Late postoperative opacification of a hydrophilic-hydrophobic acrylic intraocular lens

Intraoperative Intraocular Lens Waste: Incidence, Cost and Reasons

PURPOSE

To evaluate the incidence and cost of intraocular lens(IOL) waste during IOL implantation, as well as the reasons for it.

METHODS

A retrospective analysis was conducted on the data of 485 patients from the IOL waste registers of a single tertiary eye hospital in China during 2016-2020. The primary outcomes were the incidence, cost, and reasons for different IOL properties. Cases were examined to ascertain IOL material, design, procedural details, and causes of waste.

RESULTS

IOL waste occurred in 485 (6.62‰) of the 73,246 IOL implantations during the study period. The total cost of IOL waste was 429, 850.26 Chinese Yuan (CNY) related to waste with an average cost of 2, 442.33 CNY per procedure during the study period. Comparisons between IOL properties showed that polymethyl methacrylate (PMMA) material (39, 2.05%), three-piece design (142, 1.49%), and secondary IOL implantation (26, 2.16%) were associated with IOL wastage, and the difference was statistically significant. The causes of IOL waste were damage (107, 60.80%), patient reasons (37, 21.26%), aseptic errors (22, 12.50%), IOL quality problems (8, 4.55%), and loss (2, 1.14%).

CONCLUSIONS

The incidence of IOL waste is low, but still leads to a significant cost burden due to a large number of cataract surgeries. PMMA material, three-piece design, and secondary implantation were identified as factors increasing IOL waste. Damage emerged as the primary reason for waste, largely attributed to human error. Therefore, the development of strategies to mitigate IOL waste is imperative.

How do intraocular lens materials influence the outcome of cataract surgery?

PURPOSE OF REVIEW

This review summarizes the evidence on the effect of intraocular lens (IOL) material on the outcomes of cataract surgery, as well as on the surgical procedure itself.

RECENT FINDINGS

Differences in capsular biocompatibility between IOL materials lead to variations in capsular stability and posterior capsule opacification (PCO), while differences in uveal biocompatibility affect postoperative inflammatory response.

SUMMARY

Refractive outcomes are affected by both incision size and the rotational stability of toric IOLs. Small incision sizes favour hydrophilic IOLs. Rotational stability of hydrophobic and hydrophilic IOLs were comparable in recent studies. Visual outcomes are affected by chromatic aberrations, dysphotopsia, lens opacifications and PCO. Hydrophilic IOLs are associated with reduced chromatic dispersion. Hydrophobic IOL opacifications are caused by sub-surface glistenings, while hydrophilic IOL opacifications are due to surface calcifications. Some surgeries, including pars plana vitrectomy and lamellar corneal transplants, were shown to increase the risk of IOL calcifications, although the mechanism is still unknown. Hydrophilic IOLs have greater ease of manipulation, greater resistance to IOL damage, and higher uveal biocompatibility. Hydrophobic IOLs show better PCO prevention than hydrophilic IOLs, and should be preferred in highly myopic eyes where Nd:YAG capsulotomy might increase the risk of retinal detachment.

3D X-ray computed tomography in the analyses of intraocular lenses explanted because of postoperative opacification

PURPOSE

To use X-ray computed tomography (CT) -which describes the acquisition and reconstruction of 2-dimensional X-ray transmission images to create a 3D representation of a specimen -in the analyses of intraocular lenses (IOLs) explanted because of optical opacification occurring postoperatively.

SETTING

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

DESIGN

Laboratory study.

METHODS

A hydrophilic acrylic and a silicone lens (the latter from an eye with asteroid hyalosis) explanted because of postoperative calcification, as well as a poly(methyl methacrylate) (PMMA) lens explanted because of snowflake degeneration underwent analysis under gross and light microscopy. Then, they were attached to an appropriate support and scanned under a Zeiss Xradia Versa X-ray microscope. After data acquisition, data segmentation was performed with a commercially available program to separate image data into components.

RESULTS

Morphology, size/volume, and specific location of calcified deposits on the surface or within the substance of explanted IOLs could be demonstrated by X-ray CT within the entire volume of each lens with high contrast and resolution. The PMMA lens showed multiple spaces/fissures in relation to Nd:YAG pitting of the optic, and what appeared to be sheets of delaminated PMMA material at different levels within the optic substance.

CONCLUSIONS

The key benefit of X-ray CT is that it can be performed without physically sectioning the specimen. This preliminary study demonstrates that this technology can be potentially useful in the imaging and analyses of explanted, opacified lenses.

