Hydrophilic acrylic intraocular lens clouding: a clinicopathological review

PURPOSE: An analysis is made of a serious late complication (opacification) of different models of hydrophilic acrylic intraocular lenses (IOLs). METHODS: Seven lenses were explanted from seven patients treated for cataracts with phacoemulsification and implantation of different types of hydrophilic acrylic IOLs (five SC60B-OUV from MDR, one Aquasense from OII, and one H60M Hydroview lens from Bausch & Lomb) who developed important vision impairment in the late postoperative period (1 to 3 years) due to lens opacification. The explanted lenses were subjected to exhaustive study involving photographic analysis, scanning electron microscopy, and energy dispersive X-ray spectroscopy. RESULTS: Light and scanning electron microscopy revealed diffuse, variable-size granular deposits within the optic of the SC60B-OUV lens, and on the anterior and posterior optic surfaces of the H60M Hydroview lens, though without affecting the haptics in any of the models. Dispersive energy X-ray spectroscopy of the deposits revealed the presence mainly of calcium and phosphorus salts. CONCLUSIONS: Hydrophilic acrylic IOL opacification is a serious late complication of unknown etiology. The condition is more frequent among diabetic patients, and the only management option is IOL explantation and replacement with a lens of some other material. More frequent and longer follow-up is required of those patients wearing lenses for which cases of opacification have been documented, particularly in the presence of predisposing factors (diabetes, uveitis). Caution is required with new lenses, avoiding their generalized use until they have successfully passed the test of time.     

Hydrophilic acrylic intraocular lens as a drug-delivery system: Pilot study

PURPOSE: To evaluate the ability of a hydrophilic acrylic intraocular lens (IOL) to serve as a drug-delivery system for commercially available gatifloxacin and moxifloxacin. SETTING: David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Hydrophilic acrylic IOLs (C-flex, Rayner Ltd.), presoaked for 24 hours in commercially available solutions of gatifloxacin (Zymar) or moxifloxacin (Vigamox), were implanted in the capsular bag of 6 rabbits for a total of 12 eyes (6 in each group). Aqueous humor samples were taken 2, 4, and 6 hours after implantation. One rabbit served as a control and had nonpresoaked C-flex IOLs implanted. At the end of the operation, 1 drop of Vigamox was applied to the right eye and 1 drop of Zymar was applied to the left eye of the control rabbit. RESULTS: High concentrations of both antibiotics were found in all the samples of the eyes implanted with the presoaked IOLs. The concentrations of the antibiotics decreased over time, but even the 6-hour sample concentrations were markedly higher than the concentrations found in the control rabbit after 4 hours. CONCLUSION: The results suggest that the Rayner C-flex IOL can be effective as a drug-delivery system for fourth-generation fluoroquinolones.     

Hydrophilic acrylic intraocular lens optic opacification in a diabetic patient

Purpose  

To report clinicopathologic and ultrastructural feature of one opacified hydrophilic acrylic intraocular lens (IOL) explanted from a diabetic patient.     

Hydrophilic acrylic intraocular lens as a drug-delivery system for fourth-generation fluoroquinolones

PURPOSE: To evaluate the ability and safety of a hydrophilic acrylic intraocular lens (IOL) as a drug-delivery system for commercially available gatifloxacin and moxifloxacin. SETTING: David J. Apple, MD, Laboratories for Ophthalmic Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: Thirty rabbits were divided into 2 similar groups. In Group A (15 rabbits, 30 eyes), hydrophilic acrylic IOLs (C-flex, Rayner Intraocular Lenses, Ltd.) presoaked for 24 hours in commercially available solutions of gatifloxacin 3 mg/mL or moxifloxacin 5 mg/mL were implanted after evacuation of the crystalline lens. Group B (15 rabbits, 30 eyes) had topical preoperative and postoperative cataract prophylaxis with gatifloxacin 3 mg/mL or moxifloxacin 5 mg/mL; IOLs that were not presoaked were also implanted after evacuation of the crystalline lenses. In both groups, aqueous humor samples were taken 4, 8, or 12 hours after IOL implantation (5 eyes at each time point) to determine the antibiotic concentrations. Clinical examinations were performed 24 hours postoperatively. RESULTS: The antibiotic concentrations in Group A (presoaked IOLs) were statistically significantly higher than those in Group B (topical) for both antibiotics in all postoperative samples except moxifloxacin at 12 hours. In both groups, there was no statistically significant difference between the concentrations of the 2 antibiotics. No eye showed signs of clinical toxicity. CONCLUSION: Results show the C-flex IOL is a safe and effective drug-delivery system for fourth-generation fluoroquinolones.     

Cracked acrylic intraocular lens requiring explantation

Background: Intraoperative cracking of foldable acrylic posterior chamber intraocular lenses has previously been documented. However; most cracks have resulted in no significant visual impairment. Methods : A case report of an acrylic posterior chamber intraocular lens that cracked during folding. Results : The crack in the lens resulted in significant optical disturbance and required explantation and insertion of another lens. Conclusions: Acrylic intraocular lenses must be folded carefully with the appropriate forceps to prevent cracking of the optic.     

Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: bilateral case report and clinicopathologic correlation

OBJECTIVE: To report clinicopathologic and ultrastructural features of two opacified single-piece hydrophilic acrylic intraocular lenses (IOLs) explanted from a diabetic patient. DESIGN: Interventional case report with clinicopathologic correlation. SETTING: A 64-year-old white female underwent phacoemulsification and implantation of a single-piece hydrophilic acrylic lens (SC60B-OUV; Medical Developmental Research, Inc., Clear Water, FL) in October 1998 in the left eye and in July 1999 in the right eye. The best-corrected visual acuity after surgery was 20/60 in the left eye and 20/50 in the right eye. The patient had a marked decrease in visual acuity in June 2000 as a result of a milky, white opalescence of both lenses. Intraocular lens explantation and exchange was performed in both eyes and the explanted IOLs were submitted to our center for detailed pathologic, histochemical, and ultrastructural evaluation. They were stained with alizarin red and the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. MAIN OUTCOME MEASURES: Documentation of calcium deposits confirmed by histochemical stains and surface analyses. RESULTS: Opacification of the IOL was found to be the cause of decreased visual acuity. The opacification involved both the IOL optic and the haptics in the left eye and was confined to the IOL optic in the right eye. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic and haptics. CONCLUSIONS: There are two features that distinguish this case from those reported earlier. This is the first clinicopathologic report of lens opacification that has involved completely the lens optic and the haptics. Second, these two explanted IOLs document the first bilateral case. This process of intraoptic and haptic opacification represents dystrophic calcification of unknown cause. Diabetic patients appear to be more severely and more often affected by lens opacification. Long-term follow-up of diabetic patients implanted with this IOL design should be maintained by surgeons and manufacturers.     

Visual discomfort after acrylic intraocular lens implantation

A 64-year-old man had phacoemulsification in both eyes. In January 1998, an Allergan SI-30NB silicone intraocular lens (IOL) with a 6.0 mm optic was implanted in the right eye. In April, an Alcon AcrySof MA60BN acrylic IOL with a 6.0 mm optic was implanted in the left eye. The following October, the patient experienced visual discomfort in the left eye. Two superior radial minikeratotomies were performed. The patient continued to have visual discomfort and the next month, a topographic ablation was performed in the same eye. In January 2000, the left IOL was replaced with a 5.5 mm Allergan SI-55NB silicone IOL. Visual impairment resolved 1 day after surgery.     

Simplified technique for acrylic intraocular lens explantation

A simplified technique to explant an acrylic (AcrySof) intraocular lens through the original scleral frown incision is presented. After the haptics have been separately removed from the optic, the optic is grasped by a lens holder forcep and wiggled through the incision site. No wound enlargement is necessary. The limited intracameral manipulations minimize any potential damage to the posterior capsule or corneal endothelium.     

Single-piece acrylic intraocular lens implantation in children

PURPOSE: To assess the short-term outcomes of single-piece acrylic intraocular lens (IOL) implantation in children by determining the incidence of postoperative visual axis opacification and the need for a second procedure to clear the axis, cell deposits on the IOL optic, posterior synechias, and IOL decentration. SETTING: Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This retrospective case review comprised 43 consecutive implantations (33 patients) of a single-piece hydrophobic acrylic IOL (AcrySof SA30AL or SA60AT, Alcon). An analysis of 42 eyes with posterior capsulectomy and vitrectomy was performed. Eyes with traumatic cataract and secondary IOLs were excluded. RESULTS: Single-piece acrylic IOLs were implanted in 42 eyes. The mean age was 33.5 months +/- 28.9 (SD) (range 0.5 to 110 months) and the mean follow-up, 12.0 +/- 8.2 months (range 1.0 to 27.5 months). Postoperative opacification of the visual axis occurred in 7 eyes (16.7%). Secondary surgical procedures were required in 5 eyes (11.9%). Lens deposits were observed in 8 eyes (19.0%) and synechias, in 5 eyes (11.9%). All IOLs were well centered postoperatively. CONCLUSION: The short-term data suggest implantation of the AcrySof single-piece hydrophobic acrylic IOL is safe in the pediatric eye.     

Longitudinal study of intraocular lens exchange

PURPOSE: To analyze the indications for intraocular lens (IOL) exchange, interval between the first IOL implantation and the exchange, type and mix of IOLs used, effect on vision, and frequency of complications. SETTING: Cincinnati Eye Institute-Cincinnati-Ohio-USA. METHODS: This retrospective study comprised 49 eyes of 49 adult patients who had IOL exchange between 1986 and 2002 performed by the same surgeon. The mean age was 70 years old, and 55% were women. The mean interval between surgeries was 53.8 months and the mean follow-up, 35.6 months. The patients were divided into 2 groups according to the type of IOL originally implanted: anterior chamber (AC) or posterior chamber (PC). RESULTS: There were 15 eyes with an AC IOL and 34 eyes with a PC IOL. The difference in mean age and follow-up were not statistically significant between groups. The mean interval between the primary surgery and IOL explantation was 82.3 months in the AC IOL group and 37.9 months in the PC IOL group. The main reason for IOL exchange was inflammation (53.34%) and dislocation/decentration (85.30%), respectively. The preoperative best corrected visual acuity was similar in both groups, and visual acuity was maintained or improved in 80%. Vitreous prolapse was the main intraoperative complication. CONCLUSIONS: The primary indication for IOL exchange was intraocular inflammation in patients with an AC IOL and IOL malposition in patients with a PC IOL. The results confirm the safety and positive visual outcome in this complex group of patients.