Intraocular Lens Opacification following Intracameral Injection of Recombinant Tissue Plasminogen Activator to Treat Inflammatory Membranes after Cataract Surgery.

Simon S M Fung,Ramin Khoramnia,Dipak N Parmar,Niaz M Islam,Gerd U Auffarth,Evripidis Sykakis,Hadi J Zambarakji

doi:10.1155/2015/975075

Abstract

Purpose. To report 7 cases of intraocular lens (IOL) opacification following treatment of postoperative anterior chamber fibrin with recombinant tissue plasminogen activator (rtPA) after cataract surgery. Methods. Retrospective case series of 7 eyes in 7 patients who developed IOL opacification after receiving rtPA for anterior chamber inflammatory membrane formation resulting from phacoemulsification cataract surgery. Three explanted IOLs were investigated with light microscopy, histochemical analysis, scanning electron microscopy, and X-ray spectrometry. Results. All patients underwent uncomplicated cataract surgery and posterior chamber hydrophilic IOL implantation. Anterior chamber inflammatory membranes developed between 1 and 4 weeks of surgery and were treated with intracameral rtPA. IOL opacification was noted between 4 weeks and 6 years after rtPA treatment with reduced visual acuity, and IOL exchange was carried out in 3 patients. Light microscopy evaluation revealed diffuse fine granular deposits on the anterior surface/subsurface of IOL optic that stained positive for calcium salts. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS) confirmed the presence of calcium and phosphate on the IOL. Conclusions. Intracameral rtPA, though rapidly effective in the treatment of anterior chamber inflammatory membranes following cataract surgery, may be associated with IOL opacification.

Highlights

Postoperative uveitis associated with inflammatory membrane formation occurs in less than 3% of cases after uneventful cataract surgery and intraocular lens (IOL) implantation [1]
Inflammatory membranes developed between 1 and 4 weeks postoperatively, and resolution of inflammatory membrane occurred within 24 hours after intracameral recombinant tissue plasminogen activator (rtPA) in all cases
Patients presented with IOL opacification between 4 weeks and 8 months after treatment

Summary

Introduction

Postoperative uveitis associated with inflammatory membrane formation occurs in less than 3% of cases after uneventful cataract surgery and intraocular lens (IOL) implantation [1]. Complications from resultant membrane formation include IOL displacement, pupillary block glaucoma, posterior capsule opacification, and side-effects from prolonged topical steroid treatment [2]. Reported uncommon complications of intracameral rtPA include corneal oedema, band keratopathy, anterior chamber turbidity, and hyphaema, while IOL opacification would not appear to have been previously reported [6,7,8]. We report 7 cases of IOL opacification subsequent to rtPA treatment for postoperative inflammatory membranes following uneventful phacoemulsification and hydrophilic acrylic one-piece IOL implantation (Rayner C-flex 570C and Superflex 620H).

Methods

Results

Conclusion