Early opacification of silicone intraocular lenses: Laboratory analyses of 6 explants.
OBJECTIVE
To report laboratory analyses of 6 intraocular lenses (IOLs) explanted from patients who had visual disturbances caused by early postoperative opacification of the lens optic.


METHODS
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.


METHODS
Six patients with 3-piece silicone lenses presented with optic cloudiness as early as a few hours after implantation. The lenses were implanted in 4 locations in Brazil and in France. The lenses in Brazil were stored at the same location before implantation. Gross and microscopic analyses were performed (dry and hydrated states). One half of each specimen underwent gas chromatography/mass spectrometry (GC/MS) analysis and/or extraction by isopropyl alcohol or acetonitrile. One lens also underwent scanning electron microscopy (SEM) with energy dispersive x-ray spectroscopy (EDS). The IOLs were examined for the presence of contaminants or deposits that could cause fast optic opacification.


RESULTS
The IOLs showed a white optic discoloration in the hydrated state but became transparent on complete dehydration. Suspect exogenous chemical compounds were identified in GC/MS analyses; general classes included terpenes and ketones, typically found in industrial cleaning agents and fumigants. Surface analysis (SEM and EDS) did not show any significant deposits on the external surfaces and sagittal cut in 1 of the specimens.


CONCLUSIONS
Most IOLs are enclosed in semipermeable packages to allow sterilization by ethylene oxide gas. During cleaning or disinfection of storage rooms, aerosolized solutions may introduce chemicals through the package and onto the IOLs. This may cause surface changes in the IOL, promoting opacification by water ingress in the aqueous environment. Cleaning and disinfection procedures of IOL storage areas should be monitored carefully.
Werner
Liliana
L
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA. liliana.werner@hsc.utah.edu
Dornelles
Fabio
F
Hilgert
Christiana R
CR
Botelho
Fernando
F
Conte
Paulo F
PF
Rozot
Pascal
P
Andrenyak
David M
DM
Mamalis
Nick
N
Olson
Randall J
RJ
D000368:Aged; D020878:Device Removal; D004577:Electron Probe Microanalysis; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D018918:Phacoemulsification; D011475:Prosthesis Failure; D012826:Silicone Elastomers; D014786:Vision Disorders / Q000601:surgery
D012826:Silicone Elastomers