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Synergistic regenerative effects of functionalized endometrial stromal cells with hyaluronic acid hydrogel in a murine model of uterine damage. Acta Biomater 2019; 89:139-151. [PMID: 30898731 DOI: 10.1016/j.actbio.2019.03.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 12/13/2022]
Abstract
Clinically intractable infertility and recurrent miscarriage due to irreversible endometrial damage need to be treated with biomaterial- and cell-based therapies. Some previous studies have reported on the efficacy of a collagen scaffold and/or bone marrow-derived mesenchymal stem cells. However, the functional differentiation of grafted cells was uncertain, and the time required for regeneration was long in these studies. Here, we show the synergistic regenerative effects of hyaluronic acid (HA) hydrogel with in vitro decidualized endometrial stromal cells (EMSCs) in a murine uterine infertility (synechiae) model. Decidualized EMSCs (dEMSCs) were encapsulated with HA hydrogel, combined with three different doses of fibrinogen/thrombin (5, 50, and 500 mIU/mL). The HA/fibrin gel showed biocompatibility when mixed with dEMSCs. The addition of thrombin enhanced gel formation (5 and 50 mIU/mL) and engraftment and enabled the effective release of adhesion molecules. Within two weeks, which is a short duration, treatment with hydrogel decreased the fibrous tissue and increased the thickness of the endometrium. The regenerated endometrium demonstrated functional recovery, as evidenced by the expression and secretion of molecules essential for embryonic implantation, such as Desmin, CD44, PECAM, and IGF-1. Transferred embryos successfully implanted and the normal development of implanted embryos (n = 37) were evaluated by co-localization of distinct markers of the three germ layers (Sox2, Nestin, Brachyury, AFP, and HNF4α). Live birth of offspring was achieved in the regenerated endometrium by HA hydrogel. Therefore, HA hydrogel-mixed dEMSCs can be an innovative treatment strategy with rapid recovery of endometrial damage and may also have therapeutic potential in intractable infertility or recurrent miscarriage. STATEMENT OF SIGNIFICANCE: Decidualized EMSCs (dEMSCs) encapsulated with HA hydrogel combined with fibrinogen/thrombin (50 mIU/mL) showed injectability and biocompatibility when mixed with dEMSCs. Hydrogel-encapsulated dEMSCs can be a useful treatment for damaged endometrium in short duration, with successful implantation and normal development in a murine model.
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Scanning Electron Microscopy and Energy Dispersive Spectroscopy Findings in Explanted Pmma and Hydrophilic Acrylic Intraocular Lenses. Eur J Ophthalmol 2018; 19:28-36. [DOI: 10.1177/112067210901900105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To investigate the presence of calcium (Ca) aggregates influencing biocompatibility and the factors that affect calcium accumulation in explanted intraocular lenses (IOL) and to analyze the Ca distribution in an opacified hydrophilic acrylic lens. Methods Surface irregularities and aggregates of 13 IOLs were studied with scanning electron microscopy, and their relative concentrations with energy dispersive spectroscopy (EDS). Relationships of distribution between Ca and silicone (Si) and nitrogen (N) and between N and Si and Na, and the influence of Si on Ca accumulation and the effect of differences in lens material on the distribution of N, and the effect of endophthalmitis on the distribution of Ca were evaluated statistically. EDS analyses were performed on the surface and cross-section of the opacified lens. Results The statistically significant relationships between the distribution of Ca and N, and between the distribution of N and Na, the significant effect of Si on the Ca accumulation, significant relationship between endophthalmitis and the Ca accumulation in the aggregates were shown. The EDS analysis of the opacified IOL, Ca and P peaks were shown from the whole surface, Ca, O peaks were determined from cross-sections over a 70–80 μm distance. Conclusions In the aggregates influencing IOL biocompatibility, presence of proteins was determined to be more important than the presence of Si regarding the distribution of Ca, while the presence of Si affected the accumulation of Ca. Opacification, caused by the Ca accumulation within the lens, was found to result from Ca penetrating from lens pores.
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Liu Q, Zhang S, Wang X, Cao W, Jia Y. Acute clouding of trifocal lens during implantation: a case report. BMC Ophthalmol 2017; 17:242. [PMID: 29216854 PMCID: PMC5721382 DOI: 10.1186/s12886-017-0636-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoperative IOLs clouding of several kinds of hydrophilic acrylic intraocular lenses (IOLs) have been reported due to temperature changes. This phenomenon reported previously occurred in cold countries and during the winter months. However, no clinical case was reported about trifocal IOL opacification during operation. We report a case in which acute opacification of the optical region occurred simultaneously when AT LISA tri 839mp(Carl Zeiss) was implanted into the eye. CASE PRESENTATION A 79-year-old woman with a cortex and nucleus cataract was scheduled to undergo right eye phacoemulsification assisted by femtosecond technique. The trifocal lens (AT LISA tri 839mp), which is made of hydrophilic acrylic (25%) with hydrophobic surface properties, was chosen for implantation. As the IOL was implanted into the eye, it became cloudy immediately. Then it was replaced by another AT LISA tri 839mp, which was transferred from lens company outside, the same phenomenon was observed. These two lenses underwent the same temperature fluctuation from cold outside to operating room. Finally, a ZCB00 (Allergan) was implanted. CONCLUSIONS The acute intraoperative clouding of trifocal lens(AT LISA tri 839mp) results from fluctuation of temperature should be noticed.
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Affiliation(s)
- Qian Liu
- Shanxi Eye Hospital, No. 100 Fudong Street, Taiyuan, Shanxi, 030002, People's Republic of China
| | - Suhua Zhang
- Shanxi Eye Hospital, No. 100 Fudong Street, Taiyuan, Shanxi, 030002, People's Republic of China.
