Delayed postoperative opacification of foldable hydrophilic acrylic intraocular lenses

Abstract

Phacoemulsification and implantation of a foldable intraocular lens for cataract is almost a routine procedure in ophthalmic practice. Late postoperative opacification of hydrophilic acrylic (hydrogel) intraocular lenses (IOLs) has been reported, but the appearance differs from our findings. We report clinical, pathologic, ultrastructural, and spectroscopic analyses of foldable hydrogel IOLs undergoing late opacification resulting in visual disturbances. This retrospective study comprised 486 patients (550 eyes) who had implantation of a foldable hydrogel posterior IOL. Three cases (three eyes) had been found to have opacification of the IOLs. The three lenses were exchanged because of significant visual disturbances, and were examined using light microscopy, scanning electron microscopy and energy dispersion X-ray (EDX) spectroscopy. Incisional biopsies of the capsular membrane in contact with the opacified IOL were performed in one patient. The mean interval between implantation of the hydrogel IOLs and the diagnosis of opacification was 35.3 months (range, 34-36 months). All three of the cases had quiet anterior chamber. No obvious posterior capsular opacification were found. The best corrected visual acuity of the three cases who had exchanged IOLs were all 20/25 or better. Microscopic analysis revealed multiple, fine, granular structures both on the surface and matrix of the opacified IOLs. EDX analysis showed the presence of calcium and phosphorous were within the granular structures. Histological examination of capsular membrane did not reveal any evidence of calcium salts or special pathological exchanges. Further studies should be undertaken to determine the incidence and possible mechanisms of this phenomenon.

Microscopic analysis of opacification in Ioflex® hydrophilic acrylic intraocular lenses

“…The mean period between phacoemulsification and patient presentation with decreased vision was 31 months, with minimum being 29 and maximum 33 months. The literature shows that this mean period varies from 16.4 to 35.3 months, depending on the case series (14,17) . When comparing the visual acuity before and after IOL opacification, we noticed that all patients lost more than three Snellen lines in visual acuity.…”

Intraoperative and Postoperative Intraocular Lens Opacifications: Analysis of 42545 Cases

“…Moreover, considering the reversibility of opacification and the short interval between IOL implantation and occurrence of clouding in some cases, temporary lens epithelial cell outgrowth, delayed atypical toxic anterior segment syndrome [12,13], and even temperature volatility can be the reasons. is complication of IOL opacity has been noticed since 2010 at our institution and subjected to statistical analysis and laboratory research [14,15]. Herein, we documented a cluster of cases of irreversible opacification associated with hydrophilic IOLs and hydrophilic-hydrophobic acrylic IOLs, as well as four cases of transient clouding, during IOL implantation.…”

“…This complication of IOL opacity has been noticed since 2010 at our institution and subjected to statistical analysis and laboratory research [ 14 , 15 ]. Herein, we documented a cluster of cases of irreversible opacification associated with hydrophilic IOLs and hydrophilic-hydrophobic acrylic IOLs, as well as four cases of transient clouding, during IOL implantation.…”

Case-control study for clinical findings on intraocular lens opacity

“…This study's limitation is the small size of the evaluated sample; however, the IOL opacification either has a small incidence in the literature, or the Ioflex IOL opacification is underreported. 12,25 Furthermore, the random occurrence of late hydrophilic acrylic lenses opacification and its unknown etiology is another challenge. In conclusion, no clear patient factor could be identified in relation to Ioflex IOL opacification.…”