Intraocular lens calcification following endothelial keratoplasty: a message for all cataract surgeons

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

“…Morgan-Warren et al described the replacement of only one in a series of six opacified IOLs after DSAEK, which was performed along with the simultaneous exchange of the failed graft [14]. Park et al published a study on a similarly large group in which only one of the five IOLs with opacification after DSAEK was exchanged because of patient's severe visual impairment [4]. Thus, the described principles of management determine the limited availability of samples for testing, which results in the main limitation of our work-the analysis was made for single explanted IOL and for the reference IOL.…”

“…Opacification of the IOL caused by the formation of sediments on its surface is an uncommon postoperative complication, but it is considered a serious problem. This can lead to significant visual disturbances and thus the need for IOL explanation [ 3 , 4 , 5 ].…”

“…It is known, however, that it occurs more often after surgery involving the use of gas or air inside of the eye [ 5 , 6 , 7 ]. Because DSAEK as well as other techniques of posterior lamellar corneal transplantation have become common surgeries, they are currently the leading procedures associated with late-onset IOL opacification [ 3 , 4 , 8 ]. The incidence of hydrophilic acrylic IOL opacification after DSAEK ranged from approximately 5% [ 9 ] to 9% [ 10 ] in larger series of patients, while opacification of the hydrophobic IOLs after this procedure has been reported only sporadically [ 10 ].…”

“…Exchange of the IOL in patients after DSAEK is particularly dangerous, because it has a strong negative impact on long-term graft survival and may also cause other ocular complications [ 13 ]. Therefore, in patients with less advanced opacity, management is often limited to observation only [ 4 ]. The key factors in IOL opacification in patients after DSAEK that statistically increase the risk of this complication are repeated exposure to intracameral air or gas [ 3 , 4 , 10 ], raised IOP [ 10 ], along with the presence of hydrophilic acrylic lens.…”

“…Therefore, in patients with less advanced opacity, management is often limited to observation only [ 4 ]. The key factors in IOL opacification in patients after DSAEK that statistically increase the risk of this complication are repeated exposure to intracameral air or gas [ 3 , 4 , 10 ], raised IOP [ 10 ], along with the presence of hydrophilic acrylic lens. Besides air contact, prolonged breakdown of the blood–aqueous barrier could also play a role in the induction of IOL opacification [ 4 , 5 , 6 ].…”