Elsevier

American Journal of Ophthalmology

Volume 193, September 2018, Pages 10-19
American Journal of Ophthalmology

Original article
Material Analysis and Optical Quality Assessment of Opacified Hydrophilic Acrylic Intraocular Lenses After Pars Plana Vitrectomy

https://doi.org/10.1016/j.ajo.2018.06.002Get rights and content

Purpose

Explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after pars plana vitrectomy (PPV) were assessed for material change and optical quality, in an in vitro laboratory study.

Design

Retrospective observational case series.

Methods

Ten opacified IOLs after PPV with intraocular gas injection were analyzed in a laboratory setting. Analyses included evaluation of patients' medical history, optical quality assessment, light microscopy, histologic staining, scanning electron microscopy, and energy dispersive x-ray spectroscopy.

Results

In all 10 IOLs a thin layer of calcium phosphate that had accumulated underneath either the anterior or posterior optical surface in a central circular area of the IOL optic caused the opacification. The calcifications lead to deterioration of the modulation transfer function (MTF) across all spatial frequencies.

Conclusion

PPV with instillation of gas into a pseudophakic eye with an acrylic hydrophilic lens seems to increase the risk for secondary calcification irrespective of the manufacturer. In these cases, IOL exchange is the only treatment option available. Since IOL exchange is associated with a high intraoperative complication rate, our results suggest to consider the risk of IOL calcification when implanting hydrophilic acrylic IOLs.

Section snippets

Clinical Data

The presented study is an observational case series. The David J. Apple International Laboratory for Ocular Pathology at the Department of Ophthalmology of the University of Heidelberg received 10 hydrophilic IOLs that were explanted owing to IOL opacification after PPV. Explanting surgeons (G.U.A.: 2 IOLs and S.B.: 8 IOLs) provided all available information on the cases. Relevant clinical data were evaluated and numeric values are given as median and range. All 10 specimens were hydrophilic

Patient History

The IOLs were implanted between January 2002 and May 2016. Three patients were female and 6 male. The patients' mean age at crystalline lens replacement was 54 (range 18–77) years. In all cases patients received PPV owing to retinal detachment. Six patients underwent simultaneous phacoemulsification with IOL implantation and PPV in combined surgery. The remaining 4 patients received PPV from 3 months to 13 years after initial phacoemulsification and IOL implantation. Gas was used in at least 1

Discussion

This analysis included 10 explanted IOLs that were exchanged for new lenses owing to secondary IOL calcification following PPV. In 8 cases calcification was found just beneath the anterior central pupillary area of the IOL. In the remaining 2 cases IOL opacification was located underneath the posterior surface (Cases 1 and 7). Both patients had received posterior capsulotomy during retinal surgery. The authors could not identify a precise causative factor(s) in opacification of the studied

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