title: Intraocular lens opacification after corneal endothelial keratoplasty: electron microscopy and x-ray element spectroscopy analysis.
abstract: OBJECTIVE
  To assess a newly recognized long-term complication of Descemet-stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  Plymouth Royal Eye Infirmary and Plymouth Electron Microscope Centre, Plymouth, United Kingdom.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  This study evaluated cases of intraocular lens (IOL) opacification that developed after uneventful DSAEK. None of the IOLs was previously known to opacify. In 1 case, the opacified IOL was explanted and analyzed using detailed light microscopy, scanning electron microscopic (SEM) analysis, and element x-ray spectroscopy.
  
  
  RESULTS
  In all 5 cases, the IOL was hydrophilic acrylic and the eye developed IOL anterior surface opacification 4 to 12 months after DSAEK. In 1 eye, the opacification was symptomatic; thus, an IOL exchange was performed. Light microscopy and SEM analysis of the explanted IOL confirmed opacification on the anterior surface and subsurface areas. X-ray element spectroscopy showed the granules were composed of calcium and phosphorous.
  
  
  CONCLUSIONS
  These cases indicate that IOL opacification after DSAEK is a late, although newly recognized, complication of endothelial keratoplasty.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Royal Eye Infirmary (Park, Habib), the Peninsula Medical School (Habib), and Plymouth Electron Microscope Centre (Moate), University of Plymouth, Plymouth, United Kingdom. Electronic address: jonpark777@gmail.com.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Park
authors.affiliation: From the Royal Eye Infirmary (Park, Habib), the Peninsula Medical School (Habib), and Plymouth Electron Microscope Centre (Moate), University of Plymouth, Plymouth, United Kingdom.
authors.forename: Nabil E
authors.initials: NE
authors.lastname: Habib
authors.affiliation: From the Royal Eye Infirmary (Park, Habib), the Peninsula Medical School (Habib), and Plymouth Electron Microscope Centre (Moate), University of Plymouth, Plymouth, United Kingdom.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Moate
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000032:analysis*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; 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; D010758:Phosphorus / Q000032:analysis*; D011475:Prosthesis Failure; D012189:Retrospective Studies
chemical_list: D010758:Phosphorus; D002118:Calcium