Late-onset, snowstorm-like appearance of calcium deposits coating a poly(methyl methacrylate) posterior chamber intraocular lens

Long-term Prevalence of Opacification of a Hydrophylic Acrylic Rotationally Asymmetric Refractive Multifocal Intraocular Lens

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.].

Intraocular Lens Opacification Following Silicone Oil Endotamponade

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.].

Light scattering levels from intraocular lenses extracted from donor eyes

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.