|Year : 2023 | Volume
| 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|
4500# Gonghexin Road, Jing'an District, Shanghai - 200443
Source of Support: None, Conflict of Interest: None
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 10th 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 15th minute of the surgery [Figure 1]b. At the 20th 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 50th minute, and the retina can be seen clearly before pan-retinal photocoagulation [Figure 2]b. At the 65th 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 10th minute). (b) The accomplishment of cataract surgery (at the 15th minute)|
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|Figure 2: (a) The beginning of PPV (at the 20th minute). (b) In the process of PPV (at the 50th minute)|
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|Figure 3: (a) The accomplishment of PPV (at the 65th 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, 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. 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.,, 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. 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|| |
Gutierrez L, Rodriguez P, Garcia DA. Intraoperative opacification of a hydrophilic acrylic with hydrophobic surface IOL with spontaneous resolution in 24 hours. J Refract Surg 2013;29:360-2.
Alió JL, Rodríguez-Prats JL. Buscando La Excelencia En La Cirugía De La Catarata. Barcelona: Glosa; 2006.
Trivedi RH, Werner L, Apple DJ, Pandey SK, AM. I. Post cataract-intraocular lens (IOL) surgery opacification. Eye 2002;16:217-41.
Mackert M, Muth DR, Vounotrypidis E, Deger C, Goldblum D, Shajari M, et al
. Analysis of opacification patterns in intraocular lenses (IOL). BMJ Open Ophthalmol 2021;6:e000589.
Neuhann IM, Werner L, Izak AM, Pandey SK, Kleinmann G, Mamalis N, et al
. Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: A clinicopathological analysis of 106 explants. Ophthalmology 2004;111:2094-101.
Xie J, Liu T, Huang YS, Wu XM, Dai YH. Clinical and experimental study of late postoperative opacification of hydrophilic acrylic intraocular lenses. Zhonghua Yan Ke Za Zhi 2021;57:512-8.
[Figure 1], [Figure 2], [Figure 3]