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. 2018 Dec 15;3(1):e000157.
doi: 10.1136/bmjophth-2018-000157. eCollection 2018.

Opacification of hydrophilic intraocular lenses associated with vitrectomy and injection of intraocular gas

Arie L Marcovich #  1 , Tamer Tandogan #  2 , Mor Bareket  1 , Eva Eting  3 , Ifat Kaplan-Ashiri  4 , Amir Bukelman  1 , Gerd U Auffarth  2 , Ramin Khoramnia  2
Affiliations

Opacification of hydrophilic intraocular lenses associated with vitrectomy and injection of intraocular gas

Arie L Marcovich et al. BMJ Open Ophthalmol. .

Abstract

Objective: To report 11 cases of intraocular lens (IOL) opacification after pars plana vitrectomy (PPV) involving intravitreal gas injection.

Methods and analysis: Eleven cases of hydrophilic IOLs that opacified following PPV with intravitreal gas injection are described. Eight IOLs were explanted and analysed by light microscopy and scanning electron microscopy. Staining with alizarin red and von Kossa stains, as well as energy dispersive X-ray spectroscopy (EDX) were performed. Three IOLs were not explanted. The surgeons attached the clinical data.

Results: The IOLs were hydrophilic acrylic produced by six manufacturers. Six patients underwent primarily phacoemulsification with IOL implantation. PPV with intravitreal gas injection was performed 3 months-6 years afterwards. The other five patients underwent combined phacoemulsification with IOL implantation and PPV with intravitreal gas injection. IOL opacification was recorded 1 month -6 years after PPV. In eight patients, the IOLs were explanted 1 month-9 years after opacification was noticed. In three patients, the opacified IOL was not explanted. IOLs had opacified mainly anteriorly at the pupillary entrance or capsulorhexis opening. Light microscopy demonstrated granular surface deposits on the IOLs that stained positive for calcium by alizarin red and von Kossa stains. EDX analysis of the deposits detected calcium and phosphorus.

Conclusions: Hydrophilic acrylic IOLs can opacify due to calcium deposition after PPV and intravitreal gas injection and may require IOL explantation. A hydrophobic IOL may be preferred when a simultaneous phacoemulsification and vitrectomy with intravitreal gas is performed.

Keywords: aqueous humour; lens and zonules; retina; vitreous.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Case 1: (A) clinical photograph showing opacification of a hydrophilic IOL at the edge of the anterior capsulorhexis. (B) Photograph of the explanted IOL with a rough central anterior surface limited to the area of the capsulorhexis opening. (C and D) Low and high magnification image by SEM, demonstrating the sediments on the anterior optic. IOL, intraocular lens; SEM, scanning electron microscopy.
Figure 2
Figure 2
Case 5: (A) slit photograph showing opacification of a hydrophilic IOL at the pupillary opening not reaching the capsulorhexis edge. (B) Photograph of the explanted IOL with a rough central anterior area. (C) Alizarin red staining demonstrating positive staining for calcium. (D) Energy dispersive X-ray spectrum of the sediments shows calcium and phosphorus peaks (the silicone peak is an artefact caused by a silicone wafer, which was used for the analysis). IOL, intraocular lens.
Figure 3
Figure 3
Case 10: (A) slit lamp photograph 1 day postoperatively after phacoemulsification and hydrophilic IOL implantation combined with pars plana vitrectomy and SF6 gas intravitreal injection due to retinal detachment. In this patient, the gas migrated to the anterior chamber. Drying of the anterior surface of the IOL was noted. (B) Photograph taken at 1-month follow-up visit. The gas disappeared and the IOL looked transparent. (C) Photograph taken at 8-month follow-up visit. Anterior opacification of the IOL is evident. The IOL was not explanted due to poor visual potential of the operated eye. IOL, intraocular lens; SF6, sulfur hexafluoride.
Figure 4
Figure 4
Case 2: (A) slit photograph showing an opacified hydrophilic IOL optic implanted in the sulcus. The pupil is dilated. (B) Photograph of the explanted IOL demonstrating sedimentation that covers the entire anterior optic area and extends to the haptics. (C) Low magnification image of the IOL by SEM. The sediments cover the entire optic area and part of the haptics. (D) Energy dispersive X-ray spectrum of the sediments shows calcium and phosphorus peaks (sodium and chlorine are artefacts from the saline solution). IOL, intraocular lens; SEM, scanning electron microscopy.
Figure 5
Figure 5
Case 3: (A and B) photographs showing an explanted hydrophilic IOL demonstrating sedimentation on the anterior optic area (A) and the posterior optic area (B). (C) Image of the sediments on the posterior IOL optic by SEM. (D) element mapping shows calcium (marked with green) inside the sediments. IOL, intraocular lens; SEM, scanning electron microscopy.
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