Late Postoperative Opacification of the Foldable Hydrophilic Acrylic Intraocular Lens, ACRL-160

PURPOSE: To report pathological, histochemical, ultrastructural, and spectrographic analysis of explanted hydrophilic acrylic intraocular lenses obtained from patients who had visual disturbances caused by postoperative opacification of the IOL. METHODS: Forty-three hydrophilic IOLs (ACRL-160, Ophthalmed Inc.) were explanted from 39 patients with decreased visual acuity because of opacification of the IOL itself. All explanted IOLs were examined grossly and by light microscopy. Full-thickness sagittal sections of the optics of the randomly selected 10 IOLs were stained with the von kossa method (special stains for calcium). One of these sectioned IOLs was not stained, and submitted for scanning electron microscopy and energy dispersive X-ray spectroscopy. RESULTS: Microscopic analysis revealed multiple fine, granular deposits within the lens optics and haptics, and these deposits were stained positively with the von Kossa method. They were varible in size, and unevenly distributed in the optics on the scanning electron microscopy, and energy dispersive X-ray spectroscopy of the internal substance of IOL demonstrated the presence of calcium within the deposits. CONCLUSIONS: We evaluated 43 explanted opacified ACRL-160 lenses, and have demonstrated that the opacification was caused by the presence of granular deposits within the IOL. The deposits have the component of calcium.

A case of orbital Polyarteritis Nodosa Complicated with Retinal Vasculitis and Exophthalmos

PURPOSE: Polyarteritis nodosa is a necrotizing vasculitis affecting medium and small sized arteries throughout the vascular system, including ocular tissues. We report a case of orbital polyarteritis nodosa complicated with retinal vasculitis and exophthalmos. METHODS: A 51-year-old woman complained of swelling and hard mass in periorbital region for 3 months. The left eye was anophthalmos after enucleation secondary to corneal infection. The patient has treated marginal ulcer of the cornea and keratomalacia. Posterior synechia and motility disturbance of lateral rectus muscle were also revealed. Fundus examination showed focal retinal hemorrhage, macular hard exudate, and soft exudate, which may mean retinal vasculitis. Both eyes gradually developed exophthalmos. Orbital CT scan revealed homogenous infiltration in the orbit, ethmoid bone, and nasal cavity and perforation of the nasal septum. The pathologic examination for the biopsy specimen from the orbital tissue demonstrated a nongranulomatous vasculitis, diagnosing the polyarteritis nodosa. RESULTS: The authors present ocular manifestations, including marginal corneal ulcer, keratomalacia, dysfunction of the extraocular muscles, posterior synechia, retinal hemorrhage, soft exudate, hard exdate in the macula, and exophthalmos, in this patient with the polyarteritis nodosa.

A Case of Cryptococcal Chorioretinitis in a Renal Transplant Patient

PURPOSE: To report a case of cryptococcal chorioretinitis in the renal transplant patient. MATERIALS AND METHODS: A 31-year old male patient was admitted with visual disturbance, high fever and general weakness. On initial evaluation, visual acuity was 0.9 in the right eye and 0.3 in the left. On fundus exam, right eye showed the lesions which were expanded into posterior pole and equator and left eye showed several yellow white lesions which were larger than optic disc, and some of them were near the fovea. RESULT: Cryptococcus grew in CSF. The ocular diagnosis was cryptococcal chorioretinitis and intra-venous amphotericin B and oral flucytosine were given. In spite of 2-month treatment, the visual acuity of left eye was 0.04 due to the expansion of the lesion toward fovea. The patient refused the treatment after 4 months of treament, and he expired 1 month later.