Material Analysis of Explanted Calcified Silicone Intraocular Lenses in Association with Asteroid Hyalosis

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.

Causes of intraocular pseudophakic lens explantation in Spain

PURPOSE

To report the causes of pseudophakic intraocular lens (IOL) explantation in Spain over a 20 year period.

METHODS

Multicenter observational prospective study of a consecutive series of cases corresponding to pseudophakic intraocular lenses explantations performed in 22 Spanish clinical centres from 2002 to 2021, within a national clinical research network. The clinical data of all IOL explantation patients was evaluated, and the different causes for IOL explantation were systematically analyzed.

RESULTS

From a total of 1013 pseudophakic explantations, 919 cases were included in this investigation. The mean age of the patients at the time of explantation was 66.3 years, and 142 (15.45%) were women. Over the 20 years of the study, the five main reasons for explanting lenses in the last 20 years in Spain according to the Iberia RETICS database were: dislocation / decentration / misalignment (43.08%), bullous keratopathy (16.79%), neuroadaptation failure (13.85%), IOL opacification (9.71%), refractive surprise (6.87%). Other causes, less frequent, were uveitis / endophthalmitis / infection with 39 cases (4.25%); IOL substitution for reasons other than multifocal IOL neuroadaptation failure 3 cases (0.33%); and other causes, 47 cases (5.13%). Hydrophobic lenses were the most frequently explanted with a ratio of 47.1%.

CONCLUSIONS

Over the 20 years of the study, the five main reasons for explanting lenses in the last 20 years in Spain according to the Iberia RETICS database were: dislocation / decentration / misalignment, bullous keratopathy, neuroadaptation failure, IOL opacification, and refractive surprise.

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.].

Comparison of the Incidence of Nd:YAG Laser Capsulotomy Based on the Type of Intraocular Lens

Background and Objectives: Posterior capsular opacification (PCO) is the most common long-term complication of successful cataract surgery and can cause visual impairment. We aimed to investigate the effects of intraocular lens (IOL) characteristics on PCO by comparing the incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy for different types of intraocular lenses. Materials and Methods: A retrospective analysis was performed on 2866 eyes that underwent cataract surgery between January 2010 and December 2017, with at least 5 years of follow-up. The IOLs used for surgery were the hydrophobic lenses SN60WF (Alcon, Fort Worth, TX, USA), ZCB00 (Johnson & Johnson Vision, Santa Ana, CA, USA), and MX60 (Bausch & Lomb, Rochester, NY, USA), and the hydrophilic lens MI60 (Bausch & Lomb, Rochester, NY, USA). We analyzed the incidence of Nd:YAG laser capsulotomy according to the type of IOL used. Results: The incidence of Nd:YAG laser capsulotomy was significantly higher with MI60 lenses (31.70%, 175/552 eyes) compared to SN60WF (7.90%, 113/1431 eyes), ZCB00 (10.06%, 64/636 eyes), and MX60 (10.57%, 13/123 eyes; p < 0.001) lenses. The incidence of Nd:YAG laser capsulotomy was significantly lower with the hydrophobic IOLs (8.68%, 190/2190 eyes) than with the hydrophilic IOL (31.70%, 175/552 eyes; p < 0.001). Over time, the rate of increase in the cumulative number of Nd:YAG laser capsulotomy cases was the highest with MI60. The cumulative rate of Nd:YAG laser capsulotomy during the first 3 years was 4.90% with SN60WF (70/1431 eyes), 6.76% with ZCB00 (43/636 eyes), 8.94% with MX60 (11/123 eyes), and 26.10% with MI60 (144/552 eyes) lenses. Conclusions: The incidence of PCO is influenced by the material of the IOLs. The hydrophilic IOL was associated with a higher rate of Nd:YAG laser capsulotomy than the hydrophobic IOLs, with a shorter time to Nd:YAG laser capsulotomy.

Qualitative and quantitative analysis of an explanted opacified hydrophilic IOL after over two years from cataract surgery

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.

New exploration of ions and fatty acids in hydrophilic acrylic intraocular lens calcification

PURPOSE

To conduct a new exploration and analysis of the ion and fatty acid levels of a medium in which calcified hydrophilic intraocular lenses (IOLs) are present.

SETTING

Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.

DESIGN

Retrospective, laboratory observational case series.

