Investigation and management of an epidemic of Hydroview intraocular lens opacification.

BACKGROUND: Opacification of Hydroview posterior chamber intraocular lenses had been prescribed, but many aspects of this complication remain unknown, including its aetiology, clinical features, pathogenesis, prognosis and treatment. This paper describes an epidemic of Hydroview intraocular lens (IOL) opacification. METHODS: Subjects in whom the Hydroview IOL was implanted were recalled for evaluation of its transparency, assessment of contrast sensitivity (CS) [VCTS (Vistech CO, Dayton, Ohio, USA)] and visual acuity (LogMAR), and analysis of medical and surgical data. The results of IOL exchange in 69 eyes of 67 patients are also presented. RESULTS: Of 103 patients recalled, 46 (44.6%) and 3 (2.9%) exhibited opacification of the implanted IOL in one and both eyes, respectively. CS was significantly worse in the presence of an opacified IOL (P<0.050), even when Snellen acuity was unaffected. Where the viscoelastic employed during the primary cataract surgery was reliably documented, VISCOAT was used in 100% of cases (43/43), whereas Healonid had not been used in any (0/57) (P<0.0001). Following IOL exchange, visual acuity improved from a mean (+/-SD) of 0.75 (0.41) to 0.4 (0.34) LogMAR. CONCLUSIONS: The prevalence of Hydroview IOL opacification is associated with the use of VISCOAT in the primary cataract surgery, and there is a biochemically plausible rationale to account for this. Visual acuity and contrast sensitivity are adversely affected by opacification of the Hydroview IOL, but CS to a greater extent. Exchange of opaque IOLs is a visually rewarding procedure.

Management of endophthalmitis with retained intraocular foreign body.

AIMS: To assess the impact of primary injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of intraocular foreign body (IOFB) in patients with clinical features of bacterial endophthalmitis and retained IOFB. METHODS: Retrospective review of all patients with clinical features of infective endophthalmitis and a retained IOFB who had immediate injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of IOFB in two vitreo-retinal centres during 1995-2001. Nine patients were identified and minimum follow-up was 3 months. RESULTS: Four of the nine patients had a final visual outcome of 6/18 or better. One patient developed total retinal detachment. CONCLUSIONS: The current series suggests that immediate injection of intravitreal antibiotics with delayed removal of IOFB in eyes with clinical features of infective endophthalmitis and a retained IOFB is a possible alternative to immediate removal of IOFB. This management may be associated with preservation of the eye and restoration of useful visual acuity.