Intraocular Lens Opacification Research Articles

Secondary intraocular lens implantation: a large retrospective analysis

PurposeTo investigate preoperative ocular risk factors and indications for secondary intraocular lens (IOL) implantation and compare postoperative complications, visual and refractive outcomes in a tertiary referral center.MethodsPatients older than 14 years that underwent secondary IOL implantation and had a minimum follow-up of 3 months were enrolled in this retrospective case series. Preoperative ocular risk factors, indications for surgery, postoperative complications, and visual and refractive outcomes including prediction error (PE) and absolute error (AE) were evaluated. IOLs were fixated in following positions: anterior chamber (AC), retropupillary iris-claw (IC), sulcus, and capsular bag or sclera.ResultsOne-hundred eighty-two eyes of 174 patients with mean follow-up of 17 ± 13.6 months were evaluated. Leading cause for surgery was IOL dislocation (75%), followed by secondary aphakia (19%) and IOL opacifications (6%). Previous vitrectomy was the major preoperative ocular risk factor (43%). Mean corrected distance visual acuity improved from preoperative 0.68 ± 0.55 to 0.42 ± 0.31LogMAR by the last follow-up (p = 0.001). PE and AE differed highly depending on the indication for surgery (p = 0.041 and p = 0.008, respectively) and the IOL fixation (p = 0.011 and p = 0.028, respectively), with IC-IOLs showing the lowest PE and AE. Postoperative AC-hemorrhage occurred mainly after IC-IOLs (p = 0.003), and postoperative hypotony was significantly higher in eyes with previous uveitis (p = 0.026).ConclusionsPrevious vitrectomy seems to be a major underreported risk factor in eyes that undergo secondary IOL implantation. Refractive outcomes depend on indication for surgery and fixation type, with retropupillary IC-IOLs providing the best refractive results, though not statistically significant compared to other IOL positions.

Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases

To report clinical findings and light microscopic results of 71 opacified hydrophilic acrylic intraocular lenses (IOLs). Vivantes Klinikum Neukoelln, Ophthalmology Department, Berlin, Germany. Retrospective case series. Sixty-three patients (71 eyes) were referred to the clinic because of vision-impairing IOL opacification between December 2012 and September 2016 after routine cataract surgery elsewhere. The explanted IOLs were analyzed with light microscopy at the John A. Moran Eye Center (University of Utah, Salt Lake City, Utah, USA). Medical records were reviewed for visual acuity, comorbidities, and complications. Clinical follow up was 6months. Seventy-one opacified 1-piece or 3-piece hydrophilic acrylic IOLs (Lentis) of different designs from 2009 to 2012 (LS-502-1, LS-402-1Y, LS 312-1Y, LS-313-1Y, L-402, L-312) were found. Morphological findings were surface, subsurface, or deep calcifications of the IOL material. Explantation was performed 4years±1.2 (SD) after initial phacoemulsification. The mean patient age was 78.6±8.2years. Ocular and systemic comorbidities were found without statistical correlation: the most frequent were diabetes, uveitis, and glaucoma. The preoperative mean corrected distance visual acuity changed from 0.63±0.47 logarithm of the minimum angle of resolution (logMAR) to 0.20±0.28 logMAR postoperatively (P<.001). Different designs of IOLs by the same manufacturer, implanted between 2009 and 2012, developed late calcification with significant visual loss after routine cataract surgery. No medical, surgical, or ophthalmologic trigger could be determined. A manufacture issue might be the reason for the opacification.

Outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes with failure of primary Descemet membrane endothelial keratoplasty (DMEK)

AimTo evaluate the outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes after failure of primary Descemet membrane endothelial keratoplasty (DMEK).MethodsThis was a retrospective, non-comparative interventional case...

Two Cases of Intraoperative Acute Opacification of Hydrophilic Intraocular Lens

Two Cases of Intraoperative Acute Opacification of Hydrophilic Intraocular Lens

Unilateral intraocular lens opacification in an otherwise healthy eye

With phacoemulsification with posterior chamber intraocular lens (PCIOL) implant being the standard of care for the past few decades, sufficient time and numbers have been crossed, revealing newer long-term complication related to the procedure. One of such complications being IOL opacification. The case discussed here is a 73-year-old female with no known ocular comorbidities who presented to our center with diminution of vision. The patient had undergone phacoemulsification cataract surgery with implantation of a foldable PCIOL at another center in the year 2006. Examination revealed glistening pearl-like crystalline opacities inside the IOL optic as well as haptic. The patient underwent an uneventful IOL explant with implantation of glued scleral-fixated IOL as a secondary procedure. The explanted lens was sent to another center for analysis who confirmed the presence of crystalline calcium deposits inside the IOL. Such opacities cause severe visual disability and are not amenable to YAG capsulotomy procedures. These cases warrant IOL explant for visual rehabilitation. Although similar cases were reported from Europe and the USA, no similar cases were previously reported from the Indian subcontinent. This is the first such reported case from the Indian subcontinent.

