Calcification of hydrophilic acrylic intraocular lens in eyes with silicone oil tamponade - an interventional case series report

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.

The Postvitrectomy Cataract

To review the recent literature regarding risk factors for cataract formation after vitrectomy, the challenges and management strategies for anterior segment surgeons when facing post-vitrectomy cataract surgery, and the visual outcomes of patients undergoing post-vitrectomy cataract surgery. Cataract surgery after vitrectomy can be safely performed to significantly improve the visual outcome in most post-vitrectomy patients, although final visual acuity is primarily limited by the patient’s underlying vitreoretinal pathology.

Silicone Oil Adhesion to Hydrophobic Acrylic Intraocular Lenses: A Comparative Laboratory Study of a New versus an Established Hydrophobic Acrylic Intraocular Lens Material

Background

In vitro assessment of silicone oil adhesion to a new hydrophobic acrylic intraocular lens (IOL) material, the Clareon model CNA0T0, compared with the established AcrySof model SN60WF was carried out.

Methods

Silicone oil adhesion was assessed for two types of IOLs, Clareon CNA0T0 (n = 10) and AcrySof SN60WF (n = 10). Lenses were immersed in an aqueous sodium chloride solution for 12 hours and then incubated at room temperature in silicone oil for 12 hours. The lenses were washed with distilled water and photographed at 25x magnification using a microscope. The percent coverage was calculated by dividing the area of oil coverage by the total surface area of the lens.

Results

Silicone oil adhesion to the surface of the CNA0T0 lens ranged from 4% to 22%, with a mean ± SD coverage of 8% ± 4%. Silicone oil adhesion to the surface of the SN60WF lens ranged from 1% to 17%, with a mean coverage of 9% ± 4%. The silicone oil adhesion of CNA0T0 was equivalent to that of SN60WF (P > 0.05).

Conclusions

The new Clareon model CNA0T0 IOL has silicone oil adhesion and interaction that are equivalent to the established AcrySof IOL.

Persistent Air Bubble Sequestered at the Silicone Oil–Silicone Intraocular Lens Interface as a Cause of Reversible Visual Distortion

Purpose:

To report a novel cause of post-operative reversible visual distortion due to a persistent air bubble sequestered at the intraocular lens (IOL)–silicone oil interface.

Methods:

Two cases of persistent, sequestered air at the IOL-silicone oil interface were identified and reviewed. Relevant clinical information, images and surgical videos were analyzed and described.

Results:

Resolution of the visual distortion was achieved in both cases after silicone oil removal.

Conclusions:

Silicone oil adhesion to the posterior surface of silicone IOLs is a known cause of visual degradation. The IOL-silicone oil interface can sequester air that persists and causes visual distortion until the oil is removed. We report the first cases, to our knowledge, of reversible visual distortion due to sequestered air at the IOL-silicone oil interface.

Pseudotumor cerebri-Case report

An 46-year-old Caucasian woman was diagnosed with idiopathic intracranial hypertension (IIH) after presenting with papilledema and bilateral visual blurring. Lumbar puncture revealed an opening pressure of more than 550 mmH2O. Cerebral magnetic resonance imaging (MRI) showed bilateral flattening of the posterior sclera, enhancement of the prelaminar optic nerve, distension of the perioptic subarachnoid space, intraocular protrusion of the prelaminar optic nerve and empty sella. The main purpose of the treatment was to release the symptoms and preserve the vision. It was initiated the general treatment with Mannitol 20%, 250 ml/day, Acetazolamide 2x500 mg/day and B-vitamins. After discharge the patient followed a treatment with acetazolamide 2x250 mg/ daily doses and oral potassium supplements 30 mg bid/day. Key words: pseudotumor cerebri, idiopatic intracranial hypertension, papilledema,

Non-surgical correction of diplopia after stroke- a strong impact factor on quality of life-minireview

