Abstract
BackgroundLaboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK).MethodsThirteen 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).ResultsIn 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.ConclusionsThe 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.
Highlights
Laboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and descemet stripping automated endothelial keratoplasty (DSAEK))
In 8 subjects the opacification had appeared after descemet stripping automated endothelial keratoplasty (DSAEK; IOLs 1–5, 7, 8, 10) and 3 subjects had a descemet membrane endothelial keratoplasty (DMEK; IOLs 11–13) performed prior to the occurrence of IOL opacification
The von Kossa staining of cross sections of the IOLs revealed numerous fine granular crystalline deposits distributed in a line parallel to and immediately underneath the anterior optical surface of all IOLs
Summary
Laboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK). The opacification of hydrophilic acrylic intraocular lenses (IOLs) is a rare complication, usually occurring in the late postoperative period [1]. The exact causes and pathomechanisms leading to hydrophilic IOL opacification are unknown. There have been sporadic reports about high incidences of IOL opacification affecting whole batches of IOLs of individual manufacturers irrespective of secondary surgical interventions or Secondary surgical interventions with instillation of foreign material into the anterior chamber, such as air, gas or rtPA [5] seem to increase the risk of IOL opacification. There has been an increasing number of reports since 2011/2012 about hydrophilic IOL opacification following posterior lamellar keratoplastic surgery involving the intracameral instillation of air or gas [6–13].
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