| | - Xiaogang Wang
- Shanxi Eye Hospital, No. 100 Fudong Street, Taiyuan, Shanxi, 030002, People's Republic of China
| | - Weifang Cao
- Shanxi Eye Hospital, No. 100 Fudong Street, Taiyuan, Shanxi, 030002, People's Republic of China
| | - Yading Jia
- Shanxi Eye Hospital, No. 100 Fudong Street, Taiyuan, Shanxi, 030002, People's Republic of China
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Phogat J, Rathi M, Verma R, Marwah N, Sachdeva S, Dhull CS. Calcification of hydrophilic intraocular lenses: Laboratory analysis and surgical technique for intraocular lens exchange. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jcro.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Song L, Hu W, Wang G, Zhang H, Niu G, Cao H, Yang H, Zhu S. Synthesis and Characterization of Shape Memory (Meth)Acrylate Co-Polymers and their Cytocompatibility In Vitro. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 22:1-17. [DOI: 10.1163/092050609x12567412849136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Li Song
- a School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P. R. China
| | - Wang Hu
- b School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P. R. China
| | - Guojie Wang
- c School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P. R. China
| | - Hongbin Zhang
- d School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P. R. China
| | - Guoguang Niu
- e School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P. R. China
| | - Hui Cao
- f School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P. R. China
| | - Huai Yang
- g School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P. R. China
| | - Siquan Zhu
- h Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P. R. China
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Fodor M, Petrovski G, Moe MC, Bíró Z, Németh G, Dinya Z, Tornai I, Ujvári T, Berta A, Facskó A. Spectroscopic study of explanted opacified hydrophilic acrylic intraocular lenses. Acta Ophthalmol 2011; 89:e161-6. [PMID: 20491688 DOI: 10.1111/j.1755-3768.2010.01925.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To report a detailed spectroscopic analysis of explanted hydrophilic acrylic intraocular lenses (IOLs) that were removed because of postoperative opacification of the lens optic. METHODS Thirteen Hydroview H60M (Bausch & Lomb Surgical) IOLs were explanted from 13 different patients on average 56 months after phacoemulsification and IOL implantation. All patients had decreased visual acuity because of a fine granularity of the optical surface of the IOLs. The surface was investigated by gross, microscopic, histochemical and scanning electron microscopic analysis, and the elemental composition of the opacified IOLs was determined by X-ray fluorescence spectroscopy (XRF). The spectrograms were compared to three different originally packed and never-implanted hydrophilic acrylic IOLs. RESULTS Light and scanning electron microscopy of the optical surface of explanted IOLs revealed multiple fine granular deposits varying in size and shape that were positive for alizarin red. XRF confirmed that the explanted IOLs contained not only the previously reported calcium and phosphorous (calcium apatite), chlorine, silicone, sodium, aluminum and magnesium but also iron, sulfur, potassium as well as lesser amounts of iodine, zinc, strontium and yttrium. CONCLUSION This is the first spectroscopic analysis determining the content of more than 10 elements of explanted and originally packed never-implanted hydrophilic acrylic IOLs. The possible origin of the different elements obtained from the spectrograms and their implications are discussed.
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Affiliation(s)
- Mariann Fodor
- Department of Ophthalmology, Medical and Health Science Center, Faculty of Medicine, University of Debrecen, Hungary.
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Espandar L, Sikder S, Moshirfar M. Softec HD hydrophilic acrylic intraocular lens: biocompatibility and precision. Clin Ophthalmol 2011; 5:65-70. [PMID: 21311658 PMCID: PMC3033005 DOI: 10.2147/opth.s12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intraocular lens development is driven by higher patient expectations for ideal visual outcomes. The recently US Food and Drug Administration-approved Softec HD™ lens is an aspheric, hydrophilic acrylic intraocular lens (IOL). The hydrophilic design of the lens is optimized to address dysphotopsia while maintaining biocompatibility, optical clarity, resistance to damage, and resistance to biocontamination. Aspheric lenses decrease postoperative spherical aberration. The addition of the Softec lens provides clinicians with another option for IOL placement; however, randomized comparative studies of this lens to others already on the market remain to be completed.
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Affiliation(s)
- Ladan Espandar
- Department of Ophthalmology, Tulane University, New Orleans, LA, USA
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Jirak P, Schönherr U. Hydroview® Intraokularlinsen – Follow up 3 Jahre postoperativ. SPEKTRUM DER AUGENHEILKUNDE 2009. [DOI: 10.1007/s00717-009-0308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim SM, Choi S. Clinical efficacy and complications of intraocular lens exchange for opacified intraocular lenses. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 22:228-35. [PMID: 19096239 PMCID: PMC2629912 DOI: 10.3341/kjo.2008.22.4.228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy and complications of intraocular lens (IOL) exchange. METHODS A review of medical records was performed for 52 eyes that had undergone an IOL exchange due to IOL opacification. Surgical complications and their incidences were analyzed. The mean best corrected visual acuity (BCVA) after the IOL exchange was compared with the mean pre-exchange BCVA and with the mean BCVA after the initial IOL implantation. Prediction error of refraction and biometric data obtained for the IOL exchange were, if available, compared with those obtained for the initial IOL implantation. The prediction error for the IOL exchange, calculated from the biometric data obtained before the IOL exchange, was compared with that calculated from the measurements obtained before the initial IOL implantation. RESULTS The overall complication rates were low and no serious complications were found. The mean BCVA improved significantly after the IOL exchange and was not significantly different from that obtained after the initial IOL implantation. However, the refractive prediction for the IOL exchange was not as good as it was for the initial IOL implantation, which was thought to be related with difficulties in axial length (AL) measurements. Biometric data taken before the initial IOL implantation was associated with a significantly better refractive prediction than those taken before the IOL exchange. CONCLUSIONS IOL exchange was both efficacious and safe for visual recovery. However, IOL exchange was related with increased difficulty of predicting postoperative refraction; difficulties in AL measurements are the suggested cause.
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Affiliation(s)
- Seung Mo Kim
- Department of Ophthalmology, Seoul Veterans Hospital, Seoul, Korea
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Mamalis N, Brubaker J, Davis D, Espandar L, Werner L. Complications of foldable intraocular lenses requiring explantation or secondary intervention--2007 survey update. J Cataract Refract Surg 2008; 34:1584-91. [PMID: 18721724 DOI: 10.1016/j.jcrs.2008.05.046] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 05/28/2008] [Indexed: 11/17/2022]
Abstract
The tenth annual survey of complications associated with foldable intraocular lenses (IOLs) requiring explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were evaluated. Complications were then tabulated for each of the following major foldable IOL groups: 1-piece (plate) silicone, 1-piece hydrophobic acrylic with haptics, 3-piece silicone, 3-piece hydrophobic acrylic, 3-piece hydrophilic acrylic (hydrogel), 3-piece unknown, multifocal acrylic, and multifocal silicone. One hundred forty-two surveys were returned for evaluation. Dislocation/decentration, incorrect IOL power, glare/optical aberrations, and IOL calcification were the most common reasons for removing foldable IOLs. Good surgical technique, accurate IOL power measurements, and high manufacturing standards for foldable IOL materials and designs are the most important factors in preventing complications.
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Affiliation(s)
- Nick Mamalis
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA.
