Late postoperative opacification of a hydrophilic–hydrophobic acrylic intraocular lens

Bompastor-Ramos, Paula; Póvoa, João; Lobo, Conceição; Rodrı́guez, Alejandra; Alió, Jorge L.; Werner, Liliana; Murta, Joaquim

doi:10.1016/j.jcrs.2016.06.032

Cited by 55 publications

(54 citation statements)

References 18 publications

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“…The exact causes and pathomechanisms leading to hydrophilic IOL opacification are unknown. There have been sporadic reports about high incidences of IOL opacification affecting whole batches of IOLs of individual manufacturers irrespective of secondary surgical interventions or comorbidities [ 2 – 4 ], so that material impurities and faulty manufacturing or storage as well as interactions with the packaging material have been suggested as causative factors in these cases. Individual factors, such as ocular inflammation or ocular and systemic comorbidities that affect ocular metabolism, may contribute to the process [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…However, it is to be remembered that both increased rates of IOL opacification and PCO have been independently associated with postoperative inflammation and hydrophilic IOLs, and there may be chances that an advanced form of IOL opacification and formation of Elschnig’s pearls in our patient could have occurred due to these common underlying factors 4 11. Nevertheless, it is unlikely that such asymmetrical PC changes and IOL opacification occur due to the same material in the same patient operated by the same surgeon.…”

Section: Discussionmentioning

confidence: 79%

“…Various other risk factors associated with delayed IOL opacification include hypertension, diabetes, glaucoma, elevated intraocular calcium concentrations or breakdown of the blood–aqueous barrier secondary to postoperative inflammation and uveitis 3–5. Our patient was a systemically healthy patient and reported no underlying systemic comorbidities.…”

Section: Discussionmentioning

confidence: 85%

“…Numerous mechanisms have been proposed for IOL opacification. These include excess influx of water in the hydrophobic lenses, coating by substances such as capsular dyes, ophthalmic ointment/medications, silicone oil and also progressive degradation of the IOL biomaterial 1 2 4. Among these, the most commonly accepted cause of IOL opacification is deposition of calcium precipitates either on the surface or within the IOL substance, and the latter is considered a more severe form of IOL opacification 1 2 4.…”

Section: Discussionmentioning

confidence: 99%

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Optic shrinkage and retraction in opacified hydrophilic acrylic intraocular lens: an anterior segment optical CT-based observation

Agarwal¹,

Bhardwaj

Chetan

et al. 2019

BMJ Case Rep

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Intraocular lens (IOL) opacification is a rare phenomenon noted with hydrophilic acrylic IOLs. We report a case of advanced IOL opacification appreciated on anterior segment optical CT (ASOCT)as a shrunken biconcave optic retracted away from the posterior capsule (PC), unlike the other eye which had a clear biconvex IOL of similar material abutting the PC. After IOL exchange, the affected eye was noted to have more folds and Elschnig’s pearls on the PC when compared with the other eye. Our case points towards rare IOL changes seen in advanced cases of opacification, their association with posterior capsular changes and the aid of ASOCT as a non-invasive tool in diagnosing them correctly.

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“…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 …”

Section: Methodsmentioning

confidence: 99%

Systematic review of potential causes of intraocular lens opacification

Fernández

Sánchez‐García

Rodríguez‐Vallejo³

et al. 2019

Clinical Exper Ophthalmology

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Intraocular lens (IOL) opacification is an infrequent complication of cataract sur-gery. Surface analysis has demonstrated that the opacification of IOLs is related to calcium or phosphate precipitation on or within the lenses, but the associated mechanisms are unknown, and the scientific literature is heterogeneous and limited to case series and retrospective studies. The purpose of this systematic review was to analyse the most frequent conditions associated with opacification of IOLs reported by studies. A search was carried out using the PubMed MEDLINE, Web of Science and Scopus databases. The quality of the studies selected was evaluated using the Pierson tool. The search provided a total of 811 articles, of which 39 were selected following the inclusion and exclusion criteria. The most common opacified lenses were hydrophilic IOLs according to our analysis. The mean time of appearance of lens opacification was 14.93 ± 17.82 months. The most frequent conditions associated with opacification of the IOLs were Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK/DSEK) and diabetes mellitus (DM), followed by pars plana vitrectomy (PPV), blood hypertension (HT), and glaucoma.Concerning the quality analysis, the mean score was 7.00 ± 1.43 (scoring range from 0 to 10), indicating an acceptable quality of the case reports and retrospective studies. In conclusion, DSAEK/DSEK, DM, PPV, glaucoma and hypertension are conditions with potential risk of IOL opacification after cataract surgery, especially when implanting hydrophilic acrylic IOLs. K E Y W O R D Sacrylic IOL, cataract surgery, intraocular lens, IOL explantation, IOL opacification

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Late postoperative opacification of a hydrophilic–hydrophobic acrylic intraocular lens

Abstract: None of the authors has a financial or proprietary interest in any material or method mentioned.

Cited by 55 publications

References 18 publications

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

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

Optic shrinkage and retraction in opacified hydrophilic acrylic intraocular lens: an anterior segment optical CT-based observation

Systematic review of potential causes of intraocular lens opacification

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