title: Intraocular Lens Opacification After Endothelial Keratoplasty as Analyzed by Environmental Scanning Electron Microscopy.
abstract: OBJECTIVE
  To describe a case of hydrophilic intraocular lens (IOL) opacification based on IOL analysis after Descemet stripping automated endothelial keratoplasty.
  
  
  METHODS
  A 60-year-old woman had uneventful phacoemulsification after the implantation of a hydrophilic IOL (Akreos-Adapt; Bausch & Lomb) into both eyes. Because of postoperative corneal decompensation in the right eye, 2 Descemet stripping automated endothelial keratoplasty operations were performed within 1 year. After the second procedure, the graft was not well attached, requiring an intracameral injection of air on day 3. After 1 year, opacification was observed on the superior 2/3 of the anterior surface of the IOL, along with a significant decrease in visual acuity. The IOL was explanted 6 months after the opacification.
  
  
  RESULTS
  Environmental scanning electron microscopy followed by x-ray microanalysis revealed an organic biofilm on the surface of the IOL.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case in which the material deposited on the lens is organic rather than calcific.
authors.affiliation: *Department of Cornea and Refractive Surgery, Instituto de Microcirugía Ocular (IMO), Barcelona, Spain; †Universitat Autònoma de Barcelona, Barcelona, Spain; and ‡Department of Surgery, School of Medicine & Hospital Clínic de Barcelona (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Verdaguer
authors.forename: Oscar
authors.initials: O
authors.lastname: Gris
authors.forename: Ricardo P
authors.initials: RP
authors.lastname: Casaroli-Marano
authors.forename: Daniel
authors.initials: D
authors.lastname: Elies
authors.forename: Gerardo
authors.initials: G
authors.lastname: Muñoz-Gutierrez
authors.forename: Jose L
authors.initials: JL
authors.lastname: Güell
mesh_terms: D018441:Biofilms; D015715:Corneal Edema / Q000601:surgery; 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; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D018918:Phacoemulsification; D011475:Prosthesis Failure / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology*; D012086:Reoperation; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology