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Belin PJ, Kim JH, Sheikh A, Winokur J, Rhee D, Deramo V. Incidence and Risk of Scleral-Fixated Akreos (AO60) Lens Opacification: A Case Series. JOURNAL OF VITREORETINAL DISEASES 2021; 5:157-162. [PMID: 37009087 PMCID: PMC9979051 DOI: 10.1177/2474126420946605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Postoperative hydrophilic intraocular lens opacification can lead to decreased vision and may require intraocular lens exchange. This study aims to identify the incidence of scleral-fixated Akreos AO60’s (Bausch + Lomb) lens opacification and risk factors for this phenomenon. Methods: This is a retrospective case series of all patients who underwent scleral-fixated Akreos AO60 lens at our institution between January 1, 2015 and December 31, 2019. The following data were recorded: age, sex, medical history, indication for Akreos AO60 implantation, laterality, ocular history, previous ocular surgical procedures, subsequent intraocular surgical procedures after the Akreos implantation, lens opacification, visual significance of opacification, and Akreos explantation. Intraoperative and postoperative complications were recorded. Main outcome measures were the overall incidence of Akreos lens opacification as well as the incidence of these eyes undergoing subsequent intraocular surgery. Results: A total of 262 eyes of 257 patients underwent Akreos lens implantation. Overall, 2% (5 of 262) developed lens opacification. Two patients had Descemet stripping automated endothelial keratoplasty (DSAEK) concurrently with Akreos implantation. One patient underwent subsequent Baerveldt glaucoma implantation and DSAEK. The fourth patient had vitrectomy with sulfur hexafluoride gas followed by DSAEK. This represents a 25% (4 of 16) opacification rate among all patients who underwent DSAEK ( P ≤ .01, Fisher exact test). One patient developed opacification after undergoing 2 vitrectomies for retinal detachment in the absence of DSAEK. Conclusions: Akreos lens opacification can be visually significant and may occur after a retinal or corneal procedure that involves the use of intraocular gas or air.
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Affiliation(s)
- Peter J. Belin
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Jang H. Kim
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Ahmed Sheikh
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Jules Winokur
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - David Rhee
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Vincent Deramo
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
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2
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Sarnicola E, Sarnicola C, Cheung AY, Panico E, Panico C, Sarnicola V. Manual deep anterior lamellar keratoplasty after partial unintentional full-thickness trephination. Eur J Ophthalmol 2020; 31:774-777. [PMID: 32493069 DOI: 10.1177/1120672120932108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to describe a surgical technique to perform deep anterior lamellar keratoplasty (DALK) despite inadvertent full thickness trephination in one quadrant. METHODS Case report of a 19-year-old boy who underwent DALK for visually significant post-infectious stromal scar in his left eye. An unintentional full thickness trephination occurred in the upper-nasal quadrant at the beginning of the surgery. After suturing the perforated area, manual DALK was performed, and an air bubble was left in the anterior chamber. Evaluated outcomes included best spectacle corrected visual acuity (BSCVA), residual recipient bed thickness, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double anterior chamber. RESULTS The surgery was completed without any further complications. No double anterior chamber or Urrets-Zavalia syndrome was observed on the first postoperative day. Mean residual recipient bed thickness was 72 μm and regular. ECC was 2446 cell/mm2. BSCVA at 18 months of follow-up was 0.9. There were no episodes of rejection, and the graft remained clear at the last follow-up (4 years). CONCLUSION Inadvertent partial full thickness trephination of the recipient cornea is a largely preventable but possible complication during DALK. Penetrating keratoplasty conversion can be avoided by performing a manual dissection DALK.