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11
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Sher JH, Gooi P, Dubinski W, Brownstein S, El-Defrawy S, Nash WA. Comparison of the incidence of opacification of Hydroview hydrogel intraocular lenses with the ophthalmic viscosurgical device used during surgery. J Cataract Refract Surg 2008; 34:459-64. [DOI: 10.1016/j.jcrs.2007.10.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 09/28/2007] [Indexed: 10/22/2022]
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12
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Seo JH, Hyung S. The Clinical Outcomes of Lens Exchange in Patients with Opacified Posterior Chamber Lens. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.8.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong Hun Seo
- Department of Ophthalmology, School of Medicine Chungbuk National University, Chungbuk, Korea
| | - Sungmin Hyung
- Department of Ophthalmology, School of Medicine Chungbuk National University, Chungbuk, Korea
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13
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Haymore J, Zaidman G, Werner L, Mamalis N, Hamilton S, Cook J, Gillette T. Misdiagnosis of Hydrophilic Acrylic Intraocular Lens Optic Opacification. Ophthalmology 2007; 114:1689-95. [PMID: 17822975 DOI: 10.1016/j.ophtha.2006.12.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To report 8 patients with misdiagnosis of MemoryLens intraocular lens (IOL) late postoperative calcification and the resulting potentially avoidable procedures leading to secondary complications. DESIGN Retrospective interventional case series. PARTICIPANTS Eight patients with an opacified hydrophilic acrylic MemoryLens. METHODS Eight cases of MemoryLens IOL opacification that were originally misdiagnosed were reviewed. The following parameters were noted: baseline patient characteristics, time frame of IOL opacification, original misdiagnosis, subsequent surgical procedures, and postexplantation outcomes and complications. Two explanted lenses from this series were available for laboratory analyses. They underwent gross and light microscopic evaluation and scanning electron microscopy with energy-dispersive x-ray spectroscopy (EDS). MAIN OUTCOME MEASURES Patient parameters noted above. The IOLs were examined for distribution, structure, and composition of the deposits causing opacification of their optic components. RESULTS All 8 patients' IOLs were implanted between August 1999 and March 2000. Complaints of decreased visual function occurred 13 to 58 months after implantation. Half of the patients were initially diagnosed as having posterior capsular opacification and underwent neodymium:yttrium-aluminum-garnet laser capsulotomy. The other half were initially diagnosed with some form of vitreous involvement and underwent vitrectomies. Six of the 8 patients underwent subsequent lens exchanges, with 3 of them having postexchange complications including endophthalmitis, cystoid macular edema, and retinal detachment. Scanning electron microscopy with EDS confirmed the presence of calcified deposits on the surface of the 2 explants available for analysis. The deposits also stained positive for calcium. CONCLUSIONS Despite previous reports, misdiagnosis of MemoryLens IOL calcification leading to optic opacification still occurs. Not recognizing this process can lead to potentially avoidable surgical procedures and increased risk of complications after repeated interventions.
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Affiliation(s)
- Jonathan Haymore
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Hill DJT, Whittaker AK. Mineralization of radiation-crosslinked polyvinyl alcohol/polyvinyl pyrrolidone hydrogels. J Biomed Mater Res A 2007; 83:354-61. [PMID: 17450575 DOI: 10.1002/jbm.a.31236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A study of the calcification of the polyvinyl alcohol/polyvinyl pyrrolidone (PVA/PVP) hydrogels during their exposure to a calcium chloride solution or a simulated body fluid has been carried out. On the basis of the experiments, using a two-compartment permeation cell, the diffusion of calcium ions and their subsequent deposition in the hydrogels were elucidated. Steady-batch experiments were also performed to further elaborate the deposition pattern and the types of calcium deposits. It was demonstrated that Fick's second law of diffusion can describe the diffusion of calcium ions through PVA/PVP hydrogels at 310 K. The diffusion coefficient was determined to be (4.4+/-0.1)x10(-10) m2/s and the partition coefficient for the hydrogels was 0.06. Formation of calcium deposits was noticed taking place both on the surface and inside the hydrogels. The deposits formed on the surface have flake morphology, while the deposits inside the hydrogels are more like globular aggregates. Both types of deposits have been characterized as being comprised calcium and hydroxyl ion deficient apatites with chloride ions the most likely substituting species at the hydroxyl sites.
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Moreno-Montañés J, Palop JA, García-Gómez P, Heras H, Cristóbal JA. Intraocular lens opacification after nonpenetrating glaucoma surgery with mitomycin-C. J Cataract Refract Surg 2006; 33:139-41. [PMID: 17189810 DOI: 10.1016/j.jcrs.2006.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 07/05/2006] [Indexed: 10/23/2022]
Abstract
A 58-year-old woman had successful phacoemulsification with intraocular lens (IOL) implantation in January 2001. Two years later, nonpenetrating glaucoma surgery with mitomycin-C (MMC) 0.02% was performed for uncontrolled glaucoma. Two months later, opacification of the anterior IOL surface was observed. The IOL was removed and a hydrophobic acrylic AcrySof IOL (Alcon) implanted. The opacified IOL was studied by flame atomic absorption spectrometry, which showed the presence of calcium carbonate. A new IOL of the same model was placed in an aqueous solution with calcium carbonate and basic pH, and the same opacification developed. We hypothesize that the change in aqueous humor pH after glaucoma surgery and the characteristics of the IOL precipitated deposition of calcium.
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Affiliation(s)
- Javier Moreno-Montañés
- Department of Ophthalmology, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain.
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Altaie R, Loane E, O'Sullivan K, Beatty S. Surgical and visual outcomes following exchange of opacified Hydroview intraocular lenses. Br J Ophthalmol 2006; 91:299-302. [PMID: 17077119 PMCID: PMC1857646 DOI: 10.1136/bjo.2006.095414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To report the clinical and surgical outcomes following exchange of opacified Hydroview intraocular lenses (IOLs), and to relate the final visual and anatomic results to clinical and surgical variables. METHODS This is a prospective study of seventy-three eyes that underwent exchange of opacified Hydroview IOLs in Waterford Regional Hospital, Ireland. Preoperative, intraoperative and postoperative details were recorded. RESULTS This study comprised 73 eyes of 71 consecutive patients undergoing IOL exchange, performed at mean (+/-SD) intervals of 36.64 (+/-9.9) months following the primary cataract surgery. The mean (+/-SE) follow-up following the exchange procedure was 13 (+/-1) months (range: 1-45 months). The secondary IOL was placed in the capsular bag, in the sulcus, and in the anterior chamber in 22 (30.1%), 24 (32.9%) and 27 (37%) cases, respectively. The IOL exchange procedure was uneventful in 36 eyes (49.3%), whereas intraoperative events such as posterior capsule rupture, vitreous loss and zonular dehiscence were seen in the remainder (50.7%). Following the IOL exchange procedure, a significant improvement in best corrected visual acuity (BCVA) was noted at one and at three months, and at the final visit (Wilcoxon signed ranks test: p<0.001, p = 0.006, and p<0.001, respectively). Following exclusion of eyes with visually consequential ocular comorbidity, a better final BCVA was noted among those eyes where the secondary IOL was placed in the capsular bag or in the sulcus when compared with placement of the secondary IOL in the anterior chamber (IOL in the bag or sulcus: 26 eyes (35.6%), median (IQR) final BCVA: 0.2 (0.10-0.40); IOL in the anterior chamber: 19 eyes (26.02%), median (IQR) final BCVA: 0.5 (0.20-0.60); Mann Whitney U Test: p = 0.004). CONCLUSION IOL exchange is a technically challenging, but visually rewarding procedure. However, placement of the secondary IOL in the anterior chamber is associated with a poorer visual outcome when compared with placement of the secondary IOL in the sulcus or in the capsular bag.