Acute clouding of trifocal lens during implantation: a case report

BackgroundIntraoperative IOLs clouding of several kinds of hydrophilic acrylic intraocular lenses (IOLs) have been reported due to temperature changes. This phenomenon reported previously occurred in cold countries and during the winter months. However, no clinical case was reported about trifocal IOL opacification during operation. We report a case in which acute opacification of the optical region occurred simultaneously when AT LISA tri 839mp(Carl Zeiss) was implanted into the eye.Case presentationA 79-year-old woman with a cortex and nucleus cataract was scheduled to undergo right eye phacoemulsification assisted by femtosecond technique. The trifocal lens (AT LISA tri 839mp), which is made of hydrophilic acrylic (25%) with hydrophobic surface properties, was chosen for implantation. As the IOL was implanted into the eye, it became cloudy immediately. Then it was replaced by another AT LISA tri 839mp, which was transferred from lens company outside, the same phenomenon was observed. These two lenses underwent the same temperature fluctuation from cold outside to operating room. Finally, a ZCB00 (Allergan) was implanted.ConclusionsThe acute intraoperative clouding of trifocal lens(AT LISA tri 839mp) results from fluctuation of temperature should be noticed.

Spontaneous IOL Dislocation - What Can We Do for Prevention?

IOL dislocation and opacification represent further complications of modern IOL (intraocular lenses) implantation. Currently, an increase of IOL dislocation due to various reasons is observed. Due to capsular bag shrinkage, especially in patients with pseudoexfoliation (PEX) and other ocular condition, there is an increasing tension of the weakened zonula. The only use of capsular tension ring (CRT) is not sufficient. The shrinkage of the capsular bag and increasing tension of the zonula may be reduced by additional anterior capsule incisions. The IOL should, preferably, be fixated retrogradely in cases of zonula weakness, even in the case of a weakened capsular bag or minor intraoperative zonulysis, to prevent later IOL dislocation. The effectiveness of these interventions should be examined in larger studies in the future.

Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty - a material analysis with special reference to optical quality assessment

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.

Reversible opacification of hydrophobic acrylic intraocular lens- two cases report

BackgroundThe opacification of the intraocular lens (IOL) can cause significant visual deterioration. It is known that opacity of hydrophobic acrylic IOLs is rare. We report 2 cases of reversible optic opacification of hydrophobic acrylic intraocular lenses (Tecnis ZCB00, Abbott), observed within 2 months after uneventful cataract surgery.Case presentationCase 1: Uneventful cataract surgery was performed on the left eye of an 86-year-old diabetic man with chronic open-angle glaucoma. A hydrophobic acrylic intraocular lens (IOL; Tecnis ZCB00, Abbott, Lake Bluff, IL) was implanted in the bag. Eye drops containing 0.5% levofloxacin and 1.0% prednisolone were used after surgery along with topical anti-glaucoma medications. At 7 weeks postoperative, cloudy, concentric IOL opacification developed, accompanied by decreased visual acuity and increased intraocular pressure. However, the opacification completely disappeared after 9 weeks.Case 2: Uneventful cataract surgery was performed on the left eye of a 72-year-old woman. A hydrophobic acrylic IOL (Tecnis ZCB00) was implanted in the bag. At 2 weeks postoperative, cloudy, concentric IOL opacification developed, accompanied by ocular discomfort. After 4 weeks, opacification and discomfort completely disappeared.ConclusionsWe observed two cases of completely reversible opacification of hydrophobic acrylic IOLs. The exact nature of the transient opacity remains unclear, but an inflammatory origin cannot be completely ruled out.

