Immunohistochemical study of deposits on intraocular lenses explanted from human eyes

Immunohistochemical studies of deposits were carried out on two intraocular lenses (IOLs) explanted from human eyes. One anterior chamber intraocular lens (AC-IOL) was studied using a monoclonal anti-human type I collagen-peptide antibody (C-Ab). One posterior chamber intraocular lens (PC-IOL) was studied using a monoclonal anti-human vimentin antibody (V-Ab). Most of the cells on the AC-IOL contained many melanin granules in the cytoplasm and were thought to be macrophages. They did not show any immunoreactivity to C-Ab. Some spindle-shaped cells and fibrous deposits at the margin of the lens optics showed immunoreactivity to the antibody. These cells were thought to be fibroblasts migrating from the tissue around the IOL, such as the iris. On the PC-IOL, many mononuclear cells and multinucleated giant cells were observed. These cells showed immunoreactivity to vimentin and contained immunostained fibers which were intermediate filaments. They were thought to be either of mesodermal origin or derived from the lens epithelium.     

Cellular fibronectin on intraocular lenses explanted from patients

We investigated the origin of fibronectin (FN) on five posterior and four anterior chamber explanted intraocular lenses (IOLs) using immunohistochemical methods. Cellular deposits (assumed to be macrophages) and fibrous or membrane-like proteinaceous deposits on the IOLs showed immunoreactivity to an antibody against cellular FN. These proteinaceous deposits were believed to be products of the cells that adhered to the IOLs.     

Cytopathology of explanted intraocular lenses and the clinical correlation

PURPOSE: To study the cytopathological features of explanted intraocular lenses (IOLs) and correlate the features with their clinical presentation. SETTING: Ocular Pathology Department, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India. METHODS: The study comprised 61 explanted IOLs (48 posterior chamber IOLs and 13 anterior chamber IOLs) removed for the following reasons: pseudophakic bullous keratopathy (36), recalcitrant uveitis (7), retinal detachment (10), endophthalmitis (5), uveitis (7), IOL subluxation (2), and painful blind eye (1). The IOLs were stained with hematoxylin and eosin using a simple cytological technique. The cytopathological features were studied and correlated with the clinical presentations. RESULTS: The mean time of IOL explantation was 10.1 months after surgery. Twenty-one IOLs had granulomatous and nongranulomatous inflammations and 4, nongranulomatous inflammations. One IOL had fungal filaments on the surface. CONCLUSIONS: Intraocular lenses can produce both granulomatous and nongranulomatous inflammation. Granulomatous inflammation was the most common in this series. The surface of IOLs explanted because of intraocular infection may show infective agents.     

Spectroscopic study of explanted opacified hydrophilic acrylic intraocular lenses

Purpose: To report a detailed spectroscopic analysis of explanted hydrophilic acrylic intraocular lenses (IOLs) that were removed because of postoperative opacification of the lens optic. Methods: Thirteen Hydroview H60M (Bausch & Lomb Surgical) IOLs were explanted from 13 different patients on average 56 months after phacoemulsification and IOL implantation. All patients had decreased visual acuity because of a fine granularity of the optical surface of the IOLs. The surface was investigated by gross, microscopic, histochemical and scanning electron microscopic analysis, and the elemental composition of the opacified IOLs was determined by X‐ray fluorescence spectroscopy (XRF). The spectrograms were compared to three different originally packed and never‐implanted hydrophilic acrylic IOLs. Results: Light and scanning electron microscopy of the optical surface of explanted IOLs revealed multiple fine granular deposits varying in size and shape that were positive for alizarin red. XRF confirmed that the explanted IOLs contained not only the previously reported calcium and phosphorous (calcium apatite), chlorine, silicone, sodium, aluminum and magnesium but also iron, sulfur, potassium as well as lesser amounts of iodine, zinc, strontium and yttrium. Conclusion: This is the first spectroscopic analysis determining the content of more than 10 elements of explanted and originally packed never‐implanted hydrophilic acrylic IOLs. The possible origin of the different elements obtained from the spectrograms and their implications are discussed.     

