A new study entitled “Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas” describes seven cases of patients with hydrophilic acrylic intraocular lens undergoing calcification after procedures of endothelial keratoplasty. The study was published in the Journal of Cataract and Refractive Surgery.
Cataracts are characterized by a clouding of the lens inside the eye that affects vision and arise usually due to aging. Its symptoms include cloudy or blurry vision, impaired night vision, faded colors and the appearance of a halo surrounding lights. One of the treatments possible is surgery, wherein the surgeon removes the natural lens and then replaces it with an artificial lens, called an intraocular lens (IOL) — a plastic lens that becomes a permanent part of the eye. Recently, however, there has been increasing reports of calcification in the hydrophilic acrylic IOLs.
Here, the authors review seven cases of hydrophilic acrylic IOLs that were removed after an endothelial keratoplasty, i.e., a surgical procedure to treat corneal endothelial dysfunction (the cornea is the transparent front part of the eye) due to pattern of calcification localized in the central area of the IOL that led to decreased visual acuity and the resurgence of foggy vision.
The explanted IOLs were submitted to a series of rigorous tests in the research team’s laboratory to understand the reason of the diminished vision acuity of these patients. The analysis identified that indeed all the hydrophilic acrylic IOLs, which were designed and manufactured by five different suppliers, presented the accumulation of granular deposits, later identified as being mostly composed of calcium and phosphate precipitation within the IOLs (either on the surface or subsurface). This deposition led to a high light scattering profile, contributing to a poorer vision. The authors identified that the distinctive pattern of IOL calcification was associated with procedures that involve the use of intracameral air or gas, such as those with the endothelial keratoplasty, particularly the Descemet’s stripping endothelial keratoplasty (DSEK) or Descemet’s stripping automated endothelial keratoplasty (DSAEK).
Therefore, the authors highlight that their findings suggest surgeons should be particularly aware of these complications when dealing with patients who were submitted to hydrophilic acrylic IOLs surgery.
Liliana Werner, MD, PhD, the study’s lead author, commented, “If the eye is already implanted with a hydrophilic acrylic IOL, surgeons should be aware of the possibility of this form of postoperative localized calcification, which generally requires explantation of the lens.”