title: Analysis of elements of interlenticular opacification.
abstract: 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.
authors.affiliation: Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston 29425-5536, USA. wernerl@musc.edu
authors.forename: Liliana
authors.initials: L
authors.lastname: Werner
authors.forename: David J
authors.initials: DJ
authors.lastname: Apple
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Pandey
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Solomon
authors.forename: Michael E
authors.initials: ME
authors.lastname: Snyder
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Brint
authors.forename: Johnny L
authors.initials: JL
authors.lastname: Gayton
authors.forename: Joel K
authors.initials: JK
authors.lastname: Shugar
authors.forename: Rupal H
authors.initials: RH
authors.lastname: Trivedi
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Izak
mesh_terms: 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
chemical_list: D000180:Acrylic Resins