic Patient. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Myung Hun Yoon
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
| | - Se Young Kim
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
| | - Hee Seung Chin
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
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Otrošinová M, Novák J, Kvasnička J, Žídek O. Late postoperative opacification of a hydrophobic acrylic intraocular lens AcryNovaTMPC 610Y. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2019; 75:172-179. [PMID: 32397719 DOI: 10.31348/2019/4/1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report late postoperative opacification of a hydrophobic acrylic intraocular lens (IOL) AcryNovaTMPC 610Y as well as the clinical consequences in patients 10 years after uncomplicated cataract surgery. MATERIALS AND METHODS Medical records were reviewed of 23 patients (26 eyes) with AcryNovaTMPC 610Y implantated between years 2005 and 2007. Next clinical examination was performed 10 years after surgery. We assessed best corrected distance visual acuity (BCDVA), contrast sensitivity (CSV-1000E) and relative opacity of IOL material, (OCULUS Pentacam HR). Results of BCDVA and Pentacam were analysed statistically. One explanted IOL was analysed using anterior segment OCT in vitro and spectroscopic method EDX (Energy-dispersive X-ray spectroscopy). RESULTS Opacification led to a statistically significant reduction in the best corrected distance visual acuity (BCDVA) = (0,95 ± 0,10) versus (0,87 ± 0,20) and to increase of IOL opacity only in some lenses but statistically significant in the average (6,37 ± 2,16)% versus value of (14,22 ± 5,87)%. In the explanted IOL we have documented structural changes of primarily hydrophobic raw material leading to property of hydrophilic one. CONCLUSION Some batches of AcryNovaTMPC 610Y were produced from raw material of poor quality which is the cause of its structural changes and its progressive opacification.
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Sonbolestan SA, Abtahi ZAS. Transient intraocular lens opacification during phacoemulsification surgery. J Curr Ophthalmol 2018; 31:342-344. [PMID: 31528773 PMCID: PMC6742778 DOI: 10.1016/j.joco.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To report an interesting case of intraoperative opacification of intraocular lens (IOL). Methods This study is a report of a 61-year-old male patient who suffered from nuclear sclerosis cataract and had undergone phacoemulsification surgery. During surgery, intraoperative opacification of IOL (Cristal, Cristalens), which was a foldable, 13 mm, one piece, square edge and hydrophilic acrylic IOL, occurred. This phenomenon caused a surprise and a decision to explant the IOL, but the surgeon decided to keep the IOL in place. After a day, it was completely clear. Results The surgery was completed successfully without any complications, and the IOL was completely clear the day after surgery. Conclusion Acute, transient IOL opacification with unproven etiology may occur during cataract surgery.
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Srinivasan S. Intraocular lens opacification: What have we learned so far. J Cataract Refract Surg 2018; 44:1301-1302. [PMID: 30368348 DOI: 10.1016/j.jcrs.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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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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Zeng L, Fang F. Advances and challenges of intraocular lens design [Invited]. APPLIED OPTICS 2018; 57:7363-7376. [PMID: 30182957 DOI: 10.1364/ao.57.007363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
Phacoemulsification technique with intraocular lens implantation has been a common treatment for cataract patients. With rising demand among the public, new technologies for lens design have emerged to minimize intraocular aberrations, improving visual quality to the largest extent. This paper systematically reviews the development of materials applied in lens manufacturing, the different categories of intraocular lenses, and respective design principles. The advantages and potential drawbacks of intraocular lenses are illustrated in the paper, and prospective research to improve the design are presented in the end.
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Choudhry S, Goel N, Mehta A, Mahajan N. Anterior segment optical coherence tomography of intraocular lens opacification. Indian J Ophthalmol 2018; 66:858-860. [PMID: 29786004 PMCID: PMC5989518 DOI: 10.4103/ijo.ijo_1172_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.
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Affiliation(s)
- Saurabh Choudhry
- Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Neha Goel
- Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Aanchal Mehta
- Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Nidhi Mahajan
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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