METHODS

11 patients (11 eyes) who had implantation of foldable hydrophilic acrylic posterior IOLs were found to have opacification of the IOLs. In vivo and in vitro analyses included the evaluation of patients' clinical characteristics, microscopy, histological staining, energy dispersive X-ray spectroscopy (EDS), the ion level of the aqueous humor (AH) and preserving fluid (PF), and the fatty acid content of AH.

RESULTS

10 of 11 cases were female with unilateral opacification, and 7 cases had both-eye cataract surgery, including 1 first eye and 6 second eyes with IOL opacification. 4 types of similar serial numbers were counted. The analysis of AH showed that the concentrations of phosphorus and silicon were elevated but that of calcium decreased, and an increased level of silicon was detected in 3 random PFs. The palmitic (C16:0) and stearic (C18:0) fatty acids were higher than the others in the AH. The EDS confirmed that the IOL surface deposits were composed of calcium, phosphate, and a small amount of silicon.

CONCLUSIONS

More silicon and higher C16:0 and C18:0 were found in the AH of patients with IOL opacification. New ideas and avenues have been proposed in the study of IOL opacification.

Late postoperative opacification of a new type hydrophilic acrylic intraocular lens

Background

To report the clinical consequences and laboratory characteristics of late postoperative opacification of a hydrophilic acrylic intraocular lens (US-860UV IOL) as well as the prognosis of IOL replacement.

Methods

Forty medical records (42 eyes) of patients with US-860UV IOL opacification reporting decreased or lost vision who underwent IOL explantation between 2017 and 2019 were reviewed. Explanted IOLs were analyzed by slit-lamp examination, confocal microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) at the Shandong Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, and Qingdao University of Science and Technology, Qingdao, China.

Results

The mean age of the 40 patients was 74.83 ​± ​7.57 (63-92) years. The mean interval between cataract surgery and diagnosis of opacification was 32.38 ​± ​8.76 (17-48) months. Systemic diseases were found without statistical correlations, the most frequent being arterial hypertension, coronary heart disease, and diabetes mellitus. Visual acuity improved from 1.42 ​± ​1.03 to 0.31 ​± ​0.16 (logMAR) after IOL replacement. SEM, EDS and alizarin red staining showed uniformly distributed, diffuse, milk-white opacification, with calcium and phosphorus deposits on the optic and haptic surfaces that could be dissolved in 1% HCl.

Conclusions

Calcium and phosphorus deposition was the main cause of hydrophilic acrylic US-860UV IOL opacification. IOL replacement can safely and effectively improve the visual acuity of patients.

The effect of hypotensive drugs on intraocular lenses clarity

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.

Clinical Characteristics of Patients with Intraocular Lens Calcification after Pars Plana Vitrectomy

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.

Imaging Function and Relative Light Transmission of Explanted Opacified Hydrophilic Acrylic Intraocular Lenses

We evaluated the influence of intraocular lens (IOL) opacification on the optical performance of explanted hydrophilic acrylic IOLs. We performed a laboratory analysis of 32 Lentis LS-502-1 (Oculentis GmbH, Berlin, Germany) IOLs, explanted due to opacification, in comparison with six clear unused samples of the same IOL model. Using an optical bench setup, we obtained modulation transfer function (MTF), Strehl ratio, two-dimensional MTF, and United States Air Force (USAF) chart images. In addition, we assessed light transmission through the IOLs. The MTF values of opacified IOLs at 3-mm aperture were similar to those of clear lenses, with the median (interquartile range) values of 0.74 (0.01) vs. 0.76 (0.03) at the spatial frequency of 50 line pairs per millimeter in clear and opacified IOLs, respectively. The Strehl ratio of opacified lenses was not lower than that of clear lenses. The USAF-chart analysis showed a considerable reduction in brightness in opacified IOLs. The median (interquartile range) relative light transmission of opacified IOLs in comparison to clear lenses was 55.6% (20.8%) at the aperture size of 3 mm. In conclusion, the explanted opacified IOLs had comparable MTF values to those of clear lenses but significantly reduced light transmission.

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

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.

Visual and Refractive Outcomes Following Exchange of an Opacified Multifocal Intraocular Lens

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.

Comparison Between L-312 Hydrophobic-Hydrophilic Acrylate and US-860 UV Hydrophilic Acrylate IOL Opacification Characteristic

Objective

To compare opacity characteristics of US-860 UV and L-312 IOL, and report the phenomenon of glistenings in hydrophobic-hydrophilic acrylic IOLs.

