|Year : 2021 | Volume
| Issue : 2 | Page : 196-197
Appraisal of two fuzzy intraocular lens
Prateek Jain, Anshuman Pattnaik, Nimeshbhai Bhalaji Purohit
Department of community Ophthalmology, Global Hospital Institute of Ophthalmology, Abu Road, Sirohi, Rajasthan, India
|Date of Submission||11-Aug-2020|
|Date of Acceptance||31-Oct-2020|
|Date of Web Publication||01-Apr-2021|
Dr. Prateek Jain
Consultant, Global Hospital Institute of Ophthalmology, Abu Road, Sirohi - 307 510, Rajasthan
Source of Support: None, Conflict of Interest: None
Keywords: IOL calcification, IOL opacification, snowflake opacification
|How to cite this article:|
Jain P, Pattnaik A, Purohit NB. Appraisal of two fuzzy intraocular lens. Indian J Ophthalmol Case Rep 2021;1:196-7
| Case Report|| |
We present two patients of intraocular lens (IOL) opacification having varied presentation.
The first patient [Figure 1] presented with complain of progressive diminution of vision (BCVA: 6/60) in Right eye (RE) with history of cataract surgery ten years back. On examination, both eyes were pseudophakic with milky white opalescence of IOL in RE which was hindering fundus examination. RE Bscan findings were unremarkable. Patient had no systemic illness.
|Figure 1: Above: Milky white opalescence of entire (optic+haptic) single piece hydrophilic acrylic foldable IOL. Below: Image after explantation of opacified IOL and implantation of Scleral fixated IOL (post-operative 4 weeks)|
Click here to view
The second patient [Figure 2] presented with complain of watering in right eye (BCVA: 6/6) with history of cataract surgery twenty years back. Patient was diabetic since 10 years. On examination, both eyes were pseudophakic with scattered white deposits in IOL in RE. Dilated fundoscopy was unremarkable. He had no complains of decreased vision or glare (dysphotopsia). His contrast sensitivity was reduced to 1.80 log units on Pelli-Robson chart and colour vision assessment on Ishihara plates was normal.
|Figure 2: Above: undilated slit lamp examination image of powdery deposits in pupillary area. Below: dilated image revealed central discrete white opacities in single piece PMMA IOL leaving periphery uninvolved- snowflake opacification|
Click here to view
Diagnosis of opacification of IOL was made in both the cases. It is vital to differentiate IOL opacification from posterior capsular opacification. Different patterns of opacification are observed in different IOLs such as Snowflake opacification in Polymethylmethacrylate (PMMA) IOLs, Discoloration in Silicone IOLs, Calcification in Hydrophilic acrylic IOLs and Microvacuoles (glistenings) in Hydrophobic acrylic IOLs.,
| Discussion|| |
Onset of IOL opacification varies from 10 minutes after the surgery to 7 years or longer., It is usually unilateral but rarely can be bilateral. Local causative factors include pseudoexfoliation, dystrophic calcification (local increase in calcium concentration in aqueous humor or residual lens matter after cataract surgery), intra-operative breakdown of blood aqueous barrier, severe post-operative inflammation, chronic uveitis, glaucoma (daily use of topical glaucoma medications may lead to the rupture of blood aqueous barrier), intracameral use of rtPA, dye (direct discoloration), air/gas injection (after PPV/Endothelial keratoplasty), direct contact between lens and vitreous following Nd:YAG capsulotomy, presence of asteroid hyalosis.,,,,, Systemic associations include Hypertension, Diabetes Mellitus, Renal insufficiency and Ischemic heart disease., Other factors include type of IOL biomaterial and structure, errors in IOL manufacturing and silicone sleeves which are used to hold IOL in the vial impart negative charge to IOL resulating in its opacification.
Surgical record of the first patient revealed single piece Hydrophilic acrylic foldable IOL implant. Literature shows that immunologic response (antigen-antibody complexes) of the eye as well as increased calcium, phosphate and albumin levels in the aqueous humor resulting in formation of protein-calcium-phosphate complexes which adsorb on microdefects present on the hydrophilic IOL surface and appear as milky white opalescence.,,
Second patient, a farmer by occupation had a single piece PMMA IOL implant. It is documented that prolonged exposure to ultraviolet radiation may initiate slow destruction of the PMMA material affecting the central region of IOL and leaving the periphery relatively free of the deposits due to its protection by the iris, as in this patient. The reduction of contrast sensitivity is associated with IOL opacification, thus hindering the visual quality.
Management in visually significant opacification involves extraction of opacified IOL and implantation of new IOL. Explantation of opacified IOL and trans scleral haptic fixation of 3 piece PMMA IOL was performed in first case [Figure 1] and patient gained satisfactory vision (BCVA: 6/18). Second patient was kept under observation owing to visually insignificant opacification.
The authors acknowledge the guidance of Dr. V C Bhatnagar, Head of Department and Medical Superintendent, Global Hospital Institute of Ophthalmology.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Werner L. Glistenings and surface light scattering in intraocular lenses. J Cataract Refract Surg 2010;36:1398-420.
Apple DJ, Peng Q, Arthur SN, Werner L, Merritt JH, Vargas LG, et al
. Snowflake degeneration of polymethyl methacrylate posterior chamber intraocular lens optic material: A newly described clinical condition caused by unexpected late opacification of polymethyl methacrylate. Ophthalmology 2002;109:1666-75.
Kubaloglu A, Sari ES, Koytak A, Cinar Y, Erol K, Ozerturk Y. Intraocular lens exchange through a 3.2-mm corneal incision for opacified intraocular lenses. Indian J Ophthalmol 2011;59:17-21.
] [Full text]
Rahimi M, Azimi A, Hosseinzadeh M. Intraocular lens calcification: Clinico-pathological report of two cases and literature review. J Ophthalmic Vis Res 2018;13:195-9.
] [Full text]
Grzybowski A, Markeviciute A, Zemaitiene R. A narrative review of intraocular lens opacifications: update 2020. Ann Transl Med 2020;8:1547.
Walker NJ, Saldanha MJ, Sharp JA, Porooshani H, McDonald BM, Ferguson DJ, et al
. Calcification of hydrophilic acrylic intraocular lenses in combined phacovitrectomy surgery. J Cataract Refract Surg 2010;36:1427-31.
Ma ST, Yang CM, Hou YC. Postoperative intraocular lens opacification. Taiwan J Ophthalmol 2018;8:49-51.
] [Full text]
Dhital A, Spalton DJ, Goyal S, Werner L. Calcification in hydrophilic intraocular lenses associated with injection of intraocular gas. Am J Ophthalmol 2012;153:1154-60.
Gurabardhi M, Haaberle H, Aurich H, Werner L, Pham DT. Serial intraocular lens opacifications of different designs from the same manufacturer: Clinical and light microscopic results of 71 explant cases. J Cataract Refract Surg 2018;44:1326-32.
Goodall KL, Ghosh YK. Total opacification of intraocular lens implant after uncomplicated cataract surgery: A case series. Arch Ophthalmol 2004;122:782-4.
Apple DJ, Werner L. Complications of cataract and refractive surgery: A clinicopathological documentation. Trans Am Ophthalmol Soc 2001;99:95-107.
[Figure 1], [Figure 2]