Surgical removal of dystrophic calcification on a silicone intraocular lens in association with asteroid hyalosis

Abstract

We present a case of successful removal of late calcium deposition on the posterior surface of a silicone intraocular lens (IOL) optic in association with asteroid hyalosis using a surgical technique that included pars plana vitrectomy, a lighted pick, and a modified silicone-tipped cannula. The lighted pick provided the most efficient and complete removal of calcium deposits. Postoperatively, the dystrophic calcification was removed and the IOL optic was clear at 6 months follow-up. The patient's symptoms resolved and uncorrected distance visual acuity returned to 20/20. This method can be considered in patients with dystrophic calcification of a silicone IOL in association with asteroid hyalosis and might avoid the need for IOL exchange and its associated complications and uncertain refractive outcomes.

Steam-like clouding observed on anterior surface of intraocular lens developed soon after implantation

“…Several types of opacifications and deposits have been reported to be present on the anterior surface or within the optic of implanted postoperative IOLs. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 The opacifications include calcification in hydrogel 3 , 4 and silicone IOLs, 5 , 6 , 7 and a glistening or whitening or sub-surface nano-glistening (SSNG) in hydrophobic acrylic IOLs. 9 , 10 , 11 , 12 , 13 , 14 These two types of abnormalities should be differentiated from the steam-like clouding reported in our three cases.…”

“… 5 , 6 An opacification of an IOL can also occur several years postoperatively in eyes with asteroid hyalosis. 7 In cases with a hydrogel IOL, calcified deposits can appear several months postoperatively. 3 , 4 In cases with a hydrophobic acrylic IOL, the glistening or SSNG does not occur shortly after surgery but begins at longer postoperative times.…”

“…Crystalline or calcium deposits cover the entire IOL surface including the anterior and posterior surfaces. 3 , 4 , 5 , 6 , 7 SSNG or glistening opacities are fluid-filled microvacuoles that form within just below the surface of the optics of the IOL and not on the surface. 14 On the other hand, our three cases developed steam-like clouding only on the anterior surface of the optic where it came into contact with the aqueous humor.…”

“…First, the former occurs in cases with an implanted hydrophobic acrylic IOLs, and the latter occurs in cases with silicon and hydrogel IOLs. 3 , 4 , 5 , 6 , 7 Second, the calcium deposits are associated with some specific condition such as the use of Healon GV 3−5 or eyes having asteroid hyalosis. 7 In cases with calcium deposits, the reduction of vision is generally greater and may require additional surgical interventions such as IOL exchange compared to those with steam-like clouding.…”

“… 3 , 4 , 5 , 6 , 7 Second, the calcium deposits are associated with some specific condition such as the use of Healon GV 3−5 or eyes having asteroid hyalosis. 7 In cases with calcium deposits, the reduction of vision is generally greater and may require additional surgical interventions such as IOL exchange compared to those with steam-like clouding. The differences between the three cases and those with SSNG is also clear; the symptoms in eyes with clouding appear at an early postoperative time and is acute and benign whereas that of SSNG is chronic and longstanding.…”