Mechanism of intraocular lens opacification after cataract surgery

Objective To investigate the mechanism of intraocular lens opacification after cataract surgery. Methods Four patients with intraocular lens opacification from June 2016 to October 2016 were analyzed. Results Four patients were diagnosed with intraocular lens opacification, including hydrophobic acrylic IOL in 3 cases and hydrophilic acrylic IOL in 1 case.All the patients had a history of hypertension and among them 1 patient with diabetes history. Conclusion Intraocular lens opacification can occur in the hydrophobic acrylic IOLs and the hydrophilic acrylic IOL.Different kinds of material lead to different kinds of clinical manifstations.Hypertension and diabetes may be the main risk factors.IOL exchange is the best way to solve the problem. Key words: Lens, intraocular; Opacification; Mechanism; Exchange

Trends in corneal transplant surgery in Ireland: indications and outcomes of corneal transplant surgery and intraocular lens opacification following Descemet’s stripping automated endothelial keratoplasty

To evaluate the indications for corneal transplantation, the procedures carried out, and the postoperative outcomes and to compare these with previous Irish corneal transplant studies. A retrospective review of the case notes of all patients who underwent corneal transplantation under the care of a single surgeon, from 2008 to 2015, was performed. The risk factors for postoperative complications including transplant failure were examined. During the period studied, 42 corneal transplant surgeries were carried out on 40 eyes of 38 patients, 24 of whom were male (63%), median age at surgery was 62years (range 23-96years). The most common indication for transplantation was pseudophakic corneal decompensation associated with Fuch's endothelial dystrophy (FED) (n=13). Seventeen penetrating keratoplasties, 23 lamellar keratoplasties, and two amniotic membrane transplant procedures were carried out. Transplant failure resulting in corneal oedema or repeat corneal transplant surgery (n=4, 10%), was associated with previous transplant failure in the eye; odds ratio (OR)=1.58 (p=0.05), and with comorbid FED, OR=1.50 (p=0.02). Intraocular lens opacification occurred in one lens following DSAEK, giving an incidence rate of 7%. Pseudophakic corneal decompensation is the commonest indication for corneal transplant surgery, with lamellar keratoplasty the most frequent approach in our cohort, reflecting developments observed in corneal transplant surgery elsewhere. Prior corneal transplant failure and Fuch's dystrophy remain important risk factors for failure. The risk of intraocular lens opacification and its potential effects on vision should be elaborated prior to endothelial keratoplasty.

Intraocular Lens Explantation After Cataract Surgery: Indications, Results, and Explantation Techniques.

Intraocular lens (IOL) explantation after uneventful cataract surgery is rare but associated with a high risk of complications. In the past few years, the number of published reports about IOL explantation has grown significantly and most of them focus on explantation surgery due to spontaneous late IOL in-the-bag dislocations. This is related to the growth of the pseudophakic population, first as a result of longer lifespans, and second, because the improvements in safety and accuracy of phacoemulsification surgery have led to an increased number of phacorefractive procedures performed in younger patients. The improvement in phacoemulsification surgery goes in tandem with higher patient demands and expectations of the surgery. Therefore, incorrect lens power or patients who fail to neuroadapt to multifocal IOLs are also well‑recognized indications for IOL explantation and exchange. IOL opacification, although it was an epidemic in the past especially associated with certain IOL models, is currently still occurring even with some new IOL models. The outcomes of explantation surgeries are analyzed in this review separately according to the reason for explantation. Finally, the main reported IOL explantation techniques are reviewed as well.

Intraocular lens opacification after Descemet's stripping automated endothelial keratoplasty

Compared with conventional penetrating keratoplasty, Descemet's stripping automated endothelial keratoplasty (DSAEK) more effectively maintain global integrity and rapid vision rehabilitation with less ocular surface disorders in patients with endothelial dysfunction. Here, we report a case of a 76-year-old woman who experienced opacification of a hydrophilic intraocular lens (IOL) approximately 10 months after DSAEK. The patient with no history of systemic disease developed pseudophakic bullous keratopathy in the right eye 2 years after undergoing cataract surgery. The best-corrected visual acuity (BCVA) of the right eye was Snellen 0.01 when presented to our hospital. DSAEK was arranged and performed smoothly. However, the graft detached over the upper part of the cornea on postoperative day 1. Thus, rebubbling was performed immediately. After the procedure, the graft was well attached, and the cornea became clear gradually. The BCVA returned to Snellen 0.6. However, progressive opacification over the anterior surface of the IOL was observed 10 months postoperatively. Vision deteriorated to 0.5 with various refractive errors during 2-year follow-up. IOL exchange may be considered if the vision is getting worse. IOL opacification may result from a direct contact between the IOL surface and exogenous air, particularly in a hydrophilic IOL, and can be a rare but significant complication after DSAEK. Clinicians planning to perform DSAEK should consider the composition of the IOL, the amount of intracameral air, duration of air filling, and high intraocular pressure.

Long-term efficiency of cataract surgery with hydrophilic acrylic Ioflex intraocular lens

OBJECTIVE:To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns.METHODS:Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated.RESULTS:The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group.CONCLUSIONS:The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.

