Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens

OBJECTIVE: To report clinical, pathological and histochemical features of 5 Hydroview intraocular lenses (IOLs) explanted from five patients who had visual disturbances caused by postoperative deposits on the lens surfaces. DESIGN: Noncomparative small case series with clinicopathologic and histochemical correlations. PARTICIPANTS: Five hydrophilic IOLs explanted from five different patients. All patients presented with decreased visual acuity and glare circa 12 months after uneventful phacoemulsification and IOL implantation, associated with a red-brown granularity on the optical surfaces of the IOLs. METHODS: The lenses were explanted, fixed in buffered formaldehyde and examined by gross and light microscopy. MAIN OUTCOME MEASURES: Staining of the IOLs with 1% alizarin red and with the von Kossa method (both stains for calcium). Two additional IOLs were also stained and included as controls. RESULTS: The optical surfaces of all five IOLs were covered by a layer of irregular granular deposits, composed of multiple fine, translucent spherical-ovoid granules. The deposits stained positive for calcium in all cases. No deposit or positive staining was observed on the IOLs haptics. Staining of the control IOLs was also negative. CONCLUSION: This is the first histopathological report of calcified deposits on the surfaces of this hydrogel IOL model. Further studies on other similar cases with this lens should be done to determine the incidence and possible mechanisms of this phenomenon.     

Induction of cataracts of varying degrees of hardness in human eyes obtained postmortem for cataract surgeon training

PURPOSE: To report a method of inducing nuclear cataracts of varying degree of hardness using intralenticular injection of the Karnovsky solution. METHODS: Twelve postmortem human eyes were prepared according to the Miyake-Apple posterior video technique. After performing capsulorhexis and hydrodissection/delineation, 0.2 ml of the Karnovsky solution was injected into the lens nucleus of the eyes. Manual extracapular cataract extraction techniques and various two-handed phacoemulsification maneuvers were then practiced at various time intervals after the injection. RESULTS: Uniform nuclear cataracts with varying degrees of hardness were successfully induced in all globes. The optimum dose of the Karnovsky solution and time for induction of nuclear hardness of grade 3 (ideal for practicing two-handed phacoemulsification maneuvers) were 0.2 ml and 15 minutes, respectively. CONCLUSION: The Karnovsky solution can be successfully used for the induction of hard, uniform nuclear cataracts for learning/practicing extracapular cataract extraction and phacoemulsification.     

Cervical spine fractures and dislocations in children

A retrospective analysis of pediatric admissions over 10 years revealed 29 patients with cervical spine injuries. Eleven patients were below 12 years of age, and 10 of these had injuries involving C1, C2, or the occipitoatlantal articulation. Eighteen patients were between 12 and 16 years of age with injuries distributed throughout the cervical spine similar to injuries in the adult population. Our results suggest that teenagers with suspected cervical injuries are best evaluated by an adult radiographic series including trauma oblique views. In younger patients, careful evaluation of occipitoatlantoaxial alignment and the prevertebral soft tissues is required for diagnosis and selection of additional imaging evaluation. Presented at the Seventy-first Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, 17–22 November 1985     

Analysis of elements of interlenticular opacification

PURPOSE: To report the histopathologic and ultrastructural features of three cases of interlenticular opacification (ILO) between piggyback intraocular lenses. DESIGN: Interventional case series with clinicopathologic correlation. METHODS: Three pairs of acrylic piggyback lenses were explanted due to decrease in visual acuity associated with ILO. Lenses were evaluated with gross and light microscopic examinations in all cases. The anterior lens in one case was examined with scanning electron microscopy and energy dispersive x-ray spectroscopy. RESULTS: The material opacifying the interlenticular space was composed mostly of retained/regenerative cortical material in all cases. From the peripheral interface towards the central interface, the opacifying material changed as the interlenticular space was progressively narrower. The material attached to the peripheral interface, where the interlenticular space was wider, was very thick. At the midperipheral interface, the thick cortical material was broken into multiple globules due to liquefactive degeneration. At the paracentral zone, compression of the globules formed a flat, compact layer of an amorphous material. At the central interface (contact zone), almost no material could be found between the piggyback lenses. CONCLUSIONS: Analyses of ILO cases where all the components of the opacifying material were in situ allowed us to confirm that the pathogenesis of this complication is similar to that of posterior capsule opacification; thus, careful removal of lens epithelial cells and cortical material is mandatory in piggyback implantation.