Opacification of hydrophilic intraocular lenses after Descemet stripping automated endothelial keratoplasty

Abstract

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.

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

“…The opacified area in these cases is usually limited to a more or less circular area of the anterior optical surface, which usually corresponds to the area of the pupil and/or anterior capsulorhexis, thus to the zone of contact with the instilled air or gas, whereas parts of the IOLs covered by the capsular bag, including the haptics and the posterior optical surface, displayed no sign of opacification [ 6 – 11 , 13 , 15 , 16 ]. Furthermore, it appears to equally affect hydrophilic IOLs from different manufacturers (Bausch & Lomb [ 6 , 13 ], Ciba Vision [ 11 , 13 ], Lenstec [ 17 ], Oculentis [ 10 , 13 ], Rayner [ 8 , 17 ], Acri.Tec [ 16 ], Zeiss [ 18 ]). It seems, that the instillation of exogenous material into the anterior chamber and its prolonged direct contact to the IOL’s surface increases the risk of opacification of hydrophilic acrylic IOLs irrespective of the manufacturer and the exact material composition.…”

Intraocular lens opacification after Descemet's stripping automated endothelial keratoplasty

“…Despite the marked progress in the field of new materials and intraocular implant production technology, the incidence of IOL opacification is common. [345678910111213141516] IOL opacification is a rare but significant complication after DSAEK. The incidence of IOL opacification after DSAEK ranged from approximately 5% of 160 eyes (8 eyes)[11] to 9.7% of 154 eyes (15 eyes)[7] in a large number of patients.…”

“…Possible risk factors include an inflammatory reaction after multiple surgical procedures disrupting the blood–aqueous barrier,[4815] injection of exogenous air or gas into the AC,[61113] rebubbling after DSAEK,[10121415] and implantation of acrylic hydrophilic IOLs. [34578910111213141516]…”

“…concluded that repeated exposure to intracameral air, elevated IOP, and other patient issues might be major etiological factors for the opacification after DSAEK. [14] The lens capsule seems to act as a barrier because the opacification area is mostly on the anterior surface within the capsulorhexis margin. Ahad et al .…”

Systematic review of potential causes of intraocular lens opacification

“…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 …”