Air bubble-induced intraocular lens opacification in hydrophobic intraocular lens following posttraumatic cataract surgery: A first-ever case report

A 19 year old male presented with complaints of diminution of vision in right eye. He had undergone cataract surgery in right eye elsewhere 6 years ago for firecracker injury. On examination, eccentric pupil is noticed with intraocular lens (IOL) opacity. on dilatation, rest of the intraocular lens is clear. As the rest of the IOL, which was protected by iris, was noted to be clear, the opacification at pupillary area suggests it to be secondary to air bubble contact .IOL exchange was done and explanted was tested and got confirmed as hydrophobic material. There are cases reports of IOL opacification post intra cameral air injection in hydrophilic lenses, to our knowledge this is the first case report of IOL opacification in hydrophobic lenses. with this case report we want to highlight the fact that one should be careful before intracameral air injection in eyes with both types of IOL.

Late postoperative opacification of a hydrophilic–hydrophobic acrylic intraocular lens

To report late postoperative opacification of a model of hydrophilic-hydrophobic acrylic intraocular lens (IOL) as well as the clinical consequences and laboratory characteristics. Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Retrospective case series. Medical records were reviewed of patients with Lentis LS-502-1 IOL opacification reporting visual loss who had IOL explantation between November 2013 and March 2015. Patients were identified in the emergency room or during regular follow-up visits. Explanted IOLs were analyzed at the Ophthalmic Explants Biobank, Vissum, Spain, or at the John A. Moran Eye Center, University of Utah, USA. Twenty opacified IOLs were explanted from 19 patients. The mean interval between cataract surgery and diagnosis of opacification was 29.15months±9.57 (SD) (range 6 to 45months). Opacification led to a statistically significant reduction in corrected distance visual acuity (mean 0.86±0.76 logMAR; P<.001) and occurred in 5.1% of the hydrophilic-hydrophobic acrylic IOLs implanted at the department. The most frequently associated medical conditions were arterial hypertension, diabetes, and glaucoma. All IOLs but 1 had a similar pattern of opacification, with yellowish diffuse opacification uniformly distributed and calcium deposits on the surface and/or subsurface of the optic and haptics and within the IOL material. Opacification of the hydrophilic-hydrophobic acrylic IOL was found in a significant number of patients and had a significant effect on their vision. The opacification was attributed to primary calcification. None of the authors has a financial or proprietary interest in any material or method mentioned.

Effects of Intraocular Lens Opacification on Light Scatter, Stray Light, and Overall Optical Quality/Performance.

To evaluate light scatter and stray light in intraocular lenses (IOLs) explanted because of postoperative opacification (13 calcified hydrophilic acrylic, 1 calcified silicone, and 4 polymethylmethacrylate [PMMA] lenses with snowflake degeneration), as well as effect of opacification on other optical quality/performance indicators, in comparison with controls. The Complete Angle Scatter Instrument (CASI) scatterometer was used to measure the forward light scattering (FLS) of the IOLs, and the stray light values at various angles were calculated from the measured FLS. Modulation transfer function (MTF) was obtained with an optical bench, and a Badal optometer was used to obtain letter chart images through the lenses. Back light scatter and light transmittance were also measured. Average stray light values (Log (s)) at a scattered angle of 10° were 1.79 ± 0.37 for hydrophilic acrylic IOLs (controls 0.36 ± 0.05), 1.53 for the silicone lens (control 0.41), and 1.62 ± 0.46 for PMMA IOLs (control 0.25). Stray light was significantly higher for explanted opacified lenses (N = 18) in comparison with controls (N = 7; two-tail P < 0.001 at 10°). Modulation transfer function and Badal image contrast were drastically reduced in lenses with calcification and snowflake degeneration. Different studies described the impact of stray light in human vision, with serious hindrance above 1.47 Log (s). Lenses explanted from patients because of clinically significant opacification are associated with a considerable increase in light scatter and stray light, as well as with a decline of other optical quality/performance indicators.