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Affiliation(s)
- Enrica Sarnicola
- Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy.,Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
| | - Caterina Sarnicola
- Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy.,Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
| | | | | | - Claudio Panico
- Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy.,Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
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3
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Kalevar A, Dollin M, Gupta RR. OPACIFICATION OF SCLERAL-SUTURED AKREOS AO60 INTRAOCULAR LENS AFTER VITRECTOMY WITH GAS TAMPONADE: CASE SERIES. Retin Cases Brief Rep 2020; 14:174-177. [PMID: 28957955 DOI: 10.1097/icb.0000000000000634] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND/PURPOSE We report the first two cases of postoperative opacification of scleral-sutured Akreos AO60 intraocular lens after vitrectomy with the gas tamponade. METHODS Two patients with ectopia lentis underwent pars plana vitrectomy, pars plana lensectomy, and scleral fixation of an Akreos AO60 intraocular lens with Gore-Tex suture. Retinal breaks were noted during vitrectomy and consequently intravitreal gas tamponade was used after endolaser retinopexy. Postoperatively, both patients developed intraocular lens opacification but maintained excellent visual acuity; however, one patient developed bothersome though tolerable photophobia. CONCLUSION Although still an excellent option for the management of surgical aphakia in the absence of capsular support, caution should be taken when using a hydrophilic secondary intraocular lens, such as Akreos AO60, during vitreoretinal surgery if gas is required.
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Affiliation(s)
- Ananda Kalevar
- West Coast Retina Medical Group, San Francisco, California
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Dollin
- University of Ottawa Eye Institute, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and
| | - R Rishi Gupta
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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Fernández J, Sánchez‐García A, Rodríguez‐Vallejo M, Piñero DP. Systematic review of potential causes of intraocular lens opacification. Clin Exp Ophthalmol 2019; 48:89-97. [DOI: 10.1111/ceo.13650] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/02/2019] [Accepted: 09/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision)Vithas Virgen del Mar Hospital Almería Spain
- Department of OphthalmologyTorrecárdenas Hospital Complex Almería Spain
| | - Alicia Sánchez‐García
- Department of Ophthalmology (Qvision)Vithas Virgen del Mar Hospital Almería Spain
- Department of Optics, Pharmacology and AnatomyUniversity of Alicante Alicante Spain
| | | | - David P. Piñero
- Department of Optics, Pharmacology and AnatomyUniversity of Alicante Alicante Spain
- Department of OphthalmologyVithas Medimar International Hospital Alicante Spain
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5
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Gregori NZ, Echegaray JJ, Flynn HW. Opacification of Akreos Hydrophilic Acrylic Lens After Retinal Detachment Repair with Silicone Oil Tamponade: A Case Report. Ophthalmol Ther 2019; 8:341-345. [PMID: 30924046 PMCID: PMC6513917 DOI: 10.1007/s40123-019-0183-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 11/29/2022] Open
Abstract
We report localized opacification of a sclera-fixated Akreos® hydrophilic acrylic intraocular lens after successful repair of rhegmatogenous retinal detachment with silicone oil tamponade in a nondiabetic patient. No intraoperative lens opacification during air-fluid exchange or lens dislocation was encountered. Granular opacities within the optic were noted at 5 months after surgery, and did not relent to scrubbing with a vitrector during oil removal. Akreos lens opacification under silicone oil is not well documented in the literature. Surgeons must be aware of this potential complication, which is known to occur with various types of hydrophilic acrylic lenses after exposure to air or gas.
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Affiliation(s)
- Ninel Z Gregori
- Ophthalmology Department, Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, FL, USA. .,Bascom Palmer Eye Institute, Department of Ophthalmology of the University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Jose J Echegaray
- Ophthalmology Department, Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, FL, USA.,Bascom Palmer Eye Institute, Department of Ophthalmology of the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute, Department of Ophthalmology of the University of Miami Miller School of Medicine, Miami, FL, USA
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6
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Sanz MR, Rallo MM, Gutierrez AG, Villanueva BR. Hydrophilic intraocular lens opacification after repeated intracameral gas injection for Descemet membrane detachment. Oman J Ophthalmol 2019; 12:46-49. [PMID: 30787535 PMCID: PMC6380154 DOI: 10.4103/ojo.ojo_173_2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Descemet membrane detachment (DMD) is a complication of a variety of eye procedures that can result in severe visual loss. We report a new case of the condition, in a highly myopic patient that had undergone cataract surgery, and presented a macular hemorrhage during the intervention. DMD was successfully treated with a