title: Pathologic assessment of complications with asymmetric or sulcus fixation of square-edged hydrophobic acrylic intraocular lenses.
abstract: OBJECTIVE
  One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation because of complications, such as uveitis-glaucoma-hyphema syndrome. Similar complications may also be observed with 3-piece lenses that have a square optic edge on the anterior surface. The objective of this study was to provide pathologic evidence of complications related to out-of-the-bag fixation of 1- or 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges.
  
  
  METHODS
  Comparative case series with pathology.
  
  
  METHODS
  A total of 661 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs.
  
  
  METHODS
  Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathologic analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses.
  
  
  METHODS
  Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses.
  
  
  RESULTS
  A total of 256 eyes were implanted with hydrophobic acrylic IOLs with anterior and posterior square optic edges; 18 of them exhibiting asymmetric or sulcus IOL fixation (six 1-piece and twelve 3-piece IOLs) underwent complete histopathologic evaluation and were compared with the contralateral eyes with symmetric in-the-bag IOL implantation. Pathologic findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, iris thinning, and iris atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the control contralateral eyes and were particularly evident in relation to the sulcus-fixated haptic in the case of 1-piece lenses. The majority of the eyes with 3-piece lenses showed signs of complicated surgery.
  
  
  CONCLUSIONS
  This study provides pathologic correlation of complications that were clinically reported in the peer-reviewed literature in relation to sulcus fixation of 1-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidence of complicated surgery; therefore, all pathologic findings in those cases may not be strictly attributed to the out-of-the-bag fixation.
authors.affiliation: University of Utah, Salt Lake City, UT, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kirk
authors.forename: Liliana
authors.initials: L
authors.lastname: Werner
authors.forename: Ryan
authors.initials: R
authors.lastname: Jaber
authors.forename: Susan
authors.initials: S
authors.lastname: Strenk
authors.forename: Lawrence
authors.initials: L
authors.lastname: Strenk
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
mesh_terms: D000180:Acrylic Resins; D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging; D060437:Artificial Lens Implant Migration / Q000175:diagnosis*; D002924:Ciliary Body / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007910:Lenses, Intraocular; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications; D011474:Prosthesis Design; D019591:Pseudophakia / Q000209:etiology; D014019:Tissue Donors; D014463:Ultrasonography
chemical_list: D000180:Acrylic Resins