Intraocular lens dystrophic calcification after trans-scleral diode laser treatment for a cyclodialysis cleft

Abstract

PurposeTo describe a case of intraocular lens (IOL) dystrophic calcification as a complication of trans-scleral diode laser successfully used to treat a post-trabeculectomy cyclodialysis cleft.ObservationsA 76-year-old male with primary open angle glaucoma and pseudophakia (+19.0D Akreos M160L, Bausch & Lomb) was evaluated for vision impairment 4 months post-trabeculectomy complicated by a cyclodialysis cleft of his right eye. The patient was successfully treated with trans-scleral diode laser. After this treatment IOL opacification developed. Slit lamp examination and color photography of the anterior segment was performed prior to exchange of the opacified IOL. The explanted IOL underwent star testing, macroscopic imaging, phase contrast and scanning electron microscopy in addition to energy dispersive x-ray spectroscopy.Confluent IOL deposits developed 4 months after trans-scleral diode laser treatment requiring IOL exchange. Star optical testing of the explanted IOL showed disruption of the diffraction image. An asymmetric pattern of deposition was congruent with the laser treatment quadrant. The subsurface location and discrete nature of the deposits were seen on phase contrast and electron microscopy. Energy dispersive x-ray spectroscopy demonstrated a predominance of calcium/phosphate in the deposits. We are unaware of previous reports in the literature of IOL dystrophic calcification occurring as a complication of trans-scleral diode laser treatment for a post-trabeculectomy cyclodialysis cleft.Conclusion and importanceDelayed postoperative IOL dystrophic calcification in our case may have been from a combination of IOL biomaterial susceptibility to diode laser energy; damaged IOL material providing a nidus for calcific nucleation; and blood ocular barrier breakdown altering aqueous composition. We suggest that pseudophakia should influence the consideration of diode laser as treatment of a cyclodialysis cleft.

New exploration of ions and fatty acids in hydrophilic acrylic intraocular lens calcification

“…IOL opacification is rare, but it is one of the most annoying late-term complications of cataract surgery and commonly leads to explantation of the opacified IOL due to visual impairment. 2,6,7,[20][21][22][23][24] Although IOL technology is constantly improving, late opacification in hydrophilic acrylic IOLs has frequently been reported in recent literature. 2,7,22,23 Calcification is the major cause of opacification in hydrophilic acrylic IOLs.…”

“…2,6,7,[20][21][22][23][24] Although IOL technology is constantly improving, late opacification in hydrophilic acrylic IOLs has frequently been reported in recent literature. 2,7,22,23 Calcification is the major cause of opacification in hydrophilic acrylic IOLs. The reason analysis of primary calcification is related to the IOL itself or the patients' metabolic changes.…”

A Case of Cyclodialysis after Microhook Trabeculotomy Treated with Vitreous Surgery

“…A few treatment reports have been published concerning patients with prolonged low intraocular pressure and reduced vision after trabeculotomy. Among these, there have been reports of conventional trabeculotomy and postoperative reports of MIGS, post-Trabectome, and the Kahook Dual Blade technique [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”

Systematic review of potential causes of intraocular lens opacification

“…Although the exact mechanism of calcification is under investigation, one hypothesis is that local damage to the hydrophilic IOL surface due to direct contact with air/gas at the exposed area may lead to Ca/P deposition from the aqueous humour . In glaucoma, the hypothesis is that the presence of calcium deposits in aqueous humour is related to changes in aqueous humour pH after glaucoma surgery, since opacification was described mainly in conjunction with surgical procedures for glaucoma, such as iridotomies, trabeculectomies or Ex‐PRESS shunt implantation . On the other hand, a combination of the previously mentioned techniques (DSAEK/DSEK and PPV) can increase the possibilities of IOL opacification, as is the case of combining an intervention of DSAEK in a patient with diabetes or glaucoma, or PPV in patients with arterial hypertension …”

“…Of the 45 articles, five did not fulfil the inclusion criteria and were excluded from further analysis. The remaining included articles numbered 40 and were analysed using the Pierson tool …”