Laboratory analyses of two explanted hydrophobic acrylic intraocular lenses

Two three-piece hydrophobic acrylic intraocular lenses (IOLs) were explanted from two patients at 7 and 9 years, respectively, after implantation, because of poor fundus visualisation and/or a clinically significant decrease in visual acuity related to their opacified IOLs. In addition to light microscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy, confocal laser scanning microscopy was used for the first time to observe the explanted IOLs. The clinical aspect seemed to correspond to the phenomenon of surface light scattering, while laboratory analyses showed dense glistenings in the central layer of the IOL optic, which had no change next to the surface. Further studies on these phenomena are needed.     

Changing trends in explanted intraocular lenses: a single center study.

Over a nine-year period, our practice removed 1,091 intraocular lenses. The most common type of lens requiring explantation was the closed-loop anterior chamber lens (58.6%). The Stableflex lens represented the largest percentage of all removed lens types (28.8%). The number of closed-loop anterior chamber lenses requiring removal peaked in 1988 and then gradually declined. All other lens styles have shown gradually increasing removal rates. Older style iris-fixated lenses and rigid anterior chamber lenses, which have not been implanted for several years, have increasing removal rates. Late breakage of fixational polypropylene sutures with pupil-supported iris-fixated lenses have occurred in five cases; the average time from implantation to suture breakage was 112 months.     

Postoperative surface deposits on intraocular lenses in children

PURPOSE: To report the clinicopathologic features of 4 intraocular lenses (IOLs) composed of 3 different hydrophilic biomaterials explanted from children who had postoperative opacification of the IOL optic. SETTING: David J Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: The IOLs were explanted 20, 11, 22, and 25 months postoperatively from children aged 10, 3, 36, and 20 months old, respectively, at IOL implantation. Clinical data were obtained to correlate the findings with possible associated risk factors. The explanted IOLs were examined by gross and light microscopy. They were further analyzed with a stain for calcium, alizarin red 1%. Scanning electron microscopy and energy dispersive X-ray spectroscopy (EDS) were also performed. RESULTS: The primary reason for cataract surgery in Case 1 and Case 2 was persistent hyperplastic primary vitreous (PHPV); 1 patient received a B-Lens IOL (Hanita) and the other a Centerflex IOL (Rayner). The primary reason in Case 3 was familial bilateral congenital cataract and in Case 4, rubella cataract; both patients received a Hydroview IOL (Bausch & Lomb). All 4 IOLs had surface deposits on the optic, but the morphology of the deposits on the B-Lens and Centerflex IOLs was different than that in previously reported cases. The deposits in all four cases stained positive with alizarin red and consisted of calcium and phosphorus when imaged with EDS. CONCLUSIONS: Calcified deposits on 2 Hydroview IOLs explanted from children were similar to those seen in adults with the same IOL. The deposits on the B-Lens and Centerflex IOLs were probably secondary to a breakdown of the blood-aqueous barrier caused by preexisting PHPV.     

Opacification of hydrophilic MemoryLens U940A intraocular lenses: analysis of 2 explanted lenses