Setting

Qingdao Eye Hospital.

Design

Experimental study.

Methods

Four medical records (4 eyes) of patients with L-312 or US-860 UV IOL opacification reporting decreased or lost vision who underwent IOL explanation between 2019 and 2021 were reviewed. Explanted IOLs were analyzed by slit-lamp examination, confocal microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) at Qingdao Eye Hospital and Qingdao university of science and technology.

Results

The 4 explanted IOLs were represented by 2 hydrophilic acrylic designs. The preoperative mean corrected distance visual acuity changed from 1.84 ± 1.09 logarithm of the minimum angle of resolution (log MAR) to 0.20 ± 0.03 log MAR postoperatively except case 3. The mean interval of the L-312 IOL was 56.67 ± 14.19 months (range 44 to 72 months), and the interval of the US-860 UV IOL was 27 months. Morphological findings were surface, subsurface calcifications of the US-860 UV IOL material, and the optical region of L-312 IOLs are teeming with a great number of vacuoles by light microscope, scanning electron microscope and Energy Dispersive X-ray Spectral.

Conclusion

The cause of US-860 UV opacification was primary calcification, and vacuoles resulted in L-312 IOL opacification.

Intraoperative and Postoperative Intraocular Lens Opacifications: Analysis of 42545 Cases

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.

Multifocal IOL explantation in patients with opaque lentis after refractive lens exchange

PURPOSE

We describe the outcomes of intraocular lens (IOL) explantation in a cluster of opaque multifocal Lentis LS-313 following refractive lens exchange (RLE).

METHODS

Single-centre, single-surgeon, retrospective case series.

RESULTS

The study enrolled 10 eyes of 10 patients, 6 male and 4 female. All patients had uneventful RLE with multifocal IOL implantation. The mean patient age at the time of RLE was 53 years ± 2.52 (SD). Two eyes had YAG laser capsulotomy prior to explantation. The mean interval between the initial RLE and IOL explantation was 5.4 years ± 1.4 (SD). IOL exchange was performed in all eyes in one procedure. Five eyes had in the bag hydrophobic acrylic IOL (3 multifocal and 2 monofocal), three eyes had 3-piece hydrophobic acrylic IOL in the ciliary sulcus and two had an anterior chamber IOL. Intraoperatively one patient had weak zonules and two patients had zonular dehiscence and required anterior vitrectomy. The mean preoperative CDVA was 0.25 ± 0.15 (SD) logMAR and at the final follow-up, improved to 0.00 ± 0.07 (SD) logMAR (p < 0.01). Light microscopy with von Kossa stain confirmed IOL calcification. No postoperative complications were recorded.

CONCLUSIONS

IOL exchange appears to be a feasible and safe surgical option for multifocal IOL opacification. However, patients must be warned of additional intraoperative risks including zonular dialysis, vitreous loss, retinal detachment and need for potential scleral or iris fixated IOL or anterior chamber IOL (ACIOL) with its associated sequel of complications. Moreover, YAG laser capsulotomy should be considered carefully as it increases the chances of intraoperative complications and restricts the surgical options of secondary IOL insertion such as in-the-bag IOL exchange with MFIOL.

Microscopic Characteristics of Late Intraocular Lens Opacifications

CONTEXT.—

The increases in overall life expectancy and in lens surgeries performed on younger patients have resulted in a significant increase in the anticipated duration of artificial intraocular lenses (IOLs) in the eye. Thus, the physicochemical properties of the IOL become a critical issue, and several types of postoperative IOL opacifications have been reported.

OBJECTIVE.—

To describe the microscopic characteristics of opacified IOLs. Glistenings and subsurface nanoglistenings are fluid-related phenomena developing mainly in hydrophobic acrylic IOLs and are associated with aqueous influx into the IOL matrix. Calcification presents in hydrophilic acrylic or silicone IOLs as deposits of hydroxyapatite or other phases of calcium. Snowflake degeneration is less common, and it manifests in older polymethyl methacrylate IOLs.

DATA SOURCES.—

PubMed and ScienceDirect databases were searched for the following keywords: intraocular lens, IOL, cataract surgery, phacoemulsification, opacification, glistening, subsurface nanoglistenings, calcification, snowflake degeneration. English-language articles published up to October 15, 2019 were included in the study. The manuscript contains mainly a literature review; however, it was supplemented with original investigations from the David J. Apple International Laboratory for Ocular Pathology.