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Affiliation(s)
- Rasha Altaie
- Department of Ophthalmology, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
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Syam P, Byrne P, Lewis G, Husain T, Kleinmann G, Mamalis N, Apple DJ, Rimmer T. Hydroview lens implant calcification: 186 exchanges at a district general hospital. Eye (Lond) 2006; 22:325-31. [PMID: 17057650 DOI: 10.1038/sj.eye.6702530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM This paper describes the experience at a district general hospital of coping with an abrupt onset of calcification of Hydroview intraocular lens (IOL) implants requiring exchange surgery mostly for symptoms of glare, even though the visual acuities were relatively good. METHODS In this retrospective study, the operative details of 174 consecutive lens exchanges by one surgeon were retrieved from the surgeon's notes. Of these, pre and post-operative details of 106 consecutive patients were obtained from the hospital notes. RESULTS Of the 174 lens exchanges, all were sutureless except one and 31 eyes (18%) had had previous capsulotomies. Of 143 eyes with intact posterior capsules, eight (5.6%) needed anterior vitrectomy. Lens replacements were in the bag in 136 (95%), in the sulcus in five (3.5%), and in the anterior chamber in two (1.5%). Of the 31 eyes with previous capsulotomies, 10 (32%) needed anterior vitrectomy. Lens replacements were in the bag in 22 (71%) and in the sulcus in the remaining nine cases (29%). Postoperatively the best-corrected visual acuity was improved in 53%, remained the same in 35%, and deteriorated in 12%. CONCLUSION The lens exchange procedure was mostly predictable with satisfactory visual results allowing preoperative counselling of risks to be similar to that for cataract surgery. The onset and resolution of the period of implantation of lenses requiring exchange has not been explained.
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Affiliation(s)
- P Syam
- Eye Department, Peterborough District Hospital, Peterborough, Cambs, UK
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Knox Cartwright NE, Mayer EJ, McDonald BM, Skinner A, Salter CJ, Tole DM, Sparrow JM, Dick AD, Ferguson DJP. Ultrastructural evaluation of explanted opacified Hydroview (H60M) intraocular lenses. Br J Ophthalmol 2006; 91:243-7. [PMID: 16987894 PMCID: PMC1857641 DOI: 10.1136/bjo.2006.106401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To describe the ultrastructural appearance of explanted opacified Hydroview H60M intraocular lenses. METHODS 14 explanted lenses were examined by scanning electron microscopy, and their appearance compared with a non-implanted H60M lens from the same time period. Wavelength-dispersive x ray spectroscopy (WDX) was performed on two opacified lenses. RESULTS Subsurface deposits were seen in all explanted opacified lenses. These deposits broke only onto the surface of more densely opacified lenses. WDX confirmed that the deposits contained both calcium and phosphorous, consistent with their being calcium apatite. CONCLUSION These findings challenge the widely accepted opinion that H60M intraocular lens opacification begins on the surface of the optic.
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Balasubramaniam C, Goodfellow J, Price N, Kirkpatrick N. Opacification of the Hydroview H60M intraocular lens: total patient recall. J Cataract Refract Surg 2006; 32:944-8. [PMID: 16814051 DOI: 10.1016/j.jcrs.2006.02.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 12/23/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE To report the prevalence of intraocular lens (IOL) opacification and related clinical features in patients implanted with Hydroview IOL. SETTING Gloucestershire Eye Unit, Gloucestershire, United Kingdom. METHODS A total of 1330 eyes of 1265 patients who had cataract surgery with Hydroview IOL implantation between September 2000 and April 2001 were reviewed between April and October 2004. The visual acuity, visual symptoms, IOL status, and associated ocular comorbidity were recorded. RESULTS One hundred ninety-three (14.5%) of 1330 eyes had evidence of IOL opacification. A total of 56 (4.2%) had visually significant opacification and had IOL exchange. The prevalence of IOL opacification ranged from 1.1% in patients who had surgery in September 2000 to 36.3% in the December 2000 group. In eyes with IOL opacification, the visual symptoms were decreased vision (57%), glare (32%), and mistiness of vision (27%). One hundred forty-four eyes (75%) with IOL opacification had visual acuity of 6/12 or better; 21.5% of diabetic eyes had IOL opacification compared with 14.3% of nondiabetic eyes (P =.06); 20.5% of glaucomatous eyes had IOL opacification compared with 14.0% of nonglaucomatous eyes (P = .033). CONCLUSIONS This is the first large sample recall of patients implanted with the Hydroview H60M IOL. The overall prevalence of IOL opacification was 14.5%, with peak prevalence in patients who had surgery in December 2000.
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Altaie RW, Costigan T, Donegan S, O'brien P, Mahmood U, Bogdan AJ, Beatty S. Investigation and management of an epidemic of Hydroview intraocular lens opacification. Graefes Arch Clin Exp Ophthalmol 2005; 243:1124-33. [PMID: 15952010 DOI: 10.1007/s00417-005-1179-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Revised: 03/06/2005] [Accepted: 03/21/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Opacification of Hydroview posterior chamber intraocular lenses had been prescribed, but many aspects of this complication remain unknown, including its aetiology, clinical features, pathogenesis, prognosis and treatment. This paper describes an epidemic of Hydroview intraocular lens (IOL) opacification. METHODS Subjects in whom the Hydroview IOL was implanted were recalled for evaluation of its transparency, assessment of contrast sensitivity (CS) [VCTS (Vistech CO, Dayton, Ohio, USA)] and visual acuity (LogMAR), and analysis of medical and surgical data. The results of IOL exchange in 69 eyes of 67 patients are also presented. RESULTS Of 103 patients recalled, 46 (44.6%) and 3 (2.9%) exhibited opacification of the implanted IOL in one and both eyes, respectively. CS was significantly worse in the presence of an opacified IOL (P<0.050), even when Snellen acuity was unaffected. Where the viscoelastic employed during the primary cataract surgery was reliably documented, VISCOAT was used in 100% of cases (43/43), whereas Healonid had not been used in any (0/57) (P<0.0001). Following IOL exchange, visual acuity improved from a mean (+/-SD) of 0.75 (0.41) to 0.4 (0.34) LogMAR. CONCLUSIONS The prevalence of Hydroview IOL opacification is associated with the use of VISCOAT in the primary cataract surgery, and there is a biochemically plausible rationale to account for this. Visual acuity and contrast sensitivity are adversely affected by opacification of the Hydroview IOL, but CS to a greater extent. Exchange of opaque IOLs is a visually rewarding procedure.
