Clinical Features of Patients with Opacification of Hydrophilic Acrylic Intraocular Lens in Neovascular Glaucoma

Purpose: To report the clinical features of patients with opacification of hydrophilic acrylic intraocular lens (IOL) after cataract surgery in neovascular glaucoma.Methods: This retrospective case series included 11 eyes of 10 patients with IOL opacification and neovascular glaucoma (NVG) between January 2006 and December 2010. We included and analyzed cases with opacification of hydrophilic acrylic IOL. An IOL exchange was performed in three cases, and the explanted IOLs were examined grossly and evaluated by light microscopy. Sagittal sections of the optics of the IOLs were evaluated by Von Kossa staining, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX).Results: All 11 eyes of 10 patients were implanted with hydrophilic acrylic IOLs. In addition, there were no cases of hydrophobic acrylic IOL opacification. Nine patients of the 10 patients had diabetic retinopathy and one patient had central retinal artery occlusion. The mean period of IOL opacification after IOL implantation was 19.45 ± 8.52 months and the mean period of IOL opacification after the occurrence of NVG was 14.37 ± 8.51 months. The deposits of the explanted IOLs were shown to consist of calcium by von Kossa staining. The explanted IOLs showed fine whitish irregular granular deposits on the entire anterior surface of the optics by SEM and the presence of calcium deposition was confirmed by EDX analysis.Conclusions: Care is required when using hydrophilic acrylic IOLs in patients with risk of neovascular glaucoma, such as those with diabetic retinopathy or central retinal artery occlusion.

Optic shrinkage and retraction in opacified hydrophilic acrylic intraocular lens: an anterior segment optical CT-based observation

Intraocular lens (IOL) opacification is a rare phenomenon noted with hydrophilic acrylic IOLs. We report a case of advanced IOL opacification appreciated on anterior segment optical CT (ASOCT)as a shrunken biconcave optic retracted away from the posterior capsule (PC), unlike the other eye which had a clear biconvex IOL of similar material abutting the PC. After IOL exchange, the affected eye was noted to have more folds and Elschnig’s pearls on the PC when compared with the other eye. Our case points towards rare IOL changes seen in advanced cases of opacification, their association with posterior capsular changes and the aid of ASOCT as a non-invasive tool in diagnosing them correctly.

Management and Microbiological Characteristics of Membrane Formation on a Hydrophilic Acrylic Intraocular Lens: A Clinical Case Series and Material Comparative Study of Different IOLs

Background/Aims. To report a case series of membrane formation on intraocular lenses (IOLs) after uneventful phacoemulsification and to evaluate the material characteristics and biofilm formation on different IOLs. Methods. Ten eyes implanted with the same type of IOLs were found to have membranes on their IOLs after uneventful phacoemulsification from May 2015 to May 2016. No other patients were found with the same phenomenon among 11236 patients who underwent cataract surgeries during this period. To further investigate the reasons for their formation, we assessed seven types of IOLs used in our hospital, including their material characteristics and the presence of microbes (Staphylococcus epidermidis) on the IOL surface by scanning electron microscopy (SEM). All IOLs were incubated under in vitro flow conditions (BioFlux 1000Z). After 36 h, the IOLs were taken from the system, and both the bound bacteria and biofilm formation were observed. Results. Five eyes underwent intravitreal injections of ceftazidime and norvancomycin with one positive culture obtained from the anterior chamber fluid. The other five eyes only received topical treatment of gatifloxacin/levofloxacin and tobramycin. At the last follow-up, all patients had best-corrected visual acuity (BCVA) of 20/50 or better. In the biofilm study on the IOL surface, Staphylococcus epidermidis biofilms formed more readily on hydrophilic acrylic IOLs than on hydrophobic acrylic IOLs. Conclusions. Bacterial adhesion and biofilm tend to develop on certain types of IOLs because of the characteristics of the biomaterial.