Snowflake degeneration of polymethyl methacrylate posterior chamber intraocular lens optic material A newly described clinical condition caused by unexpected late opacification of polymethyl methacrylate

Apple, David J.; Peng, Qun; Arthur, Stella N.; Werner, Liliana; Merritt, Jennifer H.; Vargas, Luis G.; Hoddinott, Daphne S.M; Escobar-Gómez, Marcela; Schmidbauer, Josef M.

doi:10.1016/s0161-6420(02)01122-3

Cited by 56 publications

(35 citation statements)

References 19 publications

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“…Subsequently and at an increased rate over the past 4 years, 25 cases including nine explanted IOLs were submitted to our laboratory. 64,65 All of the explanted IOLs were 3-piece posterior chamber (PC)-IOLs with rigid PMMA optical components and blue polypropylene or extruded PMMA haptics. These had been implanted in the early 1980s to early 1990s in most cases and the clinical symptoms appeared late postoperatively, ca 8-15 years after the implantation.…”

Section: Introductionmentioning

confidence: 99%

Post cataract-intraocular lens (IOL) surgery opacification

Trivedi

Werner

Apple

et al. 2002

Eye

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Intraocular lens (IOL) implantation has no doubt been one of the most satisfying advances of medicine. Millions of individuals with visual disability or frank blindness from cataracts had and continue to have benefit from this procedure. It has been reported by ophthalmologists that the modern cataract-intraocular lens (IOL) surgery is safe and complication-free most of the time. This makes the watchword for any cataract surgeon to be 'implantation,' 'implantation,' 'implantation.' In the mid1980s, as IOLs were evolving rapidly, the watchword of the implant surgeon was 'fixation,' 'fixation,' 'fixation.' Most techniques, lenses and surgical adjuncts now allow us to achieve the basic requirement for successful IOL implantation, namely longterm stable IOL fixation in the capsular bag.However despite this advancement some items 'slipped through cracks.' In this article, we would like to alert the reader to a new watchword, namely 'opacification,' 'opacification,' 'opacification.' Here we will be talking about the good, the bad, and the ugly. Examples of the 'good' include the recent successes now being achieved in reducing the incidence of posterior capsule opacification. Examples of the 'bad' include various proliferations of anterior capsule cells, problems caused by silicone oil adherence to IOLs and problems with piggyback IOLs. The 'ugly' include the sometimes striking and often visually disabling opacifications occurring on and within IOL optics, both on some modern foldable IOLs as well as a poly(methyl methacrylate) (PMMA) optic degradation occurring with some models a decade or more after implantation.

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Section: Introductionmentioning

confidence: 99%

Post cataract-intraocular lens (IOL) surgery opacification

Trivedi

Werner

Apple

et al. 2002

Eye

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“…The lesions are usually found within the anterior stratum of the IOL lens. [1] However, in this case, optically empty 'cracks' were found, associated with decreased optical quality.…”

Section: Differential Diagnosismentioning

confidence: 78%

“…It has been suggested this may be related to the moulding process of PMMA lens in the 1980s and 1990s, which may have caused first, possible insufficient post annealing process of the cured PMMA polymer; or excessive thermal energy during curing process, resulting in voids in the PMMA matrix; or poor filtration of procured monomeric components (monomethyl methacrylate, UV blocker, thermal initiators) or excessive initiator substance during polymerization process. However, the exact mechanism of this phenomenon remains to be elucidated [1,5].…”

Section: Discussionmentioning

confidence: 99%

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A Late Complication of Polymethyl Methacrylate(PMMA) Intraocular Lens- an Unusual Degeneration

Heng¹,

Fearnley²,

Khoramnia

et al. 2015

J Clin Exp Ophthalmol

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Polymethyl methacrylate (PMMA) was the material used in Sir Harold Ridley's original intraocular lens (IOL). Until the last decade, PMMA has enjoyed a reputation as a reliable and high quality optical material with very few complications associated with PMMA material alterations having been reported. Here, we report a clinical case of a 72 year old gentleman who presented with progressively increasing glare and decreased vision 20 years after his routine PMMA IOL implantation. The lens was explanted and sent for pathological analysis which revealed greybrown 'bubble-like' lesions which were empty. Scanning electron microscopy showed cracks in the PMMA material which were correlated to decreased optical quality. The current findings are dissimilar from the known phenomenon of 'snow flake degeneration', which was the only reported late complication of PMMA lenses. This case report describes a new variant of an unexpected late complication associated with PMMA lenses.

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“…Destes casos observados, 9 necessitaram de explante devido à importante perda da acuidade visual (10,11) .…”

Section: Discussionunclassified

Opacificação tipo "snowflake" em lente intra-ocular de polimetilmetacrilato (PMMA)

Pereira¹,

Lima²,

Rehder³

2011

Rev. bras.oftalmol.

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RESUMOAs lentes intraoculares têm sido utilizadas na reabilitação de pacientes submetidos à cirurgia de catarata desde 1959 com grande sucesso. Entretanto, alterações no biomaterial dessas lentes vêm sendo descritas nos últimos anos, diminuindo a acuidade visual dos pacientes anos depois da cirurgia. Este relato apresenta um caso de opacificação tipo "snowflake" em lente de polimetilmetacrilato, seguida de discussão sobre as principais características dessa alteração e indicação de retirada e troca da lente intraocular.

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Snowflake degeneration of polymethyl methacrylate posterior chamber intraocular lens optic material A newly described clinical condition caused by unexpected late opacification of polymethyl methacrylate

Cited by 56 publications

References 19 publications

Post cataract-intraocular lens (IOL) surgery opacification

Post cataract-intraocular lens (IOL) surgery opacification

A Late Complication of Polymethyl Methacrylate(PMMA) Intraocular Lens- an Unusual Degeneration

Opacificação tipo "snowflake" em lente intra-ocular de polimetilmetacrilato (PMMA)

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