Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants.
OBJECTIVE
To report clinical, pathologic, histochemical, ultrastructural, and spectroscopic analyses of MemoryLens intraocular lenses (IOLs) explanted from patients who had visual disturbances caused by postoperative opacification of the lens optic.


METHODS
Noncomparative, large case series with clinicopathologic correlation.


METHODS
A total of 106 hydrophilic acrylic IOLs of the same design explanted from 106 different patients. All patients had decreased visual acuity at presentation approximately 2 years after cataract surgery, associated with a whitish fine granularity on the optical surfaces of the IOLs.


METHODS
The explanted IOLs were submitted to the John A. Moran Eye Center and were examined under light microscopy, histochemically, and with scanning electron microscopy (SEM) equipped with an energy dispersive x-ray spectroscopy detector with light element capabilities (EDS).


METHODS
The IOLs were examined for distribution, structure, and composition of the deposits causing opacification of their optic components.


RESULTS
The average interval between lens implantation and opacification was 25.8+/-11.9 months. The most frequently associated medical and ophthalmic conditions were diabetes and glaucoma. However, some patients did not have any preexisting medical or ophthalmic conditions. Most of the IOLs had been implanted in 1999 and 2000. Microscopic analyses revealed the presence of multiple fine, granular deposits of variable sizes on the anterior and posterior optic surfaces, especially on the anterior surface. The deposits stained positive for calcium. The EDS confirmed the presence of calcium and phosphate within the deposits.


CONCLUSIONS
The results obtained suggest the surface deposits to be composed, at least in part, by calcium and phosphate. A special polishing technique used in the manufacture of most of these IOLs may have caused changes in the lens surface leading to deposit formation. Further studies should be undertaken to confirm this hypothesis.
Neuhann
Irmingard M
IM
David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
Werner
Liliana
L
Izak
Andrea M
AM
Pandey
Suresh K
SK
Kleinmann
Guy
G
Mamalis
Nick
N
Neuhann
Thomas F
TF
Apple
David J
DJ
D000180:Acrylic Resins; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D002118:Calcium / Q000032:analysis; 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; D010710:Phosphates / Q000032:analysis; D011183:Postoperative Complications / Q000473:pathology*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D014786:Vision Disorders / Q000209:etiology / Q000473:pathology / Q000601:surgery
D000180:Acrylic Resins; D001672:Biocompatible Materials; D010710:Phosphates; D002118:Calcium