Abstract
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. 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. 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. 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.
Highlights
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 lm and less than 200 nm, respectively
The increases in life expectancy and in surgeries performed on younger patients with less advanced cataracts have resulted in a significant increase in the anticipated duration of the artificial intraocular lens (IOL) in the eye
Emphasis was placed on articles published since the review by Nguyen and Werner[7] from 2017; this review focused mainly on the microscopic presentation of IOL opacifications and not on their influence on visual acuity
Summary
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. The physicochemical properties of the IOL become a critical issue, and several types of postoperative IOL opacifications have been reported. In 2016, more than 20 million surgeries were carried out worldwide, of which 4.5 million were in the European Union.[1] The increases in life expectancy and in surgeries performed on younger patients with less advanced cataracts have resulted in a significant increase in the anticipated duration of the artificial intraocular lens (IOL) in the eye. Different types of late postoperative IOL opacifications have been reported; they usually develop gradually and eventually affect the vision quality. For several IOL types, up to 5% of the lenses are exchanged because of late opacification, and in some IOL materials, for Microscopic Characteristics of IOL Opacifications—Kanclerz et al 759
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