Transient Clouding of a Sutureless Scleral Fixated Hydrophilic Intraocular Lens with Spontaneous Resolution: A Case Report and in vitro Experimental Test

Abstract

A 83-year-old woman underwent phacoemulsification in the left eye, complicated by posterior capsular rupture and dislocation of nuclear fragments in the vitreous cavity. She was left aphakic and referred to the Clinica Oculistica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. After 2 days, she underwent pars plana vitrectomy, with removal of the nuclear fragments, and secondary intraocular lens (IOL) implantation. The lens used was a sutureless scleral fixation Carlevale lens (I71 FIL SSF Carlevale lens™. Soleko IOL Division), which was delivered to the operating theatre on the morning of the operation. During the implantation, it appeared opaque, without any deposit on its surfaces. The lens was not removed. On the next day, the lens was transparent, and it remained clear at the following control visits. An in vitro experimental test demonstrated that 25% hydrophilic polymers are vulnerable to thermal shock, developing an opacification which resolves after temperature stabilization of the lens.

Keywords: Cataract surgery; Hydrophilic intraocular lens; In vitro test; Intraocular lens; Transient intraocular lens clouding.

Fig. 1

a Before implantation, the optic plate of the IOL appeared milky white. b The pupillary expansion ring allowed better visualization of the dense white opacity. c On the first post-operative day, the optic plate of the IOL appeared transparent. IOL, intraocular lens.

Fig. 2

Results of the in vitro experimental test. a Opacification of the IOL at the moment of the termic shock. b–g Pictures showing the resolution of the clouding with the IOL being kept at constant temperature of 36°C (half an hour (b), one hour (c), one and a half hour (d), two hours (e), two and a half hours (f), three hours (g)). IOL, intraocular lens.