Calcification of a hydrophilic acrylic intraocular lens after Descemet-stripping endothelial keratoplasty: Case report and laboratory analyses

Abstract

We describe the case of an 83-year-old woman who had uneventful phacoemulsification with implantation of a tripod hydrophilic acrylic intraocular lens (IOL). Because of postoperative corneal decompensation, 2 Descemet-stripping endothelial keratoplasty (DSEK) procedures were performed within 2 years. After the second procedure, the graft was not well attached, requiring an intracameral injection of air on day 3. Approximately 9 months later, opacification was observed on the anterior surface of the IOL, with a significant decrease in visual acuity. The IOL was explanted within the capsular bag. Laboratory analyses revealed granular deposits densely distributed in a round pattern within the margins of the capsulorhexis. Granules were located at the anterior surface/subsurface of the IOL and stained positive for calcium (alizarin red and von Kossa method). Scheimpflug photography revealed high levels of light scattering from the opacified area. Surgeons should be aware of possible localized calcification following DSEK procedures in pseudophakic patients with hydrophilic acrylic IOLs.

Microscopic analysis of an opacified OFT CRYL® hydrophilic acrylic intraocular lens

“…This was our first case of opacification. Thus, this IOL should not be discredited based on the current report, which supports the hypothesis that intracameral gas can act as a trigger of hydrophilic lens calcification (2)(3)(4)(5)(6)(7)(8)(9) . Together with previous articles (2)(3)(4)(5)(6)(7)(8)(9) , the present report suggests that hydrophilic IOLs should be avoided in eyes that require procedures associated with intracameral presence of air or gas.…”

“…Similarly to the pattern seen in the Oft Cryl® IOL, calcification within the pupillary and anterior capsulorrhexis margins has been described in eyes in which gas or air 1) was injected intracamerally to treat Descemet's membrane detachment, to aid in graft adherence in endothelial transplants; 2) was injected to treat hypotony following trabeculoplasty; or 3) went into the anterior chamber after injection in the vitreous cavity to treat retinal detachment and ocular hypotony (2)(3)(4)(5)(6)(7)(8) . In these lenses, calcium granules were also found on the surface and subsurface of the IOLs.…”

“…Previous papers have described cases of IOL opacification in hydrophilic acrylic IOLs from different manufacturers (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) . However, to the best of our knowledge, this is the first peer-reviewed report on Oft Cryl® IOL opacification.…”

“…Recently, opacification associated with the presence of gas or air in the anterior chamber has been reported (2)(3)(4)(5)(6)(7)(8)(9) . Since 2005, the single-piece hydrophilic acrylic Oft Cryl® IOL (Oft Vision, São Paulo, Brazil) has been largely used in Brazil; however, no case of lens opacification has been reported in the peer-reviewed scientific literature.…”

Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas

“…Some of the specimens analyzed in our laboratory were the object of separate case reports, which were recently published. [20][21][22] The aim of this study is to describe clinical and laboratory findings of 7 cases analyzed in our laboratory so far, including cases not yet published in the peer-reviewed literature.…”