PURPOSE: To determine the rate of opacification of hydrophilic MemoryLens U940A intraocular lenses (IOLs) (Mentor Ophthalmics, Inc.) in the given cohort and perform a histopathological and spectrophotometer analysis of 2 explanted opacified IOLs. SETTING: Ophthalmology Department, Faculty Hospital, Nitra, Slovakia. METHOD: This retrospective study comprised 182 patients (205 eyes) who had implantation of a MemoryLens U940A IOL from June 1997 to June 2000. The patients were examined using a slitlamp to detect the presence of IOL opacification. In 4 cases, the lenses were explanted because of significant opacification and patient-reported problems; 2 lenses were provided for further analysis. One unused reference MemoryLens U940A IOL was also evaluated. All IOL were stained with von Kossa to determine the presence of calcium in the opacification. To confirm the components presence of an ultraviolet (UV) absorber, the IOLs were examined with an Avatar 330 Fourier transfer infrared (IR) spectroscope and a UV visible spectrophotometer (Philips). The IR spectrums for the IOL were identified using an IR spectrum atlas. The opacified IOLs, reference IOL, and the IOL packaging were further examined to determine the presence of silicone. RESULTS: Various amounts of opacification were found on the MemoryLens U940A IOL in 30 eyes (30 patients) (14.63%). Two explanted IOLs were positive for von Kossa staining, proving the presence of calcium deposits; the reference lens staining was negative. Spectrophotometry showed that the reference IOL and opacified IOLs were of the same polymer. The presence of the UV absorber on the benzophenone base was seen in the reference lens but not the opacified IOLs. In contrast, an increased concentration of low-molecular-weight components generated during the degradation of the polymer was present in the opacified lenses. The white cover pf the IOL is of polydimethyl siloxane, a silicone rubber. However, no silicone rubber was present in any examined lens, perhaps because the IOLs were in contact with alcohol during the histopathologic examination. CONCLUSIONS: The results indicate opacification of the hydrophilic MemoryLens U940A was caused by premature consumption of the UV absorber in the polymer component of the IOLs optic, with a subsequent degradation of the polymer. Whether silicone from the white cover led to the IOL opacification, as reported with other types of hydrophilic IOLs, could not be confirmed.     

Pigment deposits on hydrophilic intraocular lenses after phacoemulsification cataract surgery

A heterogeneous group of conditions can cause changes to the intraocular lens (IOL) during or after implantation in uneventful cataract surgery.We describe a series of 5 patients presenting distinctive deposits on the surface of hydrophilic intraocular lenses, implanted during routine cataract surgery, with a follow-up of 1 to 24 months.Disposable forceps were found to be the source of the pigmented marks when used to hold the lens during the injector loading process. At the slit-lamp examination, the pigments were located in the centre of the lens optic, easily detectable. Although involving the visual axis, none of the patients were visually affected.To our knowledge, this is the first time such unusual occurrence has been described. The reported case-series shows the importance of in-house follow-up after cataract surgery.     

Immunohistochemical evaluation of cellular deposits on posterior chamber intraocular lenses

· Purpose: We used immunohistochemistry to characterize cellular and proteinaceous deposits on the surfaces of explanted posterior chamber intraocular lenses (PC-IOLs). · Methods: A total of 30 PC-IOLs were immunostained for the α- or β-subunits of prolyl 4-hydroxylase, which is involved in collagen biosynthesis; cellular fibronectin; αB crystalline; and CD68, a macrophage marker, to characterize the cellular deposits that adhere to the IOL surfaces and to evaluate the distribution of cells involved in the deposition of extracellular matrix on IOLs. · Results: Cellular or proteinaceous deposits were observed on all 30 PC-IOLs. Cells that showed positive staining for αB crystallin were classified as lens epithelial cells; CD68-positive cells were considered to be of macrophagic origin. Positivity for cellular fibronectin, including the macrophages and related cells, appeared to be responsible for the accumulation of fibronectin on the surfaces of PC-IOLs. Prolyl 4-hydroxylase-positive cells were involved in the deposition of collagen on PC-IOLs. · Conclusion: Immunohistochemical study revealed that macrophages, foreign-body giant cells, and lens epithelial cells adhered to explanted PC-IOLs. Such adherent cells are responsible for the deposition of extracellular matrix on the surfaces of PC-IOLs and may regulate the assembly of the extracellular matrix, influencing the biocompatibility of PC-IOLs. Received: 9 December 1997 Accepted: 5 February 1998     

Spectrum of Nd:YAG laser-induced intraocular lens damage in explanted lenses

A series of explanted intraocular lenses (IOLs) and autopsy globes containing IOLs that had previously had Nd:YAG laser posterior capsulotomy were analyzed at the Intermountain Ocular Research Center. A broad spectrum of laser-induced IOL damage was found. In the majority of instances, the damage was classified as mild and consisted of tiny pits on the IOLs' posterior surface. These pits would not be expected to produce any visually significant consequences. Moderate damage consisted of larger, more extensive pitting, craters, and small cracks. The most severely damaged IOLs showed extensive cracking and focal fracturing of the optic. Extensive damage may result in unacceptable visual blurring, distortion, and glare which in extreme cases may warrant IOL explantation, as presented in a case report.     

