Objective One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation because of complications, such as uveitis-glaucoma-hyphema syndrome. Similar complications may also be observed with 3-piece lenses having a square optic edge on the anterior surface. The objective of this study was to provide pathological evidence of complications related to out-of-the-bag fixation of 1-piece or 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges. Design Comparative case series with pathology. Participants 559 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs. Methods Anterior segment scanning of whole eyes with a high-frequency ultrasound system, or with a high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathological analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses. Main Outcome Measures Findings from imaging, gross, and histopathological evaluation that could be related to out-of-the-bag fixation of the lenses. Results 256 eyes were implanted with hydrophobic acrylic IOLs with anterior and posterior square optic edges; 18 of them exhibiting asymmetric or sulcus IOL fixation (six 1-piece, and twelve 3-piece IOLs) underwent complete histopathological evaluation and were compared to the contralateral eyes with symmetric in-the-bag IOL implantation. Pathological findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, iris thinning, and iris atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the control contralateral eyes, and were particularly evident in relation to the sulcus-fixated haptic in the case of 1-piece lenses. The majority of the eyes with 3-piece lenses showed signs of complicated surgery. Conclusions This study provides pathological correlation of complications that were clinically reported in the peer-reviewed literature in relation to sulcus fixation of one-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidences of complicated surgery; therefore all pathological findings in those cases may not be strictly attributed to the out-of-the-bag fixation.

No author has a financial or proprietary interest in any material or method mentioned.

Purpose. Acanthamoeba keratitis remains a difficult diagnosis despite advances in genetic and imaging technologies. The purpose of this paper is to highlight the utility of cytology smears for diagnosis of Acanthamoeba keratitis. Methods. This is a case study of the diagnostic course for a patient with suspected Acanthamoeba keratitis. Results. A 40-year-old male with poor contact lens hygiene presented with severe left eye pain. Slit lamp examination showed two peripheral ring infiltrates without an epithelial defect. The epithelium over both infiltrates was removed with a Kimura spatula. Half of the sample was smeared on a dry microscope slide and the other half was submitted for Acanthamoeba culture and PCR. Both culture and PCR were negative for Acanthamoeba, but hematoxylin and eosin stain of the smear revealed double-walled cysts. Conclusion. H&E staining of corneal cytology specimens is an efficient and readily available test for diagnosis of Acanthamoeba keratitis.