CONCLUSIONS.—

Glistenings and subsurface nanoglistenings should be evaluated in a hydrated state and at room temperature; they manifest as microvacuoles sized from 1.0 to greater than 25.0 μm and less than 200 nm, respectively. Calcification deposits are situated on or underneath the surface of the IOL and can be stained with a 1% alizarin red solution or with the von Kossa method. Snowflake degeneration manifests as "particles" or "crystals," causing whitish IOL discoloration. Scanning electron microscopy or energy dispersive X-ray spectroscopy may improve the diagnostic accuracy.

Impact of Lens Material on Objective Refraction in Eyes with Trifocal Diffractive Intraocular Lenses

Purpose: Compare subjective (Rx) and objective (ObjRx) refractions outcomes with two autorefractors models and an aberrometer in eyes implanted with a hydrophobic trifocal IOL (FineVision POD F GF, Physiol, Liége, Belgium) and a hydrophilic one (FineVision POD F, Physiol, Liége, Belgium).Methods: Prospective comparative cohort study, with 100 subjects randomly assigned to either the POD F group (n = 50) or the POD F-GF group (n = 50). Postoperative eye examinations at 1-month visit included seven result sets, one for each assessment method: Rx, AR (automated refraction measured with the autorefractor KR8800), WF-P (Zernike-coefficients-based objective refraction, photopic pupil size), WF-M (Zernike-coefficients-based objective refraction, mesopic pupil size), WF-4 (Zernike-coefficients-based objective refraction, 4 mm pupil), OPD-C (automated refraction measured with the aberrometer OPD in the central pupil/photopic conditions), and OPD-M (automated refraction measured with the aberrometer OPD under mesopic conditions).Results: Mean differences between ObjRx and Rx reached statistical significance for sphere and spherical equivalent (M) only with OPD-C in the POD F-GF group. All ObjRx methods showed significant differences with Rx in the POD F group, with some values differing by more than 0.50 D (-0.58 D in M for the WF-P). Bland Altman plots showed better agreement for the astigmatic components, and for sphere and spherical equivalents in both IOL groups measured with AR and OPD-M.Conclusions: None of the objective methods of refraction evaluated in this study were as reliable as the subjective refraction, irrespective of the lens material, but POD F-GF ObjRx seems to differ less with Rx than POD F ObjRx values.

Fifteen years of IOL exchange: indications, outcomes, and complications

PURPOSE

To report the indications, frequency, and outcomes regarding intraocular lens (IOL) exchange in 2 university hospital tertiary referral settings over a period of 15 years.

SETTING

Ophthalmology departments of the University Hospital Antwerp and the University Hospital Leuven, Belgium.

DESIGN

Retrospective cross-sectional study.

METHODS

In this retrospective study, included were patients who underwent an IOL exchange between 2002 and 2017. Patient demographics, surgical indication, comorbidities, visual outcomes, and complications were reported. Patients who underwent IOL repositioning or add-on IOL implantation or extraction, and patients who were left aphakic, were excluded.

RESULTS

Included in the study were 492 eyes. The mean age was 66.0 ± 13.3 years (range 19-91 years). The mean time between primary surgery and IOL exchange was 54.61 ± 67.07 months (range 0-343 months). Primary indication for explantation was IOL opacification, and the most common ophthalmic comorbidity was a previous history of vitreoretinal surgery. Preoperatively, the mean uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) were 0.47 ± 0.27 (range 0-1) and 0.61 ± 0.32 (range 0-1.2), respectively. Postoperative UCVA and CDVA was 0.7 ± 0.3 (range 0-1.2) and 0.8 ± 0.28 (range 0.05-1.6), respectively. The increase in both CDVA and UCVA was statistically significant (P < .001, paired t test). The most common complication perioperatively was vitreous prolapse, which occurred in 61 eyes (16%).

CONCLUSIONS

IOL exchange is a challenging yet valuable treatment option for a wide spectrum of problematic IOL outcomes. The most common indication remains IOL opacification, although IOL dislocation and patient dissatisfaction are increasing as indications.

A review of late intraocular lens opacifications

PURPOSE OF REVIEW

Phacoemulsification cataract surgery is one of the most commonly performed surgical procedure worldwide. In the majority of cases, intraocular lenses (IOLs) are implanted. Due to the increasing life expectancy and the fact that cataract surgery is performed in earlier stages, the anticipated IOL duration in the eye has increased over the last decades. The aim of this study was to review the types and describe the characteristics of late intraocular lens opacifications.

