Analysis of opacification patterns in intraocular lenses (IOL)

LONG-TERM OUTCOME OF TRANSSCLERAL FOUR-POINT FIXATION OF AKREOS INTRAOCULAR LENS WITH CLOSED CONTINUOUS-LOOP SUTURE

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.

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.

A mini-invasive surgical technique for Carlevale IOL implantation: case series study and description of concomitant surgery

PURPOSE

To examine the feasibility and outcomes of a modified technique for the implantation of scleral fixated Carlevale intraocular lens (IOL) (I71 FIL SSF. Soleko IOL Division, Pontecorvo, Italy), and to analyze the occurrence of adverse events.

METHODS

This is a retrospective observational study conducted revising patients charts from 2018 to 2023. Thirty-five eyes of 33 patients were included. Patients requiring IOL explantation had either IOL dislocation or opacification. The implantation of the Carlevale IOL was performed with the subconjunctival positioning of the anchors without any scleral flap. All maneuvers were performed transconjunctivally. The anatomical outcomes considered were IOL positioning, and the absence of postoperative complications. The functional outcomes analyzed were best correctedvisual acuity (BCVA) and refraction.

RESULTS

In all the cases, the IOL was well positioned and centered postoperatively. No cases of conjunctival erosion were recorded. The best corrected visual acuity (BCVA) was 0.9±0.6 logMar (mean±standard deviation) preoperatively and 0.5±0.5 logMar (mean±standard deviation) postoperatively. The mean preoperative spherical equivalent was +6.8±7.7 dioptres, while postoperatively it was -1.1±1.6 dioptres. The most frequent procedure associated to secondary IOL implantation was posterior vitrectomy (25 eyes, 71.4%), which was performed with 25-gauge transconjunctival cannulas in the ciliary sulcus. The follow-up period was 24.5±16.9 months (mean±standard deviation).

CONCLUSION

The described mini-invasive technique for Carlevale IOL implantation is safe and effective. It can be recommended either as a stand-alone operation or associated to concurrent surgical procedures.