Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;13(3):791-800.
doi: 10.1007/s40123-023-00872-0. Epub 2024 Jan 20.

Material Analysis of Explanted Calcified Silicone Intraocular Lenses in Association with Asteroid Hyalosis

Lizaveta Chychko #  1 , Ramin Khoramnia #  1 , Hyeck-Soo Son  1 , Sonja K Schickhardt  1 , Ingo Lieberwirth  2 , Gerd U Auffarth  3   4 , Timur M Yildirim  1
Affiliations

Material Analysis of Explanted Calcified Silicone Intraocular Lenses in Association with Asteroid Hyalosis

Lizaveta Chychko et al. Ophthalmol Ther. 2024 Mar.

Abstract

Introduction: The aim of this study was to analyze posterior surface opacification in explanted silicone intraocular lenses (IOLs) with clinicopathologic correlation to asteroid hyalosis.

Methods: In a laboratory setup, 12 explanted silicone IOLs underwent laboratory analyses, including light microscopy, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy for elemental composition (EDX). Relevant clinical data were obtained for each case, including gender, age at IOL implantation, dates of implantation and explantation, as well as history of neodymium-dopped yttrium aluminum garnet (Nd:YAG) laser treatments or other opacification removal attempts. High-resolution optical coherence tomography (OCT) images were obtained in vitro with an anterior segment OCT device (Anterion, Heidelberg Engineering, Heidelberg, Germany).

Results: Calcification located at the posterior optic surface of each lens was identified through SEM and EDX analyses, revealing deposits composed of hydroxyapatite. In all cases, IOL polishing using Nd:YAG laser had been attempted prior to IOL exchange. The clinical functional data showed that this type of IOL opacity led to increase in straylight and subjective symptoms of glare.

Conclusions: Silicone IOLs can develop posterior surface calcification in eyes with asteroid hyalosis. There are mechanical techniques of cleaning the IOL surface but in many cases, IOL explantation is the only sustainable way to reduce the patients' straylight levels and glare symptoms. Due to the risk of posterior surface calcification, silicone IOL implantation should be avoided in eyes with asteroid hyalosis.

Keywords: Asteroid hyalosis; IOL calcification; IOL opacification; IOL pathology; Silicone IOLs.

PubMed Disclaimer

Conflict of interest statement

Lizaveta Chychko, Sonja K. Schickhardt, Hyeck-Soo Son and Ingo Lieberwirth have nothing to disclose. Timur M. Yildirim reports personal fees from Alcon and Hoya and non-financial support from Johnson & Johnson. Gerd U. Auffarth reports grants, personal fees, non-financial support and consulting fees from Johnson & Johnson and Alcon, grants, personal fees and non-financial support from Carl Zeiss Meditec, Hoya, Kowa, Oculentis/Teleon, Rayner, Santen, SIFI, URSAPHARM, grants and personal fees from Biotech, Oculus, EyeYon grants from AcuFocus, Anew, Contamac, Glaukos, Physiol, RHEACELL, outside the submitted work. Ramin Khoramnia reports research grants and lecture fees from Alcon, Hoya, Physiol, Rayner, 1stQ and Johnson & Johnson, lecture fees from Kowa, Ophtec, Teleon, Santen, AcuFocus, Bausch + Lomb and travel grants from Alcon, Teleon, Johnson & Johnson, Rayner and 1stQ outside the submitted work. No funding or sponsorship was received for this study or publication of this article.

Figures

Fig. 1
Fig. 1
Light microscopy images representing an overview of the intraocular lens (IOL), higher-magnification images, and scanning electron microscopy of the IOLs 1–12. As the opacification of the IOL 1 and 4 could partly be removed manually, these IOLs showed partially clear optic parts
Fig. 2
Fig. 2
Scanning electron microscopy of the intraocular lenses (IOLs), demonstrating a crust-like appearance of the deposits. A IOL 1. B IOL 2. C IOL 10
Fig. 3
Fig. 3
Anterior segment examination of the patient’s right eye from the case report showing diffuse white–grey granular deposits on the posterior surface of the silicone intraocular lens (IOL) in association with asteroid hyalosis. A Overview slit-lamp photograph demonstrating IOL opacification and neodymium-dopped yttrium aluminum garnet (Nd:YAG) laser pits on the posterior IOL surface. B Direct focal slit examination pointing out the diffuse dissemination of the dense deposits on the IOL surface. C Retroillumination photograph showing opacified silicone IOL and posterior capsule opening
Fig. 4
Fig. 4
Silicone intraocular lens (IOL) with posterior surface calcification. A Photograph of the explanted IOL with dystrophic opacification. B High-resolution optical coherence tomography (OCT) cross-section image of the IOL from A. The region of the posterior surface opacification is located within the red rectangle. AC artificial anterior chamber filled with distilled water
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Giers BC, Tandogan T, Auffarth GU, et al. Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty - a material analysis with special reference to optical quality assessment. BMC Ophthalmol. 2017;17:150. doi: 10.1186/s12886-017-0546-8. - DOI - PMC - PubMed
    1. Łabuz G, Yildirim TM, van den Berg T, Khoramnia R, Auffarth GU. Assessment of straylight and the modulation transfer function of intraocular lenses with centrally localized opacification associated with the intraocular injection of gas. J Cataract Refract Surg. 2018;44:615–622. doi: 10.1016/j.jcrs.2018.01.033. - DOI - PubMed
    1. Bompastor-Ramos P, Póvoa J, Lobo C, et al. Late postoperative opacification of a hydrophilic-hydrophobic acrylic intraocular lens. J Cataract Refract Surg. 2016;42:1324–1331. doi: 10.1016/j.jcrs.2016.06.032. - DOI - PubMed
    1. Izak AM, Werner L, Pandey SK, Apple DJ. Calcification of modern foldable hydrogel intraocular lens designs. Eye (Lond) 2003;17:393–406. doi: 10.1038/sj.eye.6700341. - DOI - PubMed
    1. Tandogan T, Khoramnia R, Choi CY, et al. Optical and material analysis of opacified hydrophilic intraocular lenses after explantation: a laboratory study. BMC Ophthalmol. 2015;15:170. doi: 10.1186/s12886-015-0149-1. - DOI - PMC - PubMed

LinkOut - more resources