RECENT FINDINGS

Calcification was the most commonly reported type of opacification in hydrophilic IOLs; it usually negatively impacted the visual function and required IOL explantation. Glistening manifested in hydrophobic acrylic lenses and was frequent in some IOL models. In most cases glistening and subsurface nanoglistenigs do not lead to a decline in visual acuity or require IOL exchange. Current studies indicate that fluid-related phenomena may induce straylight, leading to a decrease of comfort and quality of vision.

SUMMARY

Several reports on late IOL opacifications have been published in recent years. In some cases, particularly in glistening, the development of the opacifications might be related to IOL aging. The influence of the fluid-related microvacuoles on the quality of vision requires further research.

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.].

Long-term In Vivo Stability of Posterior Chamber Phakic Intraocular Lens: Properties and Light Transmission Characteristics of Explants

PURPOSE

To evaluate the in vivo durability of the surface and optical properties of the implantable Collamer lens (ICL).

DESIGN

Retrospective case series.

METHODS

We included patients who developed cataracts after having undergone ICL implantation from March 2003 to May 2014 and underwent ICL explantation followed by cataract surgery from March 2017 to December 2019 at the Nagoya Eye Clinic. ICL explants were submitted to Chukyo Medical Co, Ltd (Nagoya City, Japan) for laboratory analysis using ultraviolet-visible light spectroscopy, light microscopy (LM), and scanning electron microscopy. Patients' demographic and clinical data were collected and reviewed.

RESULTS

Thirteen eyes from 10 patients were studied. The average age at ICL explantation was 50.5 ± 8.5 years (range, 34.5-66.3 years). The average length of ICL stay in the eye (from implantation to explantation) was 10.5 ± 2.7 years (range, 4.4-13.7 years). No opacification or coloring of the ICL explants was observed by LM. The ICL explants showed almost the same light transmittance as that of unused ICLs. Scanning electron microscopy revealed no irregularities at the surface of the center and periphery of the optic and haptic footplate. The positioning holes did not show any deposition.

CONCLUSION

The ICLs remained in-eye for >10 years without any deterioration in the surface and optical properties of the ICL, despite their contact with the ciliary body and iris tissues and the continuous interaction with the aqueous humor components. The present study shows long-term in vivo stability of the ICL.

A narrative review of intraocular lens opacifications: update 2020

The opacifications of intraocular lenses (IOLs) can significantly impact patients visual quality. Despite the identification of specific risk factors, manufacturing changes, opacifications are not eliminated. Likewise, more attention in recent studies was paid to possible new risk factors, however one of the most important purposes of the studies remains opacifications effect on visual performance, which could be disturbed in different aspects. The aim of this review is to discuss the main risk factors of IOLs opacification in particular IOL types, and its impact on vision quality. Different risk factors were discussed in the study, including the material of IOLs, the impact of the breakdown of blood-aqueous barrier (BAB), and certain surgeries that can be associated with opacification formation. Glistenings occur more often in a hydrophobic material, however, the changes in water content of the IOLs can significantly reduce the formation of glistenings. The studies showed a significant effect of intraocular injection of exogenous air or gas during Descemet-stripping endothelial keratoplasty, Descemet-stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, and pars plana vitrectomy on calcification formation. It raises a concern, as the incidence of these surgeries is increasing. Visual acuity decreases significantly after the calcification in IOLs occurs, and it usually causes IOLs exchange. However, disability glare seems to be more affected in patients with IOLs, which were affected by glistenings than visual acuity. Disability glare is associated with increased levels of straylight, which was widely evaluated in recent studies and it was reported to be a susceptible measurement to detect the presence of IOLs pathology. For future researches, it should be noticed that disability glare and straylight are more appropriate in evaluating IOLs opacification effect on visual quality than visual acuity. While reviewing the main risk factors of IOLs opacifications particular attention must be paid on calcification occurrence in hydrophilic acrylic IOLs after surgeries with intraocular injection of exogenous air or gas.

[Functional rehabilitation of a patient with central opacification of the intraocular lens optic (clinical case)]

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.

Variation in intraocular lens calcification under different environmental conditions in eyes with supplementary sulcus-supported lenses

Purpose

Analysis of explanted intraocular lenses (IOLs) from pseudophakic eyes with supplementary sulcus-supported IOLs.

