Anterior segment optical coherence tomography of intraocular lens opacification

Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.

Prediction of Refractive Error in Combined Vitrectomy and Cataract Surgery With One-Piece Acrylic Intraocular Lens

PURPOSE: To compare the predicted and actual refractive errors of hydrophilic, one-piece, C-flex(R)570C (C-flex) intraocular lens (IOL) implantation in simultaneous vitrectomy and lens extraction in various conditions. METHODS: One hundred fifty-nine eyes of patients who had lens extraction between March 2004 and September 2005 were enrolled in a retrospective study. Group 1 had lens extraction and IOL implantation, and Group 2 had lens extraction and IOL implantation with vitrectomy. IOL calculation was done with axial length and keratometry measurements. The actual and predicted refractive errors were compared at 1 and 6 months postoperatively. The factors influencing the postoperative refractive outcomes were analyzed. RESULTS: The mean refractive predictive error (i.e., the actual minus predicted spherical equivalent) was +0.19+/-0.39 D (Diopter) and -0.26+/-0.45 D at 1 and 6 months postoperatively (all: p0.05). CONCLUSIONS: Refractive errors in combined surgery showed myopic shift of -0.50 D and -0.32 D at 1 and 6 months postoperatively compared with C-flex IOL implantation alone. With the hyperopic tendency of IOL and myopic tendency of vitrectomy, the combined surgery made postoperative refractive errors near emmetropia.

Clinical Results of Implantation of Hydrophilic Acrylic Intraocular Lenses

PURPOSE: To evaluate the clinical results of Akreos(R) hydrophilic acrylic intraocular lens (IOL) implantation compared with implantation of Acrysof(R) hydrophobic acrylic IOL. METHODS: We retrospectively analyzed each fifty eyes in 50 patients who had undergone phacoemulsification and implantation of Akreos(R) and Acrysof(R) IOLs, with a minimum follow-up period of one year. RESULTS: Final visual acuity better than 0.5 and 0.8 was 70% and 27% in the Akreos(R) implanted group, and 82% and 46% in the Acrysof(R) group. Predictability less than 1.0D was seen in 23 eyes (46%) in the Akreos(R) group. This is a significantly low percentage compared with that seen in 43 eyes (86%) in the Acrysof(R) group. The final spherical equivalent of -0.93+/-0.92D in the Akreos(R) group represented statistically significant myopic refractive error compared with -0.49+/-0.82D in the Acrysof(R) group. CONCLUSIONS: It is necessary to consider the myopic refractive error toDetermine the proper target refraction for the implantation of Akreos(R) IOL.

Comparision of the Three Different Hydrophilic Acrylic Intraocular Lenses

PURPOSE: To evaluate the stability of three different hydrophilic acrylic intraocular lenses (IOLs), which have different shapes. IOLs included in this study are three-piece acrylic IOL with PMMA (Polymethylmethacrylate) haptics (Hydroview(R) H60M, Bausch &Lomb, U.S.A), one-piece acrylic IOL with broad optic-haptic junction (Centerflex(R) 570H, RAYNER, UK), and one-piece acrylic IOL with narrow optic-haptic junction (Aquasens, Ophthalmic Innovations International, U.S.A). METHODS: We evaluated 69 patients (100 eyes) who had undergone cataract surgeries and who had hydrophilic acrylic IOLs implanted from September, 2003 to March, 2004. Forty eyes implanted with three-piece acrylic IOL with PMMA haptics, 40 eyes implanted with one-piece acrylic IOL with broad optic-haptic junction, and 20 eyes implanted with one-piece acrylic IOL with narrow optic-haptic junction were included. Slit lamp examination, best corrected visual acuity (BCVA), anterior chamber depth (ACD), refraction, and IOL decentration were evaluated at one week and at one, three, and six months postoperatively. RESULTS: There was no statistically significant difference in BCVA, ACD, mean SE or decentration between patients implanted with three different types of hydrophilic acrylic IOL during the 6 month follow-up period (P>0.05). However, Postoperative myopic shift was discovered in 4 eyes (4/20) with Aquasens. CONCLUSIONS: There were no statistically significant difference in the Stabilities of the 3-different hydrophilic acrylic IOLs. However, patients who were implanted Aquasens shold be observed carefully because Aquasense has the posibilitiy to have myopic shift more than 1 Dioptor.

Clinical Characteristics of Patients with Opacification of Hydorphilic Acrylic Intraocular Lens after Cataract Surgery

PURPOSE: To report the clinical characteristics of patients with opacification of intraocular lens (IOL) after cataract surgery with hydrophilic acrylic IOL. METHODS: Retrospective evaluation was performed for 102 eyes of 74 patients who had undergone cataract extraction, with insertion of hydrophilic acrylic IOL (ACRL-C160). The medical records of 91 eyes of 69 patients who were followed up for more than 6 months were reviewed retrospectively. The clinical characteristics of the patients with IOL opacification were analyzed, and the characteristics were compared between the groups of patients with and without IOL opacification. RESULTS: In 70 eyes of 52 patients IOL opacification developed. The incidence was 19.8% at 6 months, 52.3% at 1 year, and 84.1% at 2 years after cataract surgery. The onset of IOL opacification ranged from 2 to 25 months (11.1 months on average). The incidence of IOL opacification was not affected by systemic disease such as diabetes mellitus and hypertension. In the group of patients with IOL opacification, the onset of IOL opacification occured earlier than in the patient group with diabetes mellitus and it also developed earlier in patients with longer duration of diabetes mellitus and diabetic retinopathy. IOL opacification was more severe in patients with retinopathy than in those without diabetic retinopathy. CONCLUSIONS: The incidence of hydrophilic acrylic IOL opacification increased over time and had risen to 84.1% of cases at 2 years after surgery. Although patients with generalized disease were not associated with the development of IOL opacification, the presence of diabetes mellitus and diabetic retinopathy affected the onset and severity of IOL opacification.

Adhesion and Morphologic Change of Lens Epithelial Cell According to Materials of Intraocular Lens

PURPOSE: We investigated the adhesion rate and morphologic change of lens epithelial cell (LEC) according to materials of intraocular lens (IOL). With the results, we estimated the appearance and characteristics of posterior capsular opacity after cataract extraction. METHODS: LECs were prepared from fresh bovine lens. Hydrophobic acylic IOLs such as Acrysof(R) and Sensar(R) and hydrophilic acrylic IOLs such as Corneal(R) were tested. On the days 2, 9 and 12 of LEC culture, we calculated the adhesion rate and observed the cellular morphologic changes. Immunostaining with alpha smooth muscle actin (SMA) was performed. RESULTS: Adhesion rate was higher in hydrophilic lens on the days 2 and 9 (p-value=0.029). Acrysof(R) had the lowest adhesion rate. LEC in hydrophobic IOL showed differentiation to myofibroblast that was strong positive for SMA. LEC in hydrophilic IOL preserved natural cellular morphology until the day 12. Immunostaining with SMA was nearly negative. CONCLUSIONS: Hydrophobic acrylate induced much differentiation from LEC into myofibroblast, but had low adhesion rate. Hydrophilic acrylate does not induce the differentiation, but has high adhesion rate.

Late Opacification of Hydrophilic Acrylic Intraocular Lenses

PURPOSE: To report clinical, pathological, histochemical, ultrastructural, and spectrographic analysis of explanted hydrophilic acrylic intraocular lenses (IOLs). By IOL extraction and new IOL implantation, patients resulted in increased visual acuity. METHODS: Four hydrophilic acrylic IOLs (ACRL-C160,Opthalmed(R),California,USA)were explanted from the 3 patients who had developed decreased visual acuity after about 5months from uneventful phacoemulsification and IOL implantation. Four IOLs were examined by gross and light microscopy. Staining of IOLs was performed with 1% alizarin red and von Kossa method (both stains for calcium). Some were submitted for scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), Infrared spectral analysis (IR), X-ray diffraction (XRD) and energy dispersive X-ray spectroscopy (EDS). RESULTS: Microscopic analysis showed opaque materials on explanted IOL surface. The deposits were stained positive with Alizarin red and the von Kossa method for the detection of calcium. SEM revealed IOL surface covered by calcium crystals and collagen fibers. Many studies such as XPS, IR, EDS showed that the causes of opacification of IOLs were calcium phosphate hydroxide (hydroxyapatite). We suspect silicone promoted this reaction as catalyst. CONCLUSIONS: This is the rarest cases and clinical, pathological and spectroscopic report of opacified hydrophilic acrylic IOLs (ACRL-C160,Opthalmed(R),California,USA). We found out materials causing opacification by many special studies. Additional studies should be done to determine possible mechanisms and biocompatibility of the IOLs materials containing UV absorbable coating materials, packaging system and foldable systems in the intraocular conditions