Intraocular lens calcification: Clinico-pathological report of two cases and literature review

Abstract

Purpose:We report the clinicopathological features and surgical outcomes of two cases of intraocular lens (IOL) calcification along with a review of the current literature.Case Report:The first patient was a 53-year-old woman with diabetes mellitus (type 2) who underwent phacoemulsification with posterior chamber IOL insertion (PCIOL), and pars plana vitrectomy. Significant clouding of the IOL was first noted after 1.5 years, and the IOL was replaced with an Artisan lens. The second patient was a 22-year-old woman with Vogt-Koyanagi-Harada syndrome; she underwent a lensectomy, PCIOL, and pars plana vitrectomy. IOL opacification was first noted 4.5 years after the initial surgery and the IOL was extracted.Conclusion:The calcification of each IOL was confirmed by a pathologist. Further studies are required to determine the primary causes and mechanisms of the calcification of biomaterials including IOLs.

Physicochemical Analysis of Sediments Formed on the Surface of Hydrophilic Intraocular Lens after Descemet’s Stripping Endothelial Keratoplasty

“…Various physicochemical studies have been applied to the analysis of hydrophilic IOLs' opacification. Among them, light and electron microscopy, as well as elemental or molecular surface analytic techniques, demonstrated that the opacification, similar to presented in this work, was related to calcium phosphate precipitation or adsorption of fatty acids and proteins on the IOLs' surface [22][23][24][25]. Sediments observed on IOLs are, in most described cases, distributed on the anterior and posterior surface of the optical zone, limited to the pupillary zone, but rarely appear in the peripheral part and haptics [26].…”

“…On the basis of the results of our research and reports known in the literature, we present a diagram (see Figure 9 ) of the probable mechanism of opacification of the C-Flex lens caused by deposits formed on its surface. As results from the analysis of cases described so far, the damage to the lens is caused by drying of its surface after the DSAEK procedure, particularly when the air injection is repeated [ 5 , 6 , 7 , 8 , 9 , 11 , 12 , 13 , 14 , 22 , 23 , 24 , 26 , 27 , 28 , 29 ]. The literature reports also indicate that the source of sediment growth can be related to the altered blood–aqueous barrier, which could allow protein penetration into the IOL surface.…”

“…There are many common morphological features for IOL opacification after inracameral and intravitreal gas injection. However, it is very likely that other factors, mainly an exacerbated inflammatory response due to repeated breakdown of the blood-aqueous barrier after multiple intraocular procedures, are more important in the development of this complication after the posterior segment procedures [6,23,35,36]. In our study, we focused on the analysis of IOL opacification after DSAEK, thus we have no evidence that our model is applicable to explain the post-PPV opacity mechanism.…”

“…Opacification of hydrophilic acrylic IOLs following intraocular gas injection has been described not only after intracameral injection of air or gas. Several reports described the opacification occurred after intravitreal gas injection during pars plana vitrectomy (PPV), the surgical procedure performed for treating diseases of the posterior segment of the eye [6,23,32,36,[68][69][70][71][72]. The typical appearance of the opacification in most cases was similar to that occurring after DSAEK/DMEK [6,17,23,32,36,62,[68][69][70][71][72].…”

Systematic review of potential causes of intraocular lens opacification

“…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 …”