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Affiliation(s)
- R W Altaie
- Department of Ophthalmology, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
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21
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Lai JY, Chen KH, Hsu WM, Lee TH, Lin SY. Multiple elements in the deposits of opacified Hydroview intraocular lens. Am J Ophthalmol 2005; 139:1123-5. [PMID: 15953454 DOI: 10.1016/j.ajo.2004.11.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Accepted: 11/24/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the ultrastructural and elemental features of two opacified intraocular lenses (IOLs). DESIGN Histopathologic case series. METHODS Two opaque hydrophilic acrylic IOLs (Hydroview H60M, Bausch & Lomb Surgical Clearwater, Florida, USA) explanted from two Chinese patients in Taiwan. The explanted IOLs were evaluated by light microscopy, scanning electron microscopy, and energy-dispersive x-ray spectroscopy. RESULTS Brownish granular and scattered crystal-like deposits were found in case 2, whereas only fine white granular deposits were found in case 1. Using EDX spectroscopy, the elements of deposits on IOL optics were calcium and phosphorus in case 1, but in case 2, fluorine, magnesium, and sodium were demonstrated in addition to calcium and phosphorus. CONCLUSIONS Our study indicated a difference in morphology and elements of deposits on opaque IOL optics between these two cases. It was suggested that multiple elements may contribute to the formation of deposits.
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Affiliation(s)
- Jui-Yang Lai
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan, Republic of China
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22
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Zainuddin, Chirila T, Hill D, Whittaker A. Study of the calcification of PHEMA hydrogels using a two compartment permeation cell. J Mol Struct 2005. [DOI: 10.1016/j.molstruc.2004.06.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Dagres E, Khan MA, Kyle GM, Clark D. Perioperative complications of intraocular lens exchange in patients with opacified Aqua-Sense lenses. J Cataract Refract Surg 2005; 30:2569-73. [PMID: 15617926 DOI: 10.1016/j.jcrs.2004.04.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the perioperative complications of intraocular lens (IOL) exchange in 25 eyes of 22 patients with opacified Aqua-Sense IOLs (Ophthalmic Innovations International). SETTING Department of Ophthalmology, University Hospital Aintree, Liverpool, United Kingdom. METHODS The study comprised 22 patients (25 eyes) who had previous phacoemulsification and implantation of Aqua-Sense single-piece hydrophilic acrylic IOLs in the capsular bag and developed severe late opacification of the IOL. All patients reported glare and deterioration in vision. The IOLs were explanted and replaced with new lenses. The perioperative complications were evaluated. The best corrected visual acuity (BCVA) before and after surgery was compared. RESULTS In 24 eyes, the opacification was complete, involving the optic, haptics, and substance of the IOLs. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 13 eyes (52%). Complications occurred in the remaining 12 eyes (48%). Ten eyes (40%) developed zonular dehiscence, 4 (16%) of which were managed with anterior chamber IOL implantation. One eye (4%) developed posterior capsule rupture and 1 eye (4%), posterior capsule rupture and zonular dehiscence. The cornea decompensated in 2 eyes (8%). One eye (4%) developed Pseudomonas keratitis. The mean BCVA (decimal scale) before and after IOL exchange was 0.57 +/- 0.24 and 0.60 +/- 0.28, respectively. There was no significant difference in visual acuity between before and after IOL exchange (P=.782, paired t test). CONCLUSIONS Explantation of Aqua-Sense IOLs was challenging because of the tight adherence of the optic and haptics to the capsule. Long-term follow-up of patients with Aqua-Sense IOLs should be maintained.
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Affiliation(s)
- Evgenios Dagres
- Department of Ophthalmology, University Hospital Aintree, Liverpool, United Kingdom.
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24
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Chirila TV, Morrison DA, Gridneva Z, Meyrick D, Hicks CR, Webb JM. Effect of multipurpose solutions for contact lens care on the in vitro drug-induced spoliation of poly(2-hydroxyethyl methacrylate) in simulated aqueous humour. Cont Lens Anterior Eye 2005; 28:21-8. [PMID: 16318831 DOI: 10.1016/j.clae.2004.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Drug-induced spoliation of hydrogels as contact lenses or as implants in the anterior eye is a frequent occurrence in clinical practice. This study explores the capacity of three commercial multipurpose solutions for contact lens care to reduce the spoliation of poly(2-hydroxyethyl methacrylate) (PHEMA) specimens exposed to a simulated aqueous humour formulation and to three topical drugs commonly administered after insertion of artificial corneas (Predsol, Optimol and Depo-Ralovera). ReNu MultiPlus (Bausch & Lomb), Complete Blink-N-Cleantrade mark Lens Drops (Allergan) and Complete Protein Remover Tablets dissolved in Complete ComfortPLUS (both from Allergan) were evaluated. All multipurpose solutions were able to dislodge passively the deposits formed on hydrogels in the simulated aqueous and in the presence of Predsol and Optimol, but none were effective against the deposits induced by Depo-Ralovera. A reduction of the calcium content in deposits caused by Predsol and Optimol was confirmed after treatment with the protein remover preparation, while the other multipurpose solutions caused the complete removal of the deposits. In experiments designed to evaluate the preventive action of the multipurpose solutions, no such effects were observed regardless of the drug involved. The prospect of using multipurpose solutions as eye drops following implantation of a hydrogel artificial cornea is a valid alternative for reducing device spoliation, however it appears to depend on the nature of the postoperative medication.
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Affiliation(s)
- Traian V Chirila
- Department of Biomaterials and Polymer Research, Lions Eye Institute, and Centre for Ophthalmology and Visual Science, University of Western Australia, 2 Verdun Street, Nedlands 6009, WA, Australia.
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Ramani R, Parihar JKS, Ranganathaiah C, Awasthi P, Alam S, Mathur GN. Free volume study on calcification process in an intraocular lens after cataract surgery. J Biomed Mater Res B Appl Biomater 2005; 75:221-7. [PMID: 16025452 DOI: 10.1002/jbm.b.30303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An opacified intraocular lens explanted from a patient in the postoperative period after phacoemulsification was investigated to find the cause of opacification. From the UV-visible and energy dispersive X-ray spectroscopy (EDS) measurements, the opacification in the present case seems to be due to calcification of the intraocular lens and not due to modification in the UV absorber material of the lens. The average free volume size of the intraocular lens both in unimplanted and explanted state were obtained from positron lifetime spectroscopy (PLS). Further, the combined FTIR and PLS results indicate that calcium gets into the free volume cavities of the intraocular lens matrix as a cationic moiety, may be in the form of Ca(++). The small decrease in glass transition temperature of the calcified lens seems to indicate the plasticizing action of calcium ions. The present results could be of some use in the design of the intraocular lens material in which calcification would be minimum.
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Affiliation(s)
- R Ramani
- Polymer Science Division, DMSRDE, G.T. Road, Kanpur, 208 013, India.
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26
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Mamalis N, Davis B, Nilson CD, Hickman MS, Leboyer RM. Complications of foldable intraocular lenses requiring explantation or secondary intervention--2003 survey update. J Cataract Refract Surg 2004; 30:2209-18. [PMID: 15474838 DOI: 10.1016/j.jcrs.2004.06.051] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2004] [Indexed: 10/26/2022]
Abstract
The sixth annual survey of complications associated with foldable intraocular lenses (IOLs) requiring explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were evaluated. Complications were then tabulated for each of the following major foldable IOL groups: 3-piece monofocal silicone, 3-piece hydrophobic acrylic, 1-piece hydrophobic acrylic with haptics, 3-piece hydrophilic acrylic (hydrogel), 1-piece hydrophilic acrylic (hydrogel), 1-piece plate-type silicone, 3-piece multifocal silicone, and Collamer. Two hundred seventy-three surveys were returned for evaluation. Dislocation/decentration, incorrect lens power, IOL calcification, and glare/optical aberrations were the most common reasons for removing foldable IOLs. Good surgical technique, accurate IOL power measurements, and high manufacturing standards for foldable IOL materials and designs are the most important factors in avoiding complications with foldable IOLs.
