Analysis of elements of interlenticular opacification.
OBJECTIVE
To report the histopathologic and ultrastructural features of three cases of interlenticular opacification (ILO) between piggyback intraocular lenses.


METHODS
Interventional case series with clinicopathologic correlation.


METHODS
Three pairs of acrylic piggyback lenses were explanted due to decrease in visual acuity associated with ILO. Lenses were evaluated with gross and light microscopic examinations in all cases. The anterior lens in one case was examined with scanning electron microscopy and energy dispersive x-ray spectroscopy.


RESULTS
The material opacifying the interlenticular space was composed mostly of retained/regenerative cortical material in all cases. From the peripheral interface towards the central interface, the opacifying material changed as the interlenticular space was progressively narrower. The material attached to the peripheral interface, where the interlenticular space was wider, was very thick. At the midperipheral interface, the thick cortical material was broken into multiple globules due to liquefactive degeneration. At the paracentral zone, compression of the globules formed a flat, compact layer of an amorphous material. At the central interface (contact zone), almost no material could be found between the piggyback lenses.


CONCLUSIONS
Analyses of ILO cases where all the components of the opacifying material were in situ allowed us to confirm that the pathogenesis of this complication is similar to that of posterior capsule opacification; thus, careful removal of lens epithelial cells and cortical material is mandatory in piggyback implantation.
Werner
Liliana
L
Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston 29425-5536, USA. wernerl@musc.edu
Apple
David J
DJ
Pandey
Suresh K
SK
Solomon
Kerry D
KD
Snyder
Michael E
ME
Brint
Stephen F
SF
Gayton
Johnny L
JL
Shugar
Joel K
JK
Trivedi
Rupal H
RH
Izak
Andrea M
AM
D000180:Acrylic Resins; D000368:Aged; D020878:Device Removal; D004577:Electron Probe Microanalysis; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D011475:Prosthesis Failure; D014786:Vision Disorders / Q000209:etiology / Q000473:pathology / Q000601:surgery; D014792:Visual Acuity
D000180:Acrylic Resins