Variation in intraocular lens calcification under different environmental conditions in eyes with supplementary sulcus-supported lenses

Abstract

Purpose Analysis of explanted intraocular lenses (IOLs) from pseudophakic eyes with supplementary sulcus-supported IOLs. Methods In this laboratory investigation, ten supplementary and capsular bag IOLs were analyzed. All lenses were received between January 2012 and March 2018. Explants were examined morphologically with histological and electron microscopic techniques and patients’ medical history was evaluated. Additionally, we used a technique new to this field: Transmission Electron Microscopy and electron diffraction pattern analysis was performed to investigate the structure of the opacifying crystals in detail. Results Eleven lenses were explanted due to IOL opacification from seven polypseudophakic eyes: In three cases the supplementary lens calcified, in three cases the capsular bag IOL (both lenses analyzed) and in one case both IOLs (only the supplementary was received). Additional surgical procedures and comorbidities included pars plana vitrectomy or Descemet stripping endothelial keratoplasty and diabetes mellitus. For each opacified lens, a varying layer of a Calcium phosphate beneath the optic surface was apparent. Crystal characterization revealed its composition to be Hydroxyapatite. Conclusions and Importance We report on a series of secondary calcification in lenses explanted from polypseudophakic eyes. In some cases, calcification occurred in the capsular bag lens, in other cases in the supplementary lens, or in both. The severity of the morphological change could be related to the comorbidities and the presence of surgery subsequent to the lens implantations. Detailed morphology of the opacifying crystals was revealed.

Eintrübung von Intraokularlinsen: Erkenntnisse aus dem Labor und der Klinik

“…Bei dieser Form der Trübung unterscheidet man klassisch zwischen einer primären und sekundären Form der Kalzifikation sowie einer Pseudokalzifikation [24]. [38]. Licht-und rasterelektronenmikroskopisch können auch bei sekundär kalzifizierten IOL unterhalb oder auf der Oberfläche zahlreiche feine, granuläre, kristallähnliche Ablagerungen aus Kalziumphosphat nachgewiesen werden, die in einer zu der Oberfläche parallelen Linie angeordnet sind [13].…”

“…Wir möchten aber betonen, dass Linsenherstellern keinesfalls prinzipiell der Unwillen zur Aufarbeitung unterstellt werden sollte. Viele unserer Arbeiten wurden sogar v. a. an Explantaten durchgeführt, die uns die Hersteller und nicht die Chirurgen spezifisch zur weiteren Untersuchung zugeschickt haben [38].…”

Physicochemical Analysis of Sediments Formed on the Surface of Hydrophilic Intraocular Lens after Descemet’s Stripping Endothelial Keratoplasty

“…Several reports described the opacification occurred after intravitreal gas injection during pars plana vitrectomy (PPV), the surgical procedure performed for treating diseases of the posterior segment of the eye [ 6 , 23 , 32 , 36 , 68 , 69 , 70 , 71 , 72 ]. The typical appearance of the opacification in most cases was similar to that occurring after DSAEK/DMEK [ 6 , 17 , 23 , 32 , 36 , 62 , 68 , 69 , 70 , 71 , 72 ]. Because the opacification appears mainly on the anterior surface of the IOL, although gas is injected into the vitreous, it is presumed that gas is likely to migrate into the anterior chamber through damaged zonular fibers [ 70 ].…”

“…The direct cause of calcification is associated with the interplay between IOLs’ material characteristics, contamination resulting from manufacturing, and patient individual conditions [ 61 ]. In turn, comorbidities and the presence of surgery subsequent to the lens implantations are suspected as causes of secondary calcification in lenses explanted from polypseudophakic eyes [ 62 ].…”

“…Several reports described the opacification occurred after intravitreal gas injection during pars plana vitrectomy (PPV), the surgical procedure performed for treating diseases of the posterior segment of the eye [6,23,32,36,[68][69][70][71][72]. The typical appearance of the opacification in most cases was similar to that occurring after DSAEK/DMEK [6,17,23,32,36,62,[68][69][70][71][72].…”