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Affiliation(s)
- Nick Mamalis
- Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA.
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Abstract
Diabetes is a risk factor for the development of cataracts. Studies have shown an increased risk of ocular complications in diabetics after cataract surgery, but modern surgical techniques have minimized them, leading to an overall good visual outcome. Macular edema before surgery is the most common condition that limits post-operative visual recovery. Thus, pre-operative laser treatment is needed. Photocoagulation of preproliferative or early proliferative diabetic retinopathy is also advisable, due to the increased risk of iris neovascularization or retinopathy progression after surgery.
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Affiliation(s)
- Ugo Menchini
- Eye Clinic II, Department of Oto-Neuro-Ophthalmological Surgical Sciences, University of Florence, Italy.
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28
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Kocabora MS, Engin G, Kaya G, Yilmazli C, Taskapili M, Engin K. Calcification postopératoire des lentilles intraoculaires acryliques hydrophiles : aspects cliniques et pathologiques. J Fr Ophtalmol 2004; 27:871-6. [PMID: 15547466 DOI: 10.1016/s0181-5512(04)96229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical aspects of ten eyes with calcified hydrophilic acrylic intraocular lenses and pathological data obtained from seven explanted lenses. MATERIAL AND METHODS Forty-seven eyes of 40 patients received the same implant in the first 6-month period of 2001. Ten eyes showed intraocular lens opacification detected 6-18 months after the operation: seven lenses were explanted and three were left in place because they were not causing a decrease in visual acuity or glare at light. Five of ten eyes were diabetic. The explanted lenses were examined under the light microscope and the electron microscope. The elemental analysis of the lens surfaces was made by energy dispersive spectrometry. RESULTS The light microscopy showed an irregular surface covered by a gray-white opacity. The electron microscopy detected multiple granulations on the front and back surfaces of the lenses including some portions of the haptics. The size and density of these granulations were smaller on the back surface. The energy dispersive spectrometry showed the presence of calcium and phosphate on both surfaces. The spikes of calcium and phosphate were smaller for the back surface of the lenses. DISCUSSION Calcification was predominantly seen on the surfaces that were in contact with aqueous not covered with anterior capsule. Half (5/10) of the cases were diabetic even though 18% of all patients receiving this lens were diabetic. The presence of diabetes is very common in other series. These data suggest the role of a metabolic factor influencing the milieu of the lens in this calcification process. CONCLUSION Calcification of the hydrophilic acrylic lenses is a relatively serious complication, but the conditions leading to its appearance and the physiopathology have not yet been fully elucidated. The surgeon should be very careful in the choice of the intraocular lens to implant, and even more so if the patient is diabetic.
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Affiliation(s)
- M S Kocabora
- Service d'Ophtalmologie, SSK Hôpital Académique et de Recherche de Vakif Gureba, Istanbul, Turquie.
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29
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Chirila TV, Morrison DA, Hicks CR, Gridneva Z, Barry CJ, Vijayasekaran S. In vitro drug-induced spoliation of a keratoprosthetic hydrogel. Cornea 2004; 23:620-9. [PMID: 15257003 DOI: 10.1097/01.ico.0000121703.74077.ea] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate in vitro the effects of selected drugs on the spoliation of poly(2-hydroxyethyl methacrylate) (PHEMA), a synthetic acrylic hydrogel currently used for the manufacture of a keratoprosthesis, AlphaCor. The experiments were carried out both in the presence of simulated aqueous humor (SAH) and in its absence. METHODS Disks of PHEMA were incubated and shaken with 9 commonly prescribed drugs at 37 degrees C in sterile conditions for 1 week. Samples were incubated either in SAH only (controls), in each drug preparation, or in each drug for 1 week followed by 1 week in SAH. The drugs selected for this study were steroids (prednisolone, dexamethasone, fluorometholone, medroxyprogesterone), antiglaucoma drugs (timolol maleate and pilocarpine), and antibiotics (chloramphenicol, cephazolin, and ciprofloxacin), as commercially available formulations. Following incubation, the PHEMA specimens were examined visually and then histologically, after staining with alizarin red for the presence of calcium in the spoliating sediments/deposits. RESULTS Although only 5 of the drug formulations (dexamethasone as Maxidex, fluorometholone as FML, pilocarpine as Isopto Carpine, chloramphenicol as Chlorsig, and medroxyprogesterone as Depo-Ralovera) induced spoliation of the hydrogel in the absence of SAH, all drugs induced spoliation after postincubation in SAH, and calcium was detected in the majority of samples. The deposits on the hydrogel specimens incubated first in cephazolin (as Cefazolin-BC), pilocarpine (as Isopto Carpine), and chloramphenicol (as Chlorsig) and then in SAH did not contain calcium, despite its presence in SAH. CONCLUSIONS The study appears to confirm our earlier clinical observations that topical medication may play a role in the spoliation of the hydrogel ophthalmic devices. Presence of calcium in the deposits seems to be correlated to the nature of drug. Although the incidence of spoliation in real clinical situations is much lower than suggested by this extreme-case in vitro simulation, topical therapy after implantation of AlphaCor should be carefully considered, kept to the minimum required, and additive-free where possible.
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Affiliation(s)
- Traian V Chirila
- Lions Eye Institute, Centre for Ophthalmology and Vision Science, Perth, Australia.
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30
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Wackernagel W, Ettinger K, Weitgasser U, Bakir BG, Schmut O, Goessler W, Faschinger C. Opacification of a silicone intraocular lens caused by calcium deposits on the optic. J Cataract Refract Surg 2004; 30:517-20. [PMID: 15030853 DOI: 10.1016/s0886-3350(03)00672-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2003] [Indexed: 11/27/2022]
Abstract
We describe opacification of a plate-haptic silicone intraocular lens (IOL) caused by calcification in a diabetic patient with asteroid hyalosis. The IOL was explanted 48 months after uneventful phacoemulsification because opacification of the posterior surface was causing significant visual disturbance. Light and scanning electron microscopy and x-ray spectrometry of the explanted IOL showed the opacification consisted mainly of calcium and phosphate, presumably hydroxyapatite, in the form of precipitations on the posterior surface of the optic.