Osteogenic differentiation of human lens epithelial cells might contribute to lens calcification

Calcification of the human lens has been described in senile cataracts and in young patients with congenital cataract or chronic uveitis. Lens calcification is also a major complication of cataract surgery and plays a role in the opacification of intraocular lenses. A cell-mediated process has been suggested in the background of lens calcification, but so far the exact mechanism remained unexplored. Lens calcification shares remarkable similarities with vascular calcification; in both pathological processes hydroxyapatite accumulates in the soft tissue. Vascular calcification is a regulated, cell-mediated process in which vascular cells undergo osteogenic differentiation. Our objective was to investigate whether human lens epithelial cells (HuLECs) can undergo osteogenic transition in vitro, and whether this process contributes to lens calcification. We used inorganic phosphate (Pi) and Ca to stimulate osteogenic differentiation of HuLECs. Osteogenic stimuli (2.5mmol/L Pi and 1.2mmol/L Ca) induced extracellular matrix mineralization and Ca deposition in HuLECs with the critical involvement of active Pi uptake. Osteogenic stimuli almost doubled mRNA expressions of osteo-/chondrogenic transcription factors Runx2 and Sox9, which was accompanied by a 1.9-fold increase in Runx2 and a 5.5-fold increase in Sox9 protein expressions. Osteogenic stimuli induced mRNA and protein expressions of alkaline phosphatase and osteocalcin in HuLEC. Ca content was higher in human cataractous lenses, compared to non-cataractous controls (n=10). Osteocalcin, an osteoblast-specific protein, was expressed in 2 out of 10 cataractous lenses. We conclude that osteogenic stimuli induce osteogenic differentiation of HuLECs and propose that this mechanism might play a role in lens calcification.

Calcification of Hydrophilic Acrylic Intraocular Lenses With a Hydrophobic Surface: Laboratory Analysis of 6 Cases

To investigate the nature and characteristic features of deposits causing opacification of intraocular lenses (IOLs) based on the examination of clinical findings using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDX) analysis. Retrospective, observational case series. This is a multicenter study of 6 hydrophilic acrylic IOLs (Lentis LS-502-1; Oculentis GmbH, Berlin, Germany) with a hydrophobic surface that were explanted from 5 patients because of opacification. Three patients had an uncomplicated phacoemulsification. One patient underwent combined phacoemulsification and pars plana vitrectomy for retinal detachment and later silicone oil endotamponade owing to redetachment. The last patient had a pars plana vitrectomy and silicone oil instillation combined with phacoemulsification for tractive retinal detachment and diabetic retinopathy. The explanted lenses were submitted to our laboratory and were examined by SEM and EDX in order to identify the morphologic features and the composition of the deposits. SEM and EDX analyses confirmed the presence of calcific deposits in the interior of the opacified hydrophilic IOLs, with a pattern showing the formation of lumps on the surface. The lumps were due to subsurface formation of calcium phosphate crystalline deposits. The crystallite clusters seemed to diffuse from the IOL interior to the surface. We demonstrated the calcification pattern of the hydrophilic IOL (Lentis LS-502-1) with a hydrophobic surface. Although hydrophilic acrylic lenses have a hydrophobic surface, the development of calcification is a possible threat initiating from the hydrophilic subsurface of the IOLs.

Optical and material analysis of opacified hydrophilic intraocular lenses after explantation: a laboratory study.

BackgroundThe opacification of hydrophilic intraocular lenses (IOLs) is a very rare complication in terms of absolute numbers. We report on the analyses of opacified Euromaxx ALI313Y and ALI313 IOLs (Argonoptics, Germany) using light and scanning electron microscopy, X-ray spectroscopy and optical bench analysis.MethodsOpacified Euromaxx ALI313Y and ALI313 IOLs were explanted after patients presented with a decrease in visual acuity. The explants were sent to our laboratory and examined using light and scanning electron microscopy. The composition of the deposits was analysed using X-ray spectroscopy. The optical quality of the intraocular lens (IOL) was assessed using the OptiSpheric IOL PRO optical bench (Trioptics GmbH Wedel, Germany). Modulation transfer function (MTF) was measured at all spatial frequencies and United States Air Force (USAF) 1951 resolution target pictures were documented.ResultsMacroscopically, the entire optic was opacified in all IOLs. Light and scanning electron microscopy revealed numerous fine, granular, crystalline-like deposits, which were always distributed in a line parallel to the anterior and posterior surfaces of the IOLs. X-ray spectroscopy could prove the deposits consisted of Calcium and Phosphate. Measurements in the optical bench showed deterioration of MTF values at all spatial frequencies and the USAF target pictures demonstrated a significant reduction of brightness as well as resolution with the opacified IOLs.ConclusionsThe calcification of hydrophilic IOLs only occurs rarely. The exact chemical composition of the deposits can be assessed by means of X-ray spectroscopy. Optical quality analysis of the explanted Euromaxx ALI313Y and ALI313 IOLs showed significant reduction of MTF values, which was confirmed by USAF target pictures.