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

ABSTRACT

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.