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Affiliation(s)
- Werner Wackernagel
- Department of Ophthalmology, Karl-Franzens University Graz, Graz, Austria
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31
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Hayashi K, Hayashi H. Posterior capsule opacification after implantation of a hydrogel intraocular lens. Br J Ophthalmol 2004; 88:182-5. [PMID: 14736768 PMCID: PMC1771981 DOI: 10.1136/bjo.2003.023580] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To compare the degree of posterior capsule opacification (PCO) in eyes with a hydrophilic hydrogel intraocular lens (IOL) with that in eyes with a hydrophobic acrylic IOL. METHODS Ninety five patients underwent a hydrogel IOL implantation in one eye and an acrylic IOL implantation in the opposite eye. The PCO value of these patients was measured using the Scheimpflug videophotography system at 1, 6, 12, 18, and 24 months postoperatively. The rate of neodymium:YAG (Nd:YAG) laser posterior capsulotomy and visual acuity were also evaluated. RESULTS The mean PCO value in the hydrogel group increased significantly (p<0.0001), while that in the acrylic group did not show significant change. The PCO value in the hydrogel group was significantly greater than that in the acrylic group throughout the follow up period. Kaplan-Meier survival analysis determined that the Nd:YAG capsulotomy rate in the hydrogel group was significantly higher than that in the acrylic group (p<0.0001). Mean visual acuity in the hydrogel group decreased significantly with time (p<0.0001), and became significantly worse than that in the acrylic group at 18 and 24 months postoperatively. CONCLUSION Posterior capsule opacification in eyes with a hydrophilic hydrogel IOL is significantly more extensive than that in eyes with a hydrophobic acrylic IOL, and results in a significant impairment of visual acuity.
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Affiliation(s)
- K Hayashi
- Hayashi Eye Hospital, 4-7-13 Hakataekimae, Hakata-Ku, Fukuoka 812, Japan.
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Tehrani M, Mamalis N, Wallin T, Dick HB, Stoffelns BM, Olson R, Fry LL, Clifford WS. Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses Case series and review. J Cataract Refract Surg 2004; 30:115-22. [PMID: 14967277 DOI: 10.1016/s0886-3350(03)00461-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2003] [Indexed: 11/17/2022]
Abstract
PURPOSE To report clinical and spectrographic analyses of 2 explanted hydrophilic acrylic intraocular lenses (IOLs). SETTING John A. Moran Eye Center, Salt Lake City, Utah, USA, and Johannes Gutenberg-University, Department of Ophthalmology, Mainz, Germany. METHODS We report 6 cases of opacification of MemoryLens IOLs (Ciba Vision) that occurred approximately 2 years after implantation. The anterior and posterior surfaces of the IOLs had a white, frosted appearance, and the IOLs' interior looked brown, similar to the appearance of a brunescent cataract. Two of the IOLs were explanted because of a significant decrease in visual acuity. The IOLs were sent for further clinicopathologic analysis including scanning electron microscopy and energy dispersive x-ray spectroscopy (EDX). RESULTS Microscopic analysis revealed multiple, fine, granular deposits of various sizes on the surface of the lens optics. The EDX analysis showed the presence of calcium within the deposits. CONCLUSIONS Our cases show that hydrophilic acrylic IOLs can opacify even years after implantation. Analysis of the explanted IOLs revealed calcification.
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Affiliation(s)
- Mana Tehrani
- Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany.
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Lin SY, Chen KH, Li MJ, Cheng WT, Wang SL. Evidence of octacalcium phosphate and Type-B carbonated apatites deposited on the surface of explanted acrylic hydrogel intraocular lens. ACTA ACUST UNITED AC 2004; 70:203-8. [PMID: 15264301 DOI: 10.1002/jbm.b.30067] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fourier-transform infrared (FTIR) microspectroscopy combining with attenuated total reflection (ATR) microsampling technique and micro-Raman spectrophotometer were used to detect the deposited materials on the surface of acrylic hydrogel intraocular lens (IOL) with or without ocular implantation. Surface morphology and the interface of this IOL were further examined by a confocal laser scanning microscope. The brand-new IOL exhibited a very smooth, transparent and featureless surface, but the explanted IOL had an irregular cerebriform-like opaque appearance. Both FTIR/ATR and Raman microspectroscopic analyses showed the deposits on the surface of acrylic hydrogel IOL after ocular implantation to consist of octacalcium phosphate (OCP) and Type B carbonated apatites, leading to the opalescence of acrylic hydrogel IOL. Both vibrational microspectroscopic examinations also confirmed the mineralization still in progress on the surface of acrylic hydrogel IOL after ocular implantation for 2 years.
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Affiliation(s)
- Shan-Yang Lin
- Department of Medical Research & Education, Veterans General Hospital-Taipei, Taipei.
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34
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Macky TA, Werner L, Soliman MM, Pandey SK, Izak AM, Apple DJ. Opacification of Two Hydrophilic Acrylic Intraocular Lenses 3 Months After Implantation. Ophthalmic Surg Lasers Imaging Retina 2003. [DOI: 10.3928/1542-8877-20030501-06] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dorey MW, Brownstein S, Hill VE, Mathew B, Botton G, Kertes PJ, El-Defrawy S. Proposed pathogenesis for the delayed postoperative opacification of the hydroview hydrogel intraocular lens. Am J Ophthalmol 2003; 135:591-8. [PMID: 12719064 DOI: 10.1016/s0002-9394(02)02154-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To report the clinical, histopathologic, ultrastructural, and elemental features of 17 opacified Hydroview (Bausch and Lomb Surgical, Rochester, New York, USA) hydrogel intraocular lenses (IOL) necessitating explantation and discuss from a clinicopathologic perspective why these lenses became opacified. Interventional case series with clinicopathologic correlation. METHODS Seventeen hydrogel lenses were explanted from 17 different patients owing to decreased visual acuity or quality of vision an average of 29 months after uneventful phacoemulsification and IOL implantation and associated with a granular-appearing opacification superficially within the optic. Lenses were examined by light microscopy, transmission electron microscopy (TEM), and energy dispersion x-ray (EDX) spectroscopy. A control IOL was included in our study. RESULTS All explanted lenses showed positive staining for calcium by light microscopy. Transmission electron microscopy disclosed electron-dense crystalline deposits in the superficial substance of the IOL optic. Energy dispersion x-ray spectra analyses showed the presence of calcium and phosphorus mainly in the electron-dense periphery of the deposits in all of the specimens and the presence of silicon mainly in the electron-lucent center of the deposits in the majority of the specimens. No positive staining or deposits were observed on the IOL control or in the haptics. CONCLUSIONS Our study is the first to demonstrate that the calcium deposits are associated with silicon, which was presumably derived from the silicone gasket in the Surefold (Bausch and Lomb Surgical, Rochester, New York, USA) packaging system, manufactured specifically for this IOL. Silicon may act as a nidus for calcium deposition within the lens, which is consistent with our findings. There may be other factors involved, and this important clinical problem requires further study.