Methods

In this laboratory investigation, ten supplementary and capsular bag IOLs were analyzed. All lenses were received between January 2012 and March 2018. Explants were examined morphologically with histological and electron microscopic techniques and patients’ medical history was evaluated. Additionally, we used a technique new to this field: Transmission Electron Microscopy and electron diffraction pattern analysis was performed to investigate the structure of the opacifying crystals in detail.

Results

Eleven lenses were explanted due to IOL opacification from seven polypseudophakic eyes: In three cases the supplementary lens calcified, in three cases the capsular bag IOL (both lenses analyzed) and in one case both IOLs (only the supplementary was received). Additional surgical procedures and comorbidities included pars plana vitrectomy or Descemet stripping endothelial keratoplasty and diabetes mellitus. For each opacified lens, a varying layer of a Calcium phosphate beneath the optic surface was apparent. Crystal characterization revealed its composition to be Hydroxyapatite.

Conclusions and Importance

We report on a series of secondary calcification in lenses explanted from polypseudophakic eyes. In some cases, calcification occurred in the capsular bag lens, in other cases in the supplementary lens, or in both. The severity of the morphological change could be related to the comorbidities and the presence of surgery subsequent to the lens implantations. Detailed morphology of the opacifying crystals was revealed.

•

Intraocular lenses exhibited calcification in a series of polypseudophakic eyes.

•

Pathology occurred in the capsular bag lens, the supplementary lens, or in both.

•

Calcification was associated with different environmental factors.

•

Depending on the factor, morphology and pattern of the opacity differed.

•

Transmission Electron Microscopy revealed the opacifying crystals' ultrastructure.

Toric Lentis Mplus intraocular lens opacification: A case report

Purpose

To present the case of a patient with Toric Lentis Mplus intraocular lens (IOL) (Oculentis, Berlin, Germany) opacification after vitrectomy and his follow-up.

Observations

A 44-year-old man with high myopia and right optic neuritis history complained of visual impairment due to cataract in the right eye. We performed uneventful phacoemulsification and implanted a Toric Lentis Mplus IOL in his right eye. Six months later, he came to us with a retinal detachment in the nasal area of the right eye. We performed a 25-gauge vitrectomy with gas tamponade and endolaser treatment. Ten months after the vitrectomy, he complained of blurred vision in the right eye again. On slit-lamp examination, we observed a wide opacification localized to the anterior surface of the IOL. We explanted the IOL from the right eye and replaced it with a Clareon IOL (Alcon, Fort Worth, TX). The explanted IOL was examined under light microscopy and scanning electron microscopy.

Conclusions and importance

We described a case of postoperative opacification of Toric Lentis Mplus IOL after vitrectomy. We found calcium aggregate deposits on the anterior surface of the IOL. Given the higher frequency of fundus disease observed in patients with high myopia, hydrophilic acrylic IOLs should be used with caution in patients with high myopia and in young patients. To our knowledge, this is the first report of Toric Lentis Mplus IOL opacification after the 2017 Field Safety Notice by Oculentis in response to the Food and Drug Administration's recall.

Transection and explantation of intraocular lenses using femtosecond lasers

We present 2 cases in which a femtosecond laser was used in vitro to transect hydrophilic acrylic intraocular lenses (IOLs). At 8 μJ with 3 μm spot separation and 6 μm line separation, no charring occurred and there was no increase in total organic carbon. In vivo, the IOLs were successfully transected in the capsular bag (Case 1, opaque IOL) and the sulcus (Case 2, subluxated IOL post-pneumatic displacement of submacular hemorrhage) and explanted through a clear corneal incision (∼3.0 mm). At 3 months, in Case 1, the corrected distance visual acuity (CDVA) improved from 6/24 to 6/5, astigmatism improved by 0.23 diopters, and endothelial cell density (ECD) remained unchanged (1935 to 2210 cells/mm²); in Case 2, the CDVA was hand motion, astigmatism remained unchanged, and ECD decreased (1960 to 1600 cells/mm²), possibly as a result of complex surgery. Femtosecond IOL transection and explantation may be a clinically safe and feasible option for surgeons.

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.

Subsurface calcification of hydrophilic refractive multifocal intraocular lenses with a hydrophobic surface: A case series

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.

Optic shrinkage and retraction in opacified hydrophilic acrylic intraocular lens: an anterior segment optical CT-based observation

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.

Large-scale opacification of a hydrophilic/hydrophobic intraocular lens

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.

Late postoperative opacification of a hydrophobic acrylic intraocular lens AcryNovaTMPC 610Y

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.

Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases

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.

Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty - a material analysis with special reference to optical quality assessment

Background

Laboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK).

Methods

Thirteen opacified IOLs after posterior lamellar keratoplasty, 8 after descemet stripping automated endothelial keratoplasty (DSAEK), 3 after descemet membrane endothelial keratoplasty (DMEK) and 2 after both DSAEK and DMEK were analysed in our laboratory. Analyses included optical bench assessment for optical quality, light microscopy, scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS).

Results

In all IOLs the opacification was caused by a thin layer of calciumphosphate that had accumulated underneath the anterior optical surface of the IOLs in the area spared by the pupil/anterior capsulorhexis. The calcifications lead to a significant deterioration of the modulation transfer function across all spatial frequencies of the affected IOLs.

Conclusions

The instillation of exogenous material such as air or gas into the anterior chamber increases the risk for opacification of hydrophilic IOLs irrespective of the manufacturer or the exact composition of the hydrophilic lens material. It is recommended to avoid the use of hydrophilic acrylic IOLs in patients with endothelial dystrophy that will likely require procedures involving the intracameral instillation of air or gas, such as DMEK or DS(A)EK.

Reversible opacification of hydrophobic acrylic intraocular lens- two cases report

Background

The opacification of the intraocular lens (IOL) can cause significant visual deterioration. It is known that opacity of hydrophobic acrylic IOLs is rare. We report 2 cases of reversible optic opacification of hydrophobic acrylic intraocular lenses (Tecnis ZCB00, Abbott), observed within 2 months after uneventful cataract surgery.

Case presentation

Case 1: Uneventful cataract surgery was performed on the left eye of an 86-year-old diabetic man with chronic open-angle glaucoma. A hydrophobic acrylic intraocular lens (IOL; Tecnis ZCB00, Abbott, Lake Bluff, IL) was implanted in the bag. Eye drops containing 0.5% levofloxacin and 1.0% prednisolone were used after surgery along with topical anti-glaucoma medications. At 7 weeks postoperative, cloudy, concentric IOL opacification developed, accompanied by decreased visual acuity and increased intraocular pressure. However, the opacification completely disappeared after 9 weeks.

Case 2: Uneventful cataract surgery was performed on the left eye of a 72-year-old woman. A hydrophobic acrylic IOL (Tecnis ZCB00) was implanted in the bag. At 2 weeks postoperative, cloudy, concentric IOL opacification developed, accompanied by ocular discomfort. After 4 weeks, opacification and discomfort completely disappeared.

Conclusions

We observed two cases of completely reversible opacification of hydrophobic acrylic IOLs. The exact nature of the transient opacity remains unclear, but an inflammatory origin cannot be completely ruled out.

Trends in corneal transplant surgery in Ireland: indications and outcomes of corneal transplant surgery and intraocular lens opacification following Descemet's stripping automated endothelial keratoplasty

PURPOSE

To evaluate the indications for corneal transplantation, the procedures carried out, and the postoperative outcomes and to compare these with previous Irish corneal transplant studies.

METHODS

A retrospective review of the case notes of all patients who underwent corneal transplantation under the care of a single surgeon, from 2008 to 2015, was performed. The risk factors for postoperative complications including transplant failure were examined.

RESULTS

During the period studied, 42 corneal transplant surgeries were carried out on 40 eyes of 38 patients, 24 of whom were male (63%), median age at surgery was 62 years (range 23-96 years). The most common indication for transplantation was pseudophakic corneal decompensation associated with Fuch's endothelial dystrophy (FED) (n = 13). Seventeen penetrating keratoplasties, 23 lamellar keratoplasties, and two amniotic membrane transplant procedures were carried out. Transplant failure resulting in corneal oedema or repeat corneal transplant surgery (n = 4, 10%), was associated with previous transplant failure in the eye; odds ratio (OR) = 1.58 (p = 0.05), and with comorbid FED, OR = 1.50 (p = 0.02). Intraocular lens opacification occurred in one lens following DSAEK, giving an incidence rate of 7%.

CONCLUSIONS

Pseudophakic corneal decompensation is the commonest indication for corneal transplant surgery, with lamellar keratoplasty the most frequent approach in our cohort, reflecting developments observed in corneal transplant surgery elsewhere. Prior corneal transplant failure and Fuch's dystrophy remain important risk factors for failure. The risk of intraocular lens opacification and its potential effects on vision should be elaborated prior to endothelial keratoplasty.