title: Morphologic differences observed by scanning electron microscopy according to the reason for pseudophakic IOL explantation.
abstract: OBJECTIVE
  To compare variations in surface morphology, as studied by scanning electron microscopy (SEM), of explanted intraocular lenses (IOLs) concerning the cause leading to the explantation surgery.
  
  
  METHODS
  In this prospective multicenter study, explanted IOLs were analyzed by SEM and energy-dispersive X-ray spectroscopy. The IOLs were explanted in the centers of the research group from 2006 to 2012. The primary procedure was phacoemulsification in all cases.
  
  
  RESULTS
  The study evaluated 40 IOLs. The main causes for explantation were IOL dislocation, refractive error, and IOL opacification. Those explanted due to dislocation demonstrated calcifications in 8 lenses (50%), salt precipitates in 6 cases (37.5%), and erythrocytes and fibrosis/fibroblasts in 2 cases (12.5%). In the refractive error cases, the SEM showed proteins in 5 cases (45.5%) and salt precipitates in 4 lenses (36.4%). In IOL opacification, the findings were calcifications in 2 of the 3 lenses (66.6%) and proteins in 2 lenses (66.6%).
  
  
  CONCLUSIONS
  A marked variation in surface changes was observed by SEM. Findings did not correlate with cause for explantation. Scanning electron microscopy is a useful tool that provides exclusive information regarding the IOL biotolerance and its interactions with surrounding tissues.
authors.affiliation: Vissum Corporation, Alicante - Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fernández-Buenaga
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alio
authors.forename: José M
authors.initials: JM
authors.lastname: Ramírez
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Salazar
authors.forename: Jan Ulrik
authors.initials: JU
authors.lastname: Prause
authors.forename: Ana I
authors.initials: AI
authors.lastname: Ramírez
authors.forename: Rosa
authors.initials: R
authors.lastname: De Hoz
authors.forename: Blanca
authors.initials: B
authors.lastname: Rojas
authors.forename: Alberto
authors.initials: A
authors.lastname: Triviño
mesh_terms: D002114:Calcinosis / Q000209:etiology / Q000473:pathology; D011232:Chemical Precipitation; D020878:Device Removal; D005109:Extracellular Matrix / Q000648:ultrastructure; D005347:Fibroblasts / Q000648:ultrastructure; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008855:Microscopy, Electron, Scanning; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000473:pathology*; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000009:adverse effects*; D019591:Pseudophakia / Q000209:etiology*; D013052:Spectrometry, X-Ray Emission