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Affiliation(s)
- Michael W Dorey
- Department of Ophthalmology, University of Ottawa Eye Institute, Ontario, Canada
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36
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Mamalis N. Complications of foldable intraocular lenses requiring explantation or secondary intervention--2001 survey update. J Cataract Refract Surg 2002; 28:2193-201. [PMID: 12498859 DOI: 10.1016/s0886-3350(02)01612-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A survey of the complications associated with foldable intraocular lenses (IOLs) that required explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were assessed. Postoperative results and outcomes were also analyzed. Complications and symptoms for each of the following major groups of foldable IOLs explanted were tabulated separately: 3-piece hydrophilic acrylic or hydrogel; 3-piece monofocal silicone; 3-piece hydrophobic acrylic; 1-piece hydrophobic acrylic with haptics; 3-piece multifocal silicone; 1-piece plate-type silicone. A total of 286 surveys were returned for evaluation. Intraocular lens calcification, incorrect lens power, optical visual aberrations, and decentration/dislocation were the most common reasons for removing a foldable IOL. Accurate IOL measurements, meticulous surgical technique, proper patient counseling, and careful manufacture of foldable IOL materials are the most important factors in avoiding complications with foldable IOLs.
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Affiliation(s)
- Nick Mamalis
- Moran Eye Center, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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37
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Yu AKF, Ng ASY. Complications and clinical outcomes of intraocular lens exchange in patients with calcified hydrogel lenses. J Cataract Refract Surg 2002; 28:1217-22. [PMID: 12106731 DOI: 10.1016/s0886-3350(02)01357-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the outcomes of intraocular lens (IOL) exchange in patients with calcified hydrogel IOLs. SETTING Ophthalmology departments of 2 university hospitals in Hong Kong, China. METHODS Fifteen patients developed loss of vision resulting from calcification of hydrogel IOLs. The calcified IOLs were explanted and replaced with new IOLs. The best corrected visual acuity before and after surgery was measured and compared. RESULTS The mean visual acuity was 0.03 (range 0.01 to 0.20) before IOL exchange and 0.20 (range 0.01 to 0.50) 3 months after; the difference was significant (P <.001). Acuity improved approximately 5 Snellen lines. Complications included posterior capsule rupture in 2 patients and zonular dehiscence in 3 patients; the secondary IOL was placed in the anterior chamber or ciliary sulcus in these patients. Three patients required cutting of the haptics before the calcified IOL could be removed. CONCLUSION Intraocular lens exchange was an effective treatment in patients with calcified hydrogel IOLs.
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Affiliation(s)
- Alexis K F Yu
- Department of Ophthalmology, Tung Wah Hospital, Hong Kong, China.
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38
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Kim CY, Kang SJ, Lee SJ, Park SH, Koh HJ. Opacification of a hydrophilic acrylic intraocular lens with exacerbation of Behçet's uveitis. J Cataract Refract Surg 2002; 28:1276-8. [PMID: 12106741 DOI: 10.1016/s0886-3350(02)01356-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Behçet's disease is 1 of the most common causes of uveitis in the Eastern world. Its common ocular complications are uveitis, cataract, and obliteration of retinal vessels. Phacoemulsification with intraocular lens (IOL) implantation in patients with Behçet's disease is known to be a safe procedure. We managed a patient with Behçet's disease who had aggravated uveitis and opacification of a hydrophilic acrylic IOL (ACRL-C160, Ophthalmed) 4 months after cataract surgery. Recalcitrant uveitis despite maximum tolerable medication and IOL opacification with vitreous opacity necessitated an IOL exchange and trans pars plana vitrectomy. After the procedure, the eye became quiescent. However, the visual acuity was 20/200 because of the obliteration of retinal vessels.
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Affiliation(s)
- Chan Y Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
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39
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Lee DH, Seo Y, Joo CK. Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients. J Cataract Refract Surg 2002; 28:1271-5. [PMID: 12106740 DOI: 10.1016/s0886-3350(02)01245-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Four patients with diabetes mellitus had cataract extraction with implantation of a hydrophilic acrylic intraocular lens (IOL) (ACRL-C160, Ophthalmed). The IOLs showed progressive and generalized opacification 10 to 20 months after implantation, decreasing visual acuity. All 4 IOLs were removed. By light microscopic examination, the IOL surfaces were wrinkled and encrusted with microspheres. Electron microscopy revealed the material to be crystalline in nature. Energy dispersive x-ray spectrum analysis showed that the deposits were mainly composed of calcium and phosphate.
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Affiliation(s)
- Do Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Seoul, South Korea
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40
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Oner HF, Durak I, Saatci OA. Late Postoperative Opacification of Hydrophilic Acrylic Intraocular Lenses. Ophthalmic Surg Lasers Imaging Retina 2002. [DOI: 10.3928/1542-8877-20020701-09] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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41
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Abstract
Modern cataract surgery is constantly evolving and improving in terms of lens material and design. Researchers and physicians strive to obtain better refractive correction with smaller wound size and minimizing host cell response to limit the proliferation of lens epithelial cells leading to opacification of the lens capsule. Intraocular lens material varies in water content, refractive index, and tensile strength. Intraocular lens design has undergone revisions to prohibit lens epithelial cell migration and reflection of internal and external light. The evolution of intraocular lens and extracapsular cataract surgery has lead to faster postoperative recovery and better visual outcomes.
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Affiliation(s)
- Kim T Doan
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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42
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Letter. Eye (Lond) 2001. [DOI: 10.1038/eye.2001.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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43
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Yu AK, Kwan KY, Chan DH, Fong DY. Clinical features of 46 eyes with calcified hydrogel intraocular lenses. J Cataract Refract Surg 2001; 27:1596-606. [PMID: 11687358 DOI: 10.1016/s0886-3350(01)01038-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To clarify the clinical features of delayed calcification of hydrogel intraocular lenses (IOLs) based on observation of a large case series. SETTING Ophthalmology department of 2 university teaching hospitals, Hong Kong, China. METHODS The first 44 patients with a known diagnosis of calcified IOL were recruited. Medical and ophthalmic histories were obtained. Surgical details, surgical complications, and visual acuity before and after IOL implantation were also retrieved. Patients then had a visual acuity test, a slitlamp examination of the features of the IOL calcification, and a fundus examination for clarity of view. RESULTS Forty-six eyes of 44 patients had IOL calcification. All had a Hydroview IOL. The onset was from 4 to 26 months after surgery. Ninety-three percent of eyes had generalized IOL calcification, and 96% had forceps marks on the IOL. Mean visual acuity deteriorated from 0.4 at 3 months to 0.13 at 19 months. Visual loss was more severe in patients with diabetes mellitus or ischemic heart disease and in those in which the IOL calcified earlier after implantation. CONCLUSION All cases of IOL calcification were delayed in onset. The presence of forceps marks may provide a clue to the pathogenesis. Bilateral but asymmetric involvement in 2 patients suggests that the IOL was involved in the pathogenesis. Affected patients lost an average of 2.8 Snellen lines of visual acuity. Some eyes progressed more rapidly; however, the modulating factors remain unknown.
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Affiliation(s)
- A K Yu
- Department of Ophthalmology, Queen Mary Hospital, Hong Kong, China.
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