Intraocular Lens Opacification Research Articles

Opacification of the Intraocular Lens After Descemet Stripping Endothelial Keratoplasty.

To report the incidence of opacification of the intraocular lens (IOL) after Descemet stripping endothelial keratoplasty (DSEK) in an academic ophthalmology clinic. In this retrospective case series, all patients who underwent DSEK between 2003 and 2013 were included. In 2008, the first patient presented with reduced vision as a result of opacification of the IOL in our clinic. The period between DSEK surgery and diagnosis of IOL opacification, Snellen corrected distance visual acuity before and after the appearance of IOL opacification, IOL specifications, and incidence of IOL exchange were assessed. A total of 160 eyes were operated on. Opacification was seen in 8 eyes (5%) and was diagnosed between 4 and 24 months after DSEK (mean, 9.6; SD, 6.3; range, 4-24 months). The mean Snellen corrected distance visual acuity was 0.6 (SD, 0.2; range, 0.2-0.8) before opacification and 0.3 (SD, 0.2; range, 0.02-0.6) after opacification of the IOL occurred. The IOL material was hydrophilic acrylic in all patients. In 4 eyes, IOL exchange was performed. Opacification of the IOL can be a vision-threatening late complication after DSEK and was seen in 8 of 160 eyes.

Opacification of intraocular lens

SummarySoft hydrophobic acrylic intraocular lenses (IOLs) are increasingly being used because they can be implanted through small incisions, provide good postoperative vision. However, long‐term postoperative follow‐up has identified various problems, including calcification, glistening and whitening.Calcium deposit on surface of IOLs are sometimes reported about hydrophilic acrylic materials. Calcification reduces the transmission of light and renders the fundus virtually invisible and decrease visual function easily.Glistening has been attributed to water retention in voids of hydrophobic acrylic materials and nonuniformity of polymer network structures. Whitening refers to the clinical appearance from sub surface nano glistenings (SSNG) of reflected white light due to light scattering as light encounters nano sized fluid filled vacuoles that occur at the anterior and posterior IOL surface. With a hydrophobic IOL, the fundus remains visible despite opacification and less effect of visual function. As a result, removal and replacement of IOLs is indicated in only a few cases. However, sever glistening and whitening increased glare and decreased contrast sensitivity.

Opacification of intraocular lens implant after uncomplicated cataract surgery: A case series

Opacification of intraocular lens implant after successful cataract surgery is an important issue with the introduction of new intraocular lens. The complexity of the problem is not merely associated with visual impairment, but also lies in the difficulty in diagnosis and management of the case. We report 3 cases of late postoperative opacification of IOL implants warranted IOL exchange.

Evaluation of stability and capsular bag opacification of a new foldable adjustable intraocular lens.

Incorrect lens power remains one of the most common reasons for intraocular lens explantation/exchange. We evaluated stability and effect on capsular bag opacification of a new foldable modular lens system, with a base component and an optic component in rabbit eyes. Bilateral phacoemulsification was performed on six rabbits; one eye received the test lens (Harmoni Modular Lens, ClarVista Medical), whereas the other received a single-piece hydrophobic acrylic control lens (SA60AT, Alcon). Slit-lamp examinations were performed at postoperative weeks 1, 2, 3, 4 and 6. All rabbits were sacrificed at week 6. After enucleation, the eyes were examined grossly from the Miyake-Apple view. Following, all globes were sectioned and processed for histopathological examination. The modular lens was stable in all six rabbits. Uveal biocompatibility was similar to or better in the test eyes when compared with control eyes up to 6 weeks postoperatively. Overall, capsular bag opacification was found to be significantly lower in the test eyes when compared with control eyes. At the 6-week gross examination, central posterior capsule opacification was scored as 0.58 ± 0.73 in the test group, and as 3.00 ± 1.26 in the control group (paired two samples for means t-test; two-tail P = 0.005). The Harmoni Modular system remains stable within the capsular bag after implantation. Due to the design of the base component featuring long loops, along with peripheral anterior and posterior square edges, the lens appeared to prevent overall capsular bag opacification in the rabbit model.

Opacification of hydrophilic intraocular lenses after Descemet stripping automated endothelial keratoplasty.

PurposeOpacification of hydrophilic acrylic intraocular lenses (IOLs) is an emerging complication following Descemet stripping automated endothelial keratoplasty (DSAEK). We report six cases and review the current literature.MethodsIn this retrospective, noncomparative, observational case series, patients with IOL opacification after previous DSAEK surgery were identified from corneal clinic records. Case notes were reviewed for demographic details, indication for DSAEK, IOL model, incidence of rebubbling, and postoperative course.ResultsSix patients developed IOL opacification after DSAEK. All patients had Fuchs’ endothelial dystrophy and had previously received hydrophilic acrylic IOL models. Central anterior IOL opacification was noted in all six cases. Five cases (83%) had required rebubbling due to dislocated graft tissue, and one had an early postoperative intraocular pressure (IOP) rise. Five cases (83%) were managed conservatively, and one case with a failed graft underwent redo DSAEK and IOL exchange.ConclusionRepeated exposure to intracameral air, raised IOP, and other patient influences may be major etiological factors for IOL opacification after DSAEK. We advise avoiding hydrophilic acrylic IOL models in patients who may require future endothelial keratoplasty.

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

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.

Analyzing causes for opacification of acrylic IOLs

to study the nature of intraocular lens (IOL) opacification depending on the patient's ocular status and general condition. A total of 9 patients (9 eyes) with 3-6 year history of progressive IOL opacification were enrolled. All the IOLs were acrylic (either hydrophilic--7 cases, or hydrophobic--2 cases). Two patients had their IOLs exchanged due to opacification. Six patients earlier underwent glaucoma surgery. Two patients were type 2 diabetic. Slit lamp biomicroscopy and optical microscopy were used for IOL examination. The surface of hydrophilic acrylic lenses appeared bumpy because of multiple variously shaped translucent granules separated by a chaotic network of furrows and microfractures and located predominantly in the optic zone. In a more severe case, a bowl-shaped impression was observed in the area of opacification. Surface changes of hydrophobic acrylic lenses were in the form of isolated and confluent glistening formations (microcavities). Signs of IOL degradation develop over a long period of time (3-6 years, in our experience) and mostly involve the anterior surface of the lens optic. Ocular comorbidity, glaucoma in particular, as well as other surgery and/or therapeutic treatment following IOL implantation may contribute to its opacification. Analysis of published data and own observations suggest that hydrophobic IOLs should be preferred in patients with concomitant diseases, especially diabetes mellitus. Granular deposits, if accumulate, may lead to deformation of the lens optic, as confirmed by the bowl-like impression in one of the explanted hydrophilic IOLs.

Ultra-Late Onset Capsular Bag Distension Syndrome: Risk Factors and Characteristics on Scheimpflug Imaging

Background: To provide insights into the characteristic of ultra-late onset capsular bag distension syndrome (CBDS) after phacoemulsification. Design: An interventional, retrospective case series at a tertiary care institute. Participants: 5 Post-cataract surgery patients who presented with the retrolenticular fluid collection. Methods: This is an interventional, retrospective case series of 5 cases who presented with clinical signs of ultralate CBDS>7 years after uneventful phacoemulsification with in-the-bag posterior chamber intraocular lens implantation at a tertiary care institute. Scheimpflug imaging was used in all cases in addition to slit lamp biomicroscopic examination to assess and diagnose the condition. Neodymium:Yttrium Aluminium Garnet (Nd:YAG) posterior capsulotomy was performed in all to treat the condition. Main outcome measure: Results: All 5 patients presented with a milky fluid collection within the distended capsular bag without raised intraocular pressure or a shallow anterior chamber. Scheimpflug imaging confirmed the diagnosis in all cases and all eyes revealed a hyper-reflective space between the intraocular lens optic and the posterior capsule. Nd:YAG posterior capsulotomy was performed in all patients, with resolution of fluid and improvement of visual acuity. Conclusion: Our case series showed that Scheimpflug imaging is a useful modality to diagnose ultra-late onset CBDS and to differentiate this condition from intraocular lens opacification and posterior capsule opacification (PCO). Nd:YAG posterior capsulotomy proved to be successful treatment for ultra-late CBDS with no significant change in biometric or refractive parameters. Keywords: Ultra-late capsular bag distension syndrome;

Neodymium-yttrium aluminium garnet laser capsulotomy energy levels for posterior capsule opacification.

