Late opacification of a silicone intraocular lens caused by ophthalmic ointment

Abstract

A 55-year-old man had uneventful phacoemulsification with implantation of a 3-piece silicone intraocular lens (IOL). Postoperative medications included antibiotic-steroid drops and ointments. Eight months postoperatively, the patient started having recurrent episodes of anterior chamber inflammatory reaction. Suspicion that lens instability was causing the reactions led to a lens repositioning procedure 11 months after the initial surgical implantation and again at 13 months. Eighteen months postoperatively, the IOL had a "greasy" film. Despite antiinflammatory and antibiotic treatment, the clinical outcome did not improve. Twenty-seven months after implantation, the lens was exchanged with a hydrophilic acrylic IOL. The course after the exchange was uneventful. The explanted lens was examined by gross and microscopic evaluations, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and gas chromatography-mass spectrometry (GC-MS) using electronic ionization. Gross and microscopic evaluations confirmed the presence of a thin, oily film covering the IOL optic surface. Surface analyses at the level of the oily substance showed unspecific peaks of sodium, chloride, and potassium. The GC-MS analysis showed the presence of compounds characteristic of hydrocarbons, including docosane, tricosane, and tetracosane, which are commonly found in the vehicle of ophthalmic ointments. The GC-MS analysis of 1 ointment used postoperatively found matching peaks, suggesting deposition of those compounds on the IOL.

Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery

“…11 Postoperative medications included antibiotic/steroid drops and ointments. Eight months postoperatively, the patient started having recurrent episodes of anterior chamber inflammatory reaction.…”

Early opacification of silicone intraocular lenses: Laboratory analyses of 6 explants

“…13 We recently described cases of silicone lenses that were explanted because of coating with an oily material that was probably the ophthalmic ointment used postoperatively. 14,15 Finally, the occurrence of dystrophic calcification of silicone lenses has been described in eyes with asteroid hyalosis. [16][17][18] More recently, Tanaka et al 19 observed a phenomenon similar to the 6 cases described here in an 83-year-old Japanese patient who had implants with the same IOL design (SI40 NB).…”

“…This includes formation of crystalline deposits on the surface of the lenses during cataract surgery, [10][11][12] coating of the lenses with silicone oil in patients with previous vitreoretinal procedures, 13 and coating with ophthalmic ointment that could penetrate the anterior chamber postoperatively in small-incision procedures. 14,15 There have also been reports on dystrophic calcification with formation of calcified deposits on the posterior surface of silicone lenses. However, the latter has been observed only in eyes with associated asteroid hyalosis.…”

Intraocular ophthalmic ointment following clear corneal phacoemulsification: Clinical implications

“…[1][2][3][4][5][6][7] Several of the cases followed standard phacoemulsification. [1][2][3][4][5][6] Werner et al 6 describe cases of toxic anterior segment syndrome (TASS) associated with intraocular gentamicin-betamethasone ointment (Garasone) following phacoemulsification and patching. Garzozi et al 7 report a case of recurrent uveitis and glaucoma associated with inadvertent entry of tobramycin 0.3% ophthalmic ointment into the anterior chamber following radial keratotomy.…”

“…1,[3][4][5]8,9 Scheie et al 9 describe 2 patients, one of whom was observed for 18 years after a peanut-oil-based miotic (diisopropyl fluorophosphate) was retained in the eye after intracapsular cataract surgery. In a survey by Fraunfelder and Hanna,8 50 of 95 cases of intraocular ointment showed no apparent clinical effect.…”