One of the most frequent disorders accompanied by diplopia is represented by stroke. Beyond different symptoms of stroke, diplopia constitutes an important clinical factor in influencing the quality of life in surviving patients. In this paper we discuss the visual impairment associated with stroke location, types of diplopia, the clinical examination, and the nonsurgical treatment of diplopia. The purpose of diplopia treatment is to restore binocular vision and eliminate the double vision. The most used nonsurgical treatment for diplopia is the optical correction by the prisms. Another therapeutic option is the botulinum toxin injections. Key words: diplopia, stroke, visual rehabilitation, prism correction,

Intraocular lens dystrophic calcification after trans-scleral diode laser treatment for a cyclodialysis cleft

Purpose

To describe a case of intraocular lens (IOL) dystrophic calcification as a complication of trans-scleral diode laser successfully used to treat a post-trabeculectomy cyclodialysis cleft.

Observations

A 76-year-old male with primary open angle glaucoma and pseudophakia (+19.0D Akreos M160L, Bausch & Lomb) was evaluated for vision impairment 4 months post-trabeculectomy complicated by a cyclodialysis cleft of his right eye. The patient was successfully treated with trans-scleral diode laser. After this treatment IOL opacification developed. Slit lamp examination and color photography of the anterior segment was performed prior to exchange of the opacified IOL. The explanted IOL underwent star testing, macroscopic imaging, phase contrast and scanning electron microscopy in addition to energy dispersive x-ray spectroscopy.

Confluent IOL deposits developed 4 months after trans-scleral diode laser treatment requiring IOL exchange. Star optical testing of the explanted IOL showed disruption of the diffraction image. An asymmetric pattern of deposition was congruent with the laser treatment quadrant. The subsurface location and discrete nature of the deposits were seen on phase contrast and electron microscopy. Energy dispersive x-ray spectroscopy demonstrated a predominance of calcium/phosphate in the deposits. We are unaware of previous reports in the literature of IOL dystrophic calcification occurring as a complication of trans-scleral diode laser treatment for a post-trabeculectomy cyclodialysis cleft.

Conclusion and importance

Delayed postoperative IOL dystrophic calcification in our case may have been from a combination of IOL biomaterial susceptibility to diode laser energy; damaged IOL material providing a nidus for calcific nucleation; and blood ocular barrier breakdown altering aqueous composition. We suggest that pseudophakia should influence the consideration of diode laser as treatment of a cyclodialysis cleft.

The relationship between inflammatory mediator expression in the aqueous humor and secondary glaucoma incidence after silicone oil tamponade

The expression of inflammatory mediators in the aqueous humor and the incidence of secondary glaucoma after vitreous body resection combined with silicone oil tamponade for patients with retinal detachment were inestigated, and the roles of IL-17, IL-6 and TNF-α in secondary glaucoma after silicone oil tamponade were analyzed. Fifty-eight cases of retinal detachment treated by vitrectomy combined with silicone oil tamponade were examined at the time of silicone oil removal surgery. All patients underwent unilateral surgery. Patients were divided into observation (19 cases with) and control (39 cases without) groups depending on development of secondary glaucoma. Prior to silicone oil removal, expression levels of IL-17, IL-6 and TNF-α in the aqueous humor were examined. IL-17, IL-6 and TNF-α levels in the aqueous humor in the observation group were 204.2±18.3, 351.1±28.4 and 850.0±51.7 pg/ml, respectively, vs. 152.3±22.2, 254.4±26.8 and 625.6±61.2 pg/ml, respectively in the control group (P<0.001). The expression of IL-17 was positively correlated with those of IL-6 and TNF-α (r=0.687, 0.745; P<0.001). IL-17, IL-6 and TNF-α presented good diagnostic values for glaucoma. The receiver operating characteristic (ROC) areas were 0.957, 0.980 and 0.975, respectively (P<0.001). The expression of inflammatory mediators such as IL-17, IL-6 and TNF-α in the aqueous humor of patients with secondary glaucoma after silicone oil tamponade significantly increased relative to patients without secondary glaucoma. The resultant inflammation may be involved in the development of secondary glaucoma.