Purpose:To study factors affecting laser energy levels required for neodymium: yttrium aluminium garnet (Nd: YAG) laser capsulotomy and to evaluate whether any correlation exists between applied laser energy levels and complications.Methods:The present study examined 474 consecutive patients for a number of factors including age, type of posterior capsule opacification (PCO), material and fixation of intraocular lens (IOL) and complication rates, versus energy levels used for Nd: YAG laser capsulotomy.Results:Mean patient age was 55.6 ± 8.7 years and mean follow up period was 22.9 ± 4.5 months. IOL biomaterial (KW ANOVA; P = 0.173) and patient's age (P = 0.246) did not significantly influence total laser energy requirement for capsulotomy. However, total laser energy levels were significantly higher (KW ANOVA; P < 0.001) with fibro-membranous and fibrous subtypes of PCO. Complications such as IOL pitting, intraocular pressure (IOP) elevation, uveitis, retinal detachment (RD) and cystoid macular edema (CME) were significantly more common when higher energy levels was used. The mean total energy in patients with RD was 77.7 ± 17.7 mJ as compared to 43.4 ± 26.9 mJ in the rest of the cohort. RD was more common in patients with higher axial length [n = 7 (63%)] (P < 0.001).Conclusion:Type of PCO significantly influenced laser energy levels required for capsulotomy, whereas IOL biomaterial and fixation did not. Complications such as IOL pitting, uveitis, IOP elevation, RD and CME was significantly more common when total laser energy was higher. It is recommended that the lowest possible single pulse laser energy be used for capsulotomy to minimize complications.

Intraocular lens opacification after corneal endothelial keratoplasty: Electron microscopy and x-ray element spectroscopy analysis

To assess a newly recognized long-term complication of Descemet-stripping automated endothelial keratoplasty (DSAEK). Plymouth Royal Eye Infirmary and Plymouth Electron Microscope Centre, Plymouth, United Kingdom. Retrospective case series. This study evaluated cases of intraocular lens (IOL) opacification that developed after uneventful DSAEK. None of the IOLs was previously known to opacify. In 1 case, the opacified IOL was explanted and analyzed using detailed light microscopy, scanning electron microscopic (SEM) analysis, and element x-ray spectroscopy. In all 5 cases, the IOL was hydrophilic acrylic and the eye developed IOL anterior surface opacification 4 to 12 months after DSAEK. In 1 eye, the opacification was symptomatic; thus, an IOL exchange was performed. Light microscopy and SEM analysis of the explanted IOL confirmed opacification on the anterior surface and subsurface areas. X-ray element spectroscopy showed the granules were composed of calcium and phosphorous. These cases indicate that IOL opacification after DSAEK is a late, although newly recognized, complication of endothelial keratoplasty. No author has a financial or proprietary interest in any material or method mentioned.

Intraocular lens opacification after descemet stripping automated endothelial keratoplasty.

Intraocular lens (IOL) opacification is a rare but serious complication that may necessitate its exchange. The use of intraocular gases is a known precipitant. Descemet stripping endothelial keratoplasty (DSAEK) involves injecting air into the anterior chamber. IOL opacification has been described after this procedure; however its incidence is currently unknown. A retrospective review of case notes from a single center of all patients undergoing DSAEK, who were either already pseudophakic or had simultaneous cataract surgery. Cases with IOL opacification were analyzed, and any risk factors were identified. One hundred sixty-eight DSAEK were performed on 154 eyes of 137 patients. Fifty-four cases had simultaneous cataract surgery with implantation of an IOL. Fifteen (9.7%) eyes developed IOL opacification. This had a distinctive pattern, being limited to the anterior lens surface, in the pupillary zone. Median time interval from keratoplasty to the first observation of IOL opacification was 17 months (range, 4-34 months). The only statistically significant risk factor was rebubbling of detached endothelial grafts. Rebubbling was performed in 62.5% (10/15) of cases with IOL opacification, compared with 23% (32/139) with no opacification (P = 0.0009). This is the first study to report the incidence of IOL opacification after undergoing DSAEK. Although the mechanism is unknown, multiple injections of air into the anterior chamber statistically increase the risk of IOL opacification.

Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas

To describe clinical and laboratory findings in a series of cases of intraocular lens (IOL) opacification after procedures involving intracameral injections of air or gas. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Seven hydrophilic acrylic IOLs explanted after Descemet-stripping endothelial keratoplasty (DSEK) or Descemet-stripping automated endothelial keratoplasty (DSAEK) because of a localized central optic opacification associated with decrease in visual acuity and complaints of foggy vision were analyzed. The explanted IOLs were sent to our laboratory in the dry state or in fixative by the explanting surgeons. They underwent pathological and histochemical evaluation (alizarin red and von Kossa method). Light scattering measurements were also performed on the surface of 1 explant using Scheimpflug photography. A questionnaire was sent to the surgeons to obtain information pertinent to each case. The 7 explanted IOLs were represented by 6 hydrophilic acrylic designs from 5 manufacturers. Gross and light microscopy showed that granular deposits were densely distributed in an overall round pattern within the margins of the capsulorhexis or the pupil on the anterior surface/subsurface of the IOLs. The granules stained positive for calcium (alizarin red and von Kossa method). Light scattering on the anterior optic surface was very high (228 versus 13 computer-compatible tapes on a control IOL). A localized pattern of calcification was seen on the anterior surface/subsurface ofvarious hydrophilic acrylic IOLs. Surgeons should be aware of this phenomenon following DSEK/DSAEK procedures in pseudophakic patients with hydrophilic acrylic IOLs. No author has a financial or proprietary interest in any material or method mentioned.

