Akreos Adapt AO Intraocular Lens Opacification: A Case Report

Forlini, Matteo; Orabona, Giancarlo DellʼAversana; Bratu, Adriana; Rossini, Paolo Maria; Cavallini, Gian Maria; Forlini, Cesare

doi:10.1159/000355414

Cited by 14 publications

(11 citation statements)

References 9 publications

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“…However, potential complications with this technique are numerous and include lens tilt, variability in lens location, suture erosion, lens dislocation, and potential opacification with air or gas. [ 20 21 22 23 24 25 26 27 28 ] Khan et al [ 16 ] described 84 eyes undergoing Gore-Tex suture scleral fixation of secondary IOL in the setting of PPV, with a similar rate of ocular hypertension occurring in their study: 3.6% of eyes vs. 4.4% in our study. Notably, they reported an increased rate of vitreous hemorrhage (7.1%) but a lower rate of postoperative CME (4.8%), compared with 0% and 8.8% in our study respectively.…”

Section: Discussionsupporting

confidence: 72%

Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Mahapatra

Mannem

2021

Indian Journal of Ophthalmology

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Purpose: To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens. Methods: In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted. Results: Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases. Conclusion: Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.

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Section: Discussionsupporting

confidence: 72%

Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Mahapatra

Mannem

2021

Indian Journal of Ophthalmology

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“…Although the exact mechanism of calcification is under investigation, one hypothesis is that local damage to the hydrophilic IOL surface due to direct contact with air/gas at the exposed area may lead to Ca/P deposition from the aqueous humour . In glaucoma, the hypothesis is that the presence of calcium deposits in aqueous humour is related to changes in aqueous humour pH after glaucoma surgery, since opacification was described mainly in conjunction with surgical procedures for glaucoma, such as iridotomies, trabeculectomies or Ex‐PRESS shunt implantation . On the other hand, a combination of the previously mentioned techniques (DSAEK/DSEK and PPV) can increase the possibilities of IOL opacification, as is the case of combining an intervention of DSAEK in a patient with diabetes or glaucoma, or PPV in patients with arterial hypertension …”

Section: Discussionmentioning

confidence: 99%

“…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 …”

Section: Methodsmentioning

confidence: 99%

Systematic review of potential causes of intraocular lens opacification

Fernández

Sánchez‐García

Rodríguez‐Vallejo³

et al. 2019

Clinical Exper Ophthalmology

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Intraocular lens (IOL) opacification is an infrequent complication of cataract sur-gery. Surface analysis has demonstrated that the opacification of IOLs is related to calcium or phosphate precipitation on or within the lenses, but the associated mechanisms are unknown, and the scientific literature is heterogeneous and limited to case series and retrospective studies. The purpose of this systematic review was to analyse the most frequent conditions associated with opacification of IOLs reported by studies. A search was carried out using the PubMed MEDLINE, Web of Science and Scopus databases. The quality of the studies selected was evaluated using the Pierson tool. The search provided a total of 811 articles, of which 39 were selected following the inclusion and exclusion criteria. The most common opacified lenses were hydrophilic IOLs according to our analysis. The mean time of appearance of lens opacification was 14.93 ± 17.82 months. The most frequent conditions associated with opacification of the IOLs were Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK/DSEK) and diabetes mellitus (DM), followed by pars plana vitrectomy (PPV), blood hypertension (HT), and glaucoma.Concerning the quality analysis, the mean score was 7.00 ± 1.43 (scoring range from 0 to 10), indicating an acceptable quality of the case reports and retrospective studies. In conclusion, DSAEK/DSEK, DM, PPV, glaucoma and hypertension are conditions with potential risk of IOL opacification after cataract surgery, especially when implanting hydrophilic acrylic IOLs. K E Y W O R D Sacrylic IOL, cataract surgery, intraocular lens, IOL explantation, IOL opacification

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“…It was theorized that a metabolic change in the anterior chamber due to the presence of exogenous gas in the eye, or an exacerbated inflammatory reaction after multiple surgical procedures might cause the calcification of IOL. Later Mattro Forlini et al [ 8 ] and Chong Eun Lee et al [ 5 ] each outlined a single case developing optic opacification after glaucoma surgeries using Akreos adapt AO IOL separately; however, pathologic analysis were unavailable in those two cases.…”

Section: Discussionmentioning

confidence: 99%

Akreos Adapt AO Intraocular lens opacification after vitrectomy in a diabetic patient: a case report and review of the literature

et al. 2016

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BackgroundPostoperative optic opacification of hydrophilic acrylic intraocular lenses (IOLs) is an uncommon complication leading to IOL explantation. In the past decade, several studies reported that the granular deposits responsible for the opacification were probably calcium and phosphate salts; however, the exact mechanism causing calcification of IOLs is unknown. The aim of this study is to describe clinical and laboratory findings of a case of late postoperative opacification of an aspheric hydrophilic acrylic IOL (Akreos Adapt AO) after vitrectomy.Case presentationA 60-year-old woman diagnosed with cataract and severe nonproliferative diabetic retinopathy (NPDR) underwent uneventful phacoemulsification and hydrophilic acrylic IOL (Akreos Adapt AO, Bausch & Lomb) implantation in both eyes. Seven months later, the woman came back with a complaint of blurry vision in the left eye. Fundus examination revealed vitreous hemorrhage in the left eye veiling the retinal detail. A 23-gauge vitrectomy with endolaser treatment was performed in the left eye. Ten months after the vitrectomy, the patient complained of decreased visual acuity in the left eye again. On slit-lamp examination, we observed a well circumscribed centrally and paracentrally located opacification within the pupillary area localized to the anterior surface of the IOL. The IOL was explanted from the left eye together with the capsular bag, and an iris-claw lens (Artisan Aphakia OPHTEC) was implanted. The explanted IOL was examined under pathological evaluation (alizarin red method).ConclusionsIOL opacification is a rare event. We described a case of postoperative opacification of the Akreos Adapt AO IOL after vitrectomy in a patient with proliferative diabetic retinopathy and found the deposits on the anterior surface of the IOL consisted of calcium aggregates. Given the higher frequency of postoperative opacification observed in diabetic patients, hydrophilic acrylic IOLs should be used with caution in patients with diabetes.

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Akreos Adapt AO Intraocular Lens Opacification: A Case Report

Cited by 14 publications

References 9 publications

Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Systematic review of potential causes of intraocular lens opacification

Akreos Adapt AO Intraocular lens opacification after vitrectomy in a diabetic patient: a case report and review of the literature

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