Opacification of hydrophilic acrylic intraocular lenses: a clinical and ultrastructural analysis of three explanted lenses

BACKGROUND: The purpose of our study was to report the clinical and ultrastructural results of the late opacification of three Hydroview intraocular lenses (IOLs) explanted from three patients with late postoperative visual acuity drop. PATIENTS AND METHODS: Three different patients without any systemic or ocular associated pathology presented with decreased visual acuity 12 to 24 months after uneventful phacoemulsification and Hydroview IOL implantation. The lenses were explanted and examined by photon and transmission electron microscopy (TEM), as well as through laboratory chemical analysis using bleaching with H 2 O 2, SDS-electrophoresis and silver staining for protein detection. They were cut in small pieces, fixed with osmium tetroxide 1.5 %, dehydrated through ascending grades of ethanol, and embedded in EPON 812. Ultrathin sections were stained with aqueous solutions of uranyl acetate and lead citrate, and they were examined with JEOL 2000 CX TEM. One normal IOL was also prepared in the same way and served as control. RESULTS: Control: It was transparent and no material on the surface of semithin and thin sections was detected. Cases 1 and 2: A total gray-whitish opacification of these lenses occurred. An amorphous loose material was present on semithin sections in alternation with normal areas. Evaluation with TEM revealed a pattern of network distribution within the lenses material. The latter was continuous and lightly granulated at the periphery, yet irregularly arranged in the center, more intensely stained, leaving areas of normal appearance. After bleaching, no changes in opacification were seen macroscopically. SDS-electrophoresis and silver staining did not detect proteins. Case 3: This lens had a small opacification close to the periphery. CONCLUSIONS: Late opacification of hydrophilic IOLs is not an uncommon phenomenon after uneventful cataract surgery. Although calcified deposits on the surfaces of such lenses have been reported, this is the first study that describes ultrastructural changes in the IOL material itself.     

Ultrastructural evaluation of explanted opacified Hydroview (H60M) intraocular lenses

AIM: To describe the ultrastructural appearance of explanted opacified Hydroview H60M intraocular lenses. METHODS: 14 explanted lenses were examined by scanning electron microscopy, and their appearance compared with a non-implanted H60M lens from the same time period. Wavelength-dispersive x ray spectroscopy (WDX) was performed on two opacified lenses. RESULTS: Subsurface deposits were seen in all explanted opacified lenses. These deposits broke only onto the surface of more densely opacified lenses. WDX confirmed that the deposits contained both calcium and phosphorous, consistent with their being calcium apatite. CONCLUSION: These findings challenge the widely accepted opinion that H60M intraocular lens opacification begins on the surface of the optic.     

Biomicroscopy of surface deposits resembling foreign-body giant cells on implanted intraocular lenses

Deposits resembling foreign-body giant cells, which can be seen on specular reflex slit-lamp examination, were studied in vivo with a wide-field specular microscope using a low-power dipping cone lens in three cases of posterior chamber lens implantation. The deposits seen as iris pigment on routine examination showed two types of cell-like figures: round, bipolar or ameboid small figures with long branching processes and round, oval, or bizarre large figures. The large cell type had the pigment particles at the central or paracentral area and vacuole-like structures adjacent to the pigment particles. The specular photomicrographic characteristics were similar to those of fibroblast-like cells and foreign-body giant cells, which had been shown on the surfaces of extracted implanted intraocular lenses by the lens implant cytology technique.