Over-the-counter migration of steroid use: impact on the eye.

To provide opinions on the potential impact of increasing use of steroids by various formulations, as recent approvals have switched intranasal steroids to over-the-counter (OTC) status. Systemic glucocorticosteroids are the predominant formulations available only by prescription, whereas low-dose dermatological formulations are also available OTC. The recently approved OTC intranasal steroid has generated questions on their potential adverse effects, especially on the eye. Oral and ophthalmic steroids have the most potent impact on the development of increased intraocular pressure (IOP) and lens opacifications (ILO), but other factors such as age, race and comorbidities (e.g. hypertension, diabetes and smoking) also play a role. There are no biomarkers that have been established to identify populations at additional risk. However, individuals of Caribbean, African, Hispanic or Asian ancestry have a higher predilection for the development of glaucoma and thus may be predisposed to IOP. ILO has been noted to have a slight increase with intranasal corticosteroids, but no specific correlations with the development of cataracts. The OTC placement of intranasal steroid may cause a subset of genetically sensitive individuals to earlier development of IOP and ILO, but the socioeconomic benefit for patients with allergies having access to the 'OTC open formulary' appears to warrant consideration with caveats of monitoring the effect at large, especially in susceptible populations such as those with a family history or specific ancestries.

Intra-ocular lens opacification in the anterior chamber leading to loss of vision in an adolescent.

To report a rare case of intraocular lens (ACIOL) opacification in the anterior chamber in an adolescent and to discuss the possible mechanism of its occurrence and the ways of its prevention. A 16-year-old male underwent cataract surgery for developmental cataract with placement of a foldable posterior chamber IOL in the anterior chamber. There was subsequent opacification of the IOL, which was replaced by a scleral fixated posterior chamber intraocular lens. The post-operative visual acuity improved to 6/18. The posterior chamber IOL implanted in the anterior chamber can get opacified possibly due to postoperative intraocular inflammation.

Case-control study for clinical findings on intraocular lens opacity

OBJECTIVE: To evaluate clinical features of patients related to opacification of hydrophilic acrylic intraocular lenses, four years after surgery. METHODS: We evaluated six cases of late opacification of Ioflex intraocular lenses (case group) compared to 24 patients (control group) with no opacification. Both groups underwent phacoemulsification as a result of a community campaign for underprivileged people. Patients who underwent bilateral cataract surgery had only the right eye included on the study. The patients were submitted to ophthalmic examination, including measurements of corrected distance visual acuity and biomicroscopy slitlamp evaluation. Detailed medical histories were obtained. Surgical details were retrieved. RESULTS: Systemic arterial hypertension was recorded in 4 patients from the case group and 11 in the control group, with no statistically significant difference between groups. A single patient in the control group had diabetes mellitus, and so was not considered for statistical analysis. No environmental factor could be related. There were no statistically significant differences for mean visual acuity between the groups of patients regarding the evaluation periods. One eye in the control group received an Ioflex intraocular lens with the same lot number as one of the opacified lenses. CONCLUSION: No clear patient factor could be related to late Ioflex lens opacification.

Incidence of posterior capsule opacification following the implantation of a foldable hydrophilic acrylic intraocular lens: a 4 year follow-up study.

To evaluate the incidence of posterior capsule opacification (PCO) four years after the implantation of a hydrophilic acrylic intraocular lens (IOL). Fifty-eight randomly selected eyes from 58 patients were analyzed four years after phacoemulsification and Ioflex IOL implantation. The patients underwent an ophthalmic examination to detect PCO and a detailed medical history was obtained. The patients' charts were reviewed for their corrected distance visual acuity prior to the IOL implantation, as well as for one month postoperatively. The Student's t-test was used for statistical analysis. The mean age of patients without PCO was 74.6 ± 9.5 years, compared to 70.3 ± 15 years in patients with PCO. Four years after surgery, 39 of the 58 eyes (67%) had detectable PCO and 24 eyes (41.3%) had decreased visual acuity (VA) due to PCO. These patients were referred for Nd:YAG laser capsulotomy. Three patients (5.1%) had decreased VA due to glaucoma, IOL opacification, or age-related macular degeneration. Twelve eyes (20.7%) presented mild PCO with unchanged VA. Systemic arterial hypertension was reported by 45% of the patients, and in 3.5% of these cases this was associated with diabetes mellitus. This study found the incidence of PCO to be 67% four years after phacoemulsification and Ioflex IOL implantation.

