Late opacification of a silicone intraocular lens caused by ophthalmic ointment.
A 55-year-old man had uneventful phacoemulsification with implantation of a 3-piece silicone intraocular lens (IOL). Postoperative medications included antibiotic-steroid drops and ointments. Eight months postoperatively, the patient started having recurrent episodes of anterior chamber inflammatory reaction. Suspicion that lens instability was causing the reactions led to a lens repositioning procedure 11 months after the initial surgical implantation and again at 13 months. Eighteen months postoperatively, the IOL had a "greasy" film. Despite antiinflammatory and antibiotic treatment, the clinical outcome did not improve. Twenty-seven months after implantation, the lens was exchanged with a hydrophilic acrylic IOL. The course after the exchange was uneventful. The explanted lens was examined by gross and microscopic evaluations, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and gas chromatography-mass spectrometry (GC-MS) using electronic ionization. Gross and microscopic evaluations confirmed the presence of a thin, oily film covering the IOL optic surface. Surface analyses at the level of the oily substance showed unspecific peaks of sodium, chloride, and potassium. The GC-MS analysis showed the presence of compounds characteristic of hydrocarbons, including docosane, tricosane, and tetracosane, which are commonly found in the vehicle of ophthalmic ointments. The GC-MS analysis of 1 ointment used postoperatively found matching peaks, suggesting deposition of those compounds on the IOL.
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
Jesse J L
JJ
Chew
Liliana
L
Werner
Gary
G
Mackman
Nick
N
Mamalis
D020878:Device Removal; D003907:Dexamethasone / Q000737:chemistry; D004577:Electron Probe Microanalysis; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D009823:Ointment Bases / Q000009:adverse effects* / Q000737:chemistry; D009824:Ointments / Q000737:chemistry; D018918:Phacoemulsification; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation; D012826:Silicone Elastomers; D014031:Tobramycin / Q000737:chemistry
D009823:Ointment Bases; D009824:Ointments; D012826:Silicone Elastomers; D003907:Dexamethasone; D014031:Tobramycin