Intraocular lens opacification during pars-plana vitrectomy: A case report

Yan Jiang; Shasha Wang; Feiping Xu; Rui Liu; Tingyi Cao; Wen Yuan; Jili Chen

doi:10.4103/ijo.IJO_2115_22

CASE REPORT

Year : 2023 | Volume : 3 | Issue : 2 | Page : 330-332

Intraocular lens opacification during pars-plana vitrectomy: A case report

Yan Jiang, Shasha Wang, Feiping Xu, Rui Liu, Tingyi Cao, Wen Yuan, Jili Chen
Department of Ophthalmology, Shanghai Jing'an District Shibei Hospital, China

Date of Submission	24-Aug-2022
Date of Acceptance	08-Feb-2023
Date of Web Publication	28-Apr-2023

Correspondence Address:
Jili Chen
4500# Gonghexin Road, Jing'an District, Shanghai - 200443
China

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2115_22

Abstract

Intraocular lens (IOL) opacification after cataract surgery has been widely reported, but opacification during pars-plana vitrectomy (PPV) has not been reported. In our case, a 59-year-old male patient underwent PPV. During the surgery, IOL was found to be cloudy, and the area accounted for half of IOL. The surgical field was not affected. At the end of surgery, the degree of opacification decreased significantly. On the first day after surgery, IOL was completely transparent. IOL opacification may be caused by condensation and does not affect retina observation during PPV. It is not necessary to remove and replace the IOL immediately.

Keywords: Intraocular lens, opacification, pars-plana vitrectomy

How to cite this article:
Jiang Y, Wang S, Xu F, Liu R, Cao T, Yuan W, Chen J. Intraocular lens opacification during pars-plana vitrectomy: A case report. Indian J Ophthalmol Case Rep 2023;3:330-2

How to cite this URL:
Jiang Y, Wang S, Xu F, Liu R, Cao T, Yuan W, Chen J. Intraocular lens opacification during pars-plana vitrectomy: A case report. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 2];3:330-2. Available from: https://www.ijoreports.in/text.asp?2023/3/2/330/374936

Long-term intraocular opacity of intraocular lens (IOL) after cataract surgery has been widely reported at home and abroad, but IOL opacification during pars-plana vitrectomy (PPV) has not been reported. In clinical work, we found one case of IOL opacification during PPV. The case is reported as follows.

Case Report

A 59-year-old male patient underwent PPV, phacoemulsification extraction of cataract, and IOL implantation of the left eye in our hospital on January 20, 2022 due to diabetic retinopathy, vitreous hemorrhage, and complicated cataract of the left eye. Local anesthesia was performed in the intraoperative eye, transparent corneal incision was made, routine circular capsulorhexis was performed, phacoemulsification of the lens nucleus was performed in the capsular bag, and the lens cortex was cleared. At the 10^th minute of the surgery, 52501TY single-chip fold-back chamber IOL made by Mede Company of Holland was implanted into the capsular bag, and the optical part of the IOL was found to be white and cloudy. The area accounted for about half of the optical part of IOL [Figure 1]a. After adjusting the position of IOL and removing viscoelastic agent, IOL opacification did not change significantly at the 15^th minute of the surgery [Figure 1]b. At the 20^th minute, total retinoscopy was used to observe the retina under optical fibers, and the surgical field was not affected by IOL opacification, so PPV was continued [Figure 2]a. PPV was completed at the 50^th minute, and the retina can be seen clearly before pan-retinal photocoagulation [Figure 2]b. At the 65^th minute, the surgery finished. The degree of opacification in the optical part of IOL decreased significantly, and the range narrowed from the periphery to the center. The opacification area accounted for about one-third of the optical part of IOL [Figure 3]a. On the first day after surgery, the patient's naked eye visual acuity was 0.12, and the IOL was completely transparent without opacification residue under a slit lamp [Figure 3]b. Supplementary Video materials[Additional file 1] are available for brief surgical procedures.

Figure 1: (a) The implantation of IOL (at the 10^th minute). (b) The accomplishment of cataract surgery (at the 15^th minute)

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Figure 2: (a) The beginning of PPV (at the 20^th minute). (b) In the process of PPV (at the 50^th minute)

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Figure 3: (a) The accomplishment of PPV (at the 65^th minute). (b) Postoperative day 1

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Discussion

The IOL used in this case was confirmed to have been stored in an outdoor cold environment (below 4°C) for more than 12 h, and implanted in the eye within 1 h after admission to the operating room, without rewarming at room temperature. We speculate that this opacification is related to the condensation of water caused by a sudden change in temperature. In the relevant report,^[1] in vitro experiments have proved that when IOL is cooled below 4°C for 24 h and then placed in a balanced salt solution at 37°C, uniform and complete opacification appears on the surface of IOL quickly.

Hydrophilic IOLs are made from a combination of polyhydroxyethylmethacrylate and hydrophilic acrylic monomers, which are soft lenses with good biocompatibility for easy entry and exit of the eye. In this kind of IOLs, hydrophilicity is conducive to cell migration on the surface and proliferation of epithelial cells.^[2] In recent years, there have been many reports of postoperative complications related to hydrophilic IOL implantation, with most opacification occurring in the second year after surgery. Lens surface calcification has been found in various types of hydrophilic IOLs, and factors associated with this include silicone contamination in lens packaging, chemical buffers used in manufacturing, and patient metabolic factors.^[3],[4],[5] A large amount of coral-like particulate precipitates are observed on the surface of cloudy IOLs under confocal microscopy. Scanning electron microscopy showed that the precipitation crystals of particulate matter gathered in multiple forms, interlaced up and down, with a sense of hierarchy. Energy spectrum analysis confirmed that the sediments attached to IOL contained calcium and phosphorus.^[6] In this case, IOL replacement can safely and effectively improve patients' prognostic visual acuity.

Condensation is the physical change of a substance from a gas to a liquid state. Condensation usually occurs when the steam is cooled, but it may also occur when the steam is compressed (pressure increases) or when both are cooled and compressed. Water vapor in the air condenses on the surface only at lower temperatures or beyond its saturation limit.

It is important to understand this reversible IOL opacification. Before implantation, preventive measures should be taken to avoid cold storage of IOL. The IOL sent to the operating room in a cold environment needs to be rewarmed at room temperature. If intraoperative IOL opacification is found after implantation, it is not necessary to remove and replace it immediately. Such opacification is likely to be caused by condensation and can disappear spontaneously without affecting intraoperative retina observation during PPV.

Conclusion

IOL opacification caused by condensation doesn't affect the surgical field during PPV and it can resolve spontaneously after operation. It is not necessary to remove and replace the IOL immediately.

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 initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Advanced and Appropriate Technology Promotion Project of Shanghai Health Commission (2019SY012), Shanghai Medical Key Special Construction Project (ZK2019B27), Project of Shanghai Municipal Commission of Health and Family Planning (202140224,20204Y0037), Project of Shanghai Jing'an District Municipal Commission of Health and Family Planning (2020QN05), Shanghai Jing'an District Shibei Hospital Research Project Grant (2020SBYMZB01), Project of Shanghai Jing'an District Shibei Hospital New Technology, and New Project Incubation (2022XJSC10).

Conflicts of interest

There are no conflicts of interest.

References

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