Capsular bag stability and posterior capsule opacification of a plate-haptic design microincision cataract surgery intraocular lens: 3-year results of a randomised trial

PurposeTo compare capsular bag stability and posterior capsule opacification (PCO) of a plate-haptic intraocular lens (IOL) and a standard three-piece open-loop-haptic IOL of the same acrylic material.MethodsIn this randomised bilateral...

Intraocular Lens Calcification After Keratoplasty

To report calcification of intraocular lenses (IOLs) after various keratoplasty procedures. Clinical data of all cases with calcified IOLs after keratoplasty procedures were analyzed. A total of 6 explanted IOLs were analyzed with light microscopy before and after staining with 1% alizarin red and the von Kossa method. A total of 7 cases occurred after Descemet stripping automated endothelial keratoplasty, 1 case after deep anterior lamellar keratoplasty, and 2 cases after penetrating keratoplasty. Median time interval from keratoplasty to first notice of IOL opacification was 6.5 months (minimum 3 months, maximum 51 months). A total of 3 IOLs had been placed at the time of keratoplasty and 7 IOLs before keratoplasty. All affected IOLs were hydrophilic acrylic and comprised IOLs from at least 3 different polymer sources. Common clinical aspects were some amount of inflammation in the anterior chamber during the postoperative period and use of air at the end of surgery in 8 of the 10 cases. Histochemical analysis demonstrated the presence of fine granular deposits located within the very superficial optic material in all cases. The deposits stained positive for calcium with alizarin red and the von Kossa method. IOL calcification associated with keratoplasty in our series does not seem to be a problem related to a specific IOL model or polymer. The process of calcification may be mediated by inflammation, which also may be related to multiple injections of air into the anterior chamber.

Intraoperative Opacification of a Hydrophilic Acrylic With Hydrophobic Surface IOL With Spontaneous Resolution in 24 Hours

To report an intraocular lens opacification case during cataract surgery. An 80-year-old woman with a history of hypertension and type 2 diabetes mellitus presented with advanced nuclear cataract in her left eye and underwent coaxial phacoemulsification through a 1.8-mm micro-incision and insertion of an in-the-bag intraocular lens (IOL). There was subsequently rapid, homogenous, and complete opacification of the lens, which remained opaque for 2 hours postoperatively. At 24 hours postoperatively, the IOL was transparent with no signs of opacification and the only findings were moderate corneal edema and mild remains of sub-incisional cortex. At the last postoperative visit 1 month after surgery, the IOL remained clear and the visual acuity was 20/20. The same conditions were reproduced in vitro and the same complete and homogenous opacification of the lens was observed. After an extensive review of the literature about other IOL opacification cases reported, no previously published case related to this condensation was found. The description of the temporary IOL opacification phenomenon due to condensation could be useful to cataract surgeons, who might avoid cold storage of IOLs. The known self-resolution of this type of IOL opacification makes advisable to delay IOL surgical explantation in these cases.

Late opacification in hydrophilic acrylic intraocular lenses: Analysis of 87 eyes in a random sample of 102 patients

To report the incidence of late postoperative opacification of a hydrophilic acrylic foldable intraocular lens (IOL). Altino Ventura Foundation, Pernambuco, Brazil. Cross-sectional study. Patients were examined 4 years after phacoemulsification with Ioflex IOL implantation in the rural areas of Pernambuco, Brazil, as part of a community campaign for underprivileged people. The patients had a detailed ophthalmic examination to detect late IOL opacification. The patients' charts were reviewed for preexisting ocular pathology and corrected distance visual acuity (CDVA) before and 1 month after surgery. The IOL opacification was classified according to its location and severity. All surgeries were uneventful intraoperatively and postoperatively. Six (7%) of the 87 eyes (58 patients) examined had a diagnosis of late IOL opacification; asteroid hyalosis and high myopia were associated ocular findings in 2 of the eyes. The preoperative CDVA ranged from hand motions (HM) to 20/80. The postoperative CDVA ranged from 20/20 to 20/40 except in 1 eye with posterior segment disease. Over the 4-year follow-up, 2 of the 6 eyes had a decrease in visual acuity to HM and 20/80, respectively, as a result of late IOL opacification. They had IOL replacement and CDVA improved to 20/60 and 20/20, respectively. A third eye with severe late opacification was not referred for IOL replacement because of macular disease. Intraocular lens opacification was observed in 7% of the eyes studied. No risk factors could be determined.