Observation of late postoperative opacification of hydrogel intraocular lens

Abstract

To report clinical, histopathologic, ultrastructural, and chemical features of extracted hydrogel intraocular lens (IOL, Bausch and Lomb, H60M) from patients who had visual disturbances caused by postoperative opacification of the lens, and discuss the possible causes of this phenomenon. Four cases (4 eyes) were presented after uneventful phacoemulsification and IOL implantation. Two IOLs were removed from 2 patients (2 eyes) with severe decreased visual acuity. Clinical aspects of patients who had opacification of this IOL were observed. Extracted lenses were stained with alizarin red (special stains for calcium), examined by scanning electron microscope (SEM) and energy dispersive x-ray spectroscopy (EDS). The extracted lenses showed positive staining for alizarin red, indicating that calcium was present on the surface. SEM disclosed coralliform deposits on the superficial substance of the IOL optic. EDS showed that the presence of calcium and phosphorus mainly in the opacification region. The surface of the IOL is subject to opacification as a result of calcium phosphate deposition, thereby limiting the patient's visual outcome, and in some cases necessitating the extraction of the lens. These changes may be relevant to the nature of the materials used for the construction of hydrogel IOLs. This important clinical problem requires further studies.