Intraocular Lens Opacification following Intracameral Injection of Recombinant Tissue Plasminogen Activator to Treat Inflammatory Membranes after Cataract Surgery

Abstract

Purpose. To report 7 cases of intraocular lens (IOL) opacification following treatment of postoperative anterior chamber fibrin with recombinant tissue plasminogen activator (rtPA) after cataract surgery. Methods. Retrospective case series of 7 eyes in 7 patients who developed IOL opacification after receiving rtPA for anterior chamber inflammatory membrane formation resulting from phacoemulsification cataract surgery. Three explanted IOLs were investigated with light microscopy, histochemical analysis, scanning electron microscopy, and X-ray spectrometry. Results. All patients underwent uncomplicated cataract surgery and posterior chamber hydrophilic IOL implantation. Anterior chamber inflammatory membranes developed between 1 and 4 weeks of surgery and were treated with intracameral rtPA. IOL opacification was noted between 4 weeks and 6 years after rtPA treatment with reduced visual acuity, and IOL exchange was carried out in 3 patients. Light microscopy evaluation revealed diffuse fine granular deposits on the anterior surface/subsurface of IOL optic that stained positive for calcium salts. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS) confirmed the presence of calcium and phosphate on the IOL. Conclusions. Intracameral rtPA, though rapidly effective in the treatment of anterior chamber inflammatory membranes following cataract surgery, may be associated with IOL opacification.

Figure 1

(a)–(d) Patient 4: (a) slit lamp photograph showing refractile fine granular opacities of the anterior IOL surface; (b) explanted bisected IOL; (c) high power photomicrograph (unstained) showing granular infiltration beneath anterior IOL surface; (d) positive staining with alizarin red (OM ×100). (IOL: intraocular lens; OM: original magnification).

Figure 2

(a)–(d) Patient 2: (a) explanted IOL shows a band shaped configuration of fine white granular material in the central part of the optic. (b) Cross section through IOL shows positive granular staining with alizarin red. The granules are arranged linearly and diminish towards the periphery of the IOL optic (OM ×40). (c) The deposits are distributed below the surface of the IOL (OM ×5000, scanning electron microscopy). (d) Energy-dispersive X-ray spectrometry confirms the presence of calcium (Ca) and phosphate (P) in the deposits. Note that the spike for silicon (Si) is an artefact caused by a silicon wafer which was used for the analysis. (IOL: intraocular lens; OM: original magnification).