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Intraocular Lens (IOL) Opacification and Calcification in Patients with Hydrophilic Lenses

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Title: Intraocular Lens (IOL) Opacification and Calcification in Patients with Hydrophilic Lenses

Author (s): Cuneyt Ozkardes, MS; Kevin Eid, MD; Austin Nakatsuka, MD

Date: 7/20/2023

Keywords/Main Subjects: IOL; cataract complications; hydrophilic lens; calcification.

Diagnosis: Calcification of a hydrophilic intraocular lens.

Summary of the Case:

Description of Case:

Introduction

Intraocular Lens (IOL) opacification is a late post-operative complication of cataract surgery, especially in patients with hydrophilic lenses.1 The most common cause of opacification is calcification of the lens material.2 Proposed causes of this phenomenon include reactions with post-operative intracameral substances (i.e. Silicone, gas, viscoelastic), metabolic changes in the anterior chamber, or inflammatory reactions caused by surgical procedures.3-5 The only known treatment for this phenomenon is explantation with or without exchanging of the lens.6,7 In addition to their association with lens calcification, meta-analyses have shown hydrophilic lenses tend to have higher PCO rates compared to lenses of other materials.8 Because of this known complication associated with hydrophilic lens material, the most common implanted lenses are currently made of hydrophobic material.

Case Presentation

An 83-year-old male patient with a known history of pseudoexfoliation glaucoma in both eyes presented to our clinic with complaints of slowly worsening blurry and limited vision in the right eye over the past six months. Despite these symptoms, previous slit lamp examinations during this period had been unremarkable with BCVA of 20/20 bilaterally. The patient had undergone trabeculectomy in the right eye 21 months prior, which was complicated by a choroidal hemorrhage and subsequent choroidal detachment one week later. He was treated conservatively with prednisolone and atropine drops daily, as well as oral prednisone. His visual acuity improved from 20/300 at presentation to 20/20 after 8 weeks of treatment.

Upon examination during the current visit, BCVA in the right eye was 20/20. Slit-lamp examination revealed a central cloudy opacity in the posterior chamber intraocular lens (PCIOL), with haptics positioned at 2 and 8 o’clock. The left eye showed no signs of opacification or other complications. Based on the clinical findings and the significant impact on visual function, the decision was made to proceed with an IOL exchange surgery to address the opacification using a hydrophobic TECNIS Eyhance IOL.

The original IOL, placed nearly 13 years prior, was removed and sent for pathological analysis. It was identified as an Akreos Bausch and Lomb one-piece [plate] hydrophilic acrylic posterior capsule IOL (Model MI60L). The pathology report described the specimen as having a deposition of a white granular material on the anterior surface of the IOL in the center of the optic. The deposition was consistent with calcium and was specifically deposited centrally, denoting the area where the anterior capsulotomy is open. The peripheral part of the optic as well as the footplates showed no deposition of this material.

Follow-up examination eleven weeks after the IOL exchange surgery revealed a well-centered IOL with mild posterior capsule opacification (PCO). The patient’s BCVA was 20/20, with the patient noting he was much happier with his vision and seeing well. He expressed overall satisfaction with the new lens and reported no further visual complaints. Continued monitoring and regular follow-up visits were scheduled to assess the long-term stability of the IOL and to manage any potential future complications.

Images or video:

Figure 1. Slit-lamp examination revealing central cloudy opacification of the intraocular lens (IOL ).

Figure 1. Slit-lamp examination revealing central cloudy opacification of the intraocular lens (IOL ).

 Figure 2. Extracted Akreos Bausch and Lomb hydrophilic acrylic posterior capsule IOL (Model MI60L).

Figure 2. Extracted Akreos Bausch and Lomb hydrophilic acrylic posterior capsule IOL (Model MI60L).

Figure 3. Close-up image of extracted capsule demonstrating central opacification .  

Figure 3. Close-up image of extracted capsule demonstrating central opacification .

Figure 4. Enhanced view revealing widespread calcification (seen in the image as diffuse round globules ) coating the central and anterior surfaces of the extracted IOL.

Figure 4. Enhanced view revealing widespread calcification (seen in the image as diffuse round globules ) coating the central and anterior surfaces of the extracted IOL.

Format: Case Report

 References:

  1. Grzybowski, A., Markeviciute, A., & Zemaitiene, R. (2020). A narrative review of intraocular lens opacifications: Update 2020. Annals of Translational Medicine, 8(22).
  2. Drimtzias, E. G., Rokidi, S. G., Gartaganis, S. P., & Koutsoukos, P. G. (2011). Experimental investigation on mechanism of hydrophilic acrylic intraocular lens calcification. American Journal of Ophthalmology, 152, 824-833.
  3. Werner, L., Wilbanks, G., Nieuwendaal, C. P., et al. (2015). Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas. Journal of Cataract and Refractive Surgery, 41, 199-207.
  4. Stanojcic, N., Hull, C., & O’Brart, D. P. (2020). Clinical and material degradations of intraocular lenses: A review. European Journal of Ophthalmology, 30, 823-839.
  5. Pérez-Vives, C. (2018). Biomaterial Influence on Intraocular Lens Performance: An Overview. Journal of Ophthalmology, 2018, 2687385.
  6. Haymore, J., Zaidman, G., Werner, L., et al. (2007). Misdiagnosis of hydrophilic acrylic intraocular lens optic opacification: Report of 8 cases with the MemoryLens. Ophthalmology, 114, 1689-1695.
  7. Werner, L. (2007). Causes of intraocular lens opacification or discoloration. Journal of Cataract and Refractive Surgery, 33, 713-726.
  8. Findl, O., Buehl, W., Bauer, P., & Sycha, T. (2010). Interventions for preventing posterior capsule opacification. Cochrane Database of Systematic Reviews, 2. CD003738.

 

Faculty Approval by: Austin Nakatsuka, MD

Identifier: Moran_CORE_126859

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