A Case of Hydrophilic Acrylic Intraocular Lens Opacification in a Patient with Proliferative Diabetic Retinopathy

PURPOSE: To report a case of hydrophilic acrylic intraocular lens (IOL) opacification in a patient who underwent vitrectomy and cataract surgery for the treatment of diabetic retinopathy. CASE SUMMARY: A 54-year-old female complained of blurred vision for 15 months after having combined vitrectomy and phacoemulsification with IOL (Rayner(R) Superflex(R) 620H) implantation for the treatment of high-risk proliferative diabetic retinopathy. On slit-lamp examination, IOL opacification was evident. IOL exchange was performed and the explanted IOL analyzed. Scanning electron microscopy (SEM) revealed the presence of translucent granular deposits on the anterior subsurface of the IOL. Energy dispersive X-ray spectroscopy (EDS) demonstrated calcium and phosphate deposition within the IOL optic.

Postoperative Deposition of Calcium on the Surface of a Hydrophilic Acrylic IOL in Diabetic Patients

PURPOSE: Through a study of 3 diabetic patients who experienced decreased visual acuity due to deposit on the surface of hydrophilic acrylic IOLs which were inserted after cataract extraction, the authors attempted to examine pathological and histochemical characteristics of such undesirable deposit on the IOL surface and also evaluate whether a correlation exists between that and diabetes mellitus. METHODS: A 42 year old male patient with bilateral proliferative diabetic retinopathy who has had diabetes for 10 years, a 43 year old male with identical clinical history, and a 46 year old male with bilateral proliferative diabetic retinopathy and clinically significant macular edema who has had diabetes for 13 years were selected for the study. Cataract was extracted by phacoemulsification and after hydrophilic acrylic IOL was inserted into the bag, deposit appeared on IOL surface which caused decreased visual acuity. IOL exchange was conducted thereafter, and by studying the pathological and histochemical characteristics of deposit found on the surface of the retrieved IOL, and by examining the deposit's fine details with electron microscope, the authors attempted to identify the causative material and also evaluate whether diabetes plays a significant role in giving rise to such undesirable deposit. RESULTS: All three IOL that have been retrieved from the patients were covered with multiple deposits which took on a structure with fine circular granules, and all these deposits tested positive when 1% alizarin red staining and von Kossa staining (designed to identify calcium in a given material) were conducted. Electron microscopic study of the deposit also showed needlelike calcium crystals.

A Clinical Comparison of AcrySof(r) with Hyd rophilic Acrylic IOLs

To evaluate and compare the clinical results of implantation of the AcrySof(r) with Hydrophilic Acrylic IOLs in early postoperative period(to 2 months), we retrospectively analyzed 34patients who had taken clear cornea incision and had been implanted with AcrySof(r)IOL in one eye and Hydrophilic Acrylic IOL in the other eye. There were no stastically significant difference in postoperative best corrected visual acuity, preoperative and postopearative astigmatic changes between AcrySof(r) and Hydrophilic Acrylic IOLs. But, the rates of postoperative capsular fibrosis and contracture of Hydrophilic Acrylic IOL was higher than those of AcrySof(r) IOL as well as postoperative complications. In conclusion, in the degree and rate of after-cataract, AcrySof(r)IOLs are more useful than Hydrophilic Acrylic IOLs. ;therefore, more excellent in long term visual prognosis. Further studies will be needed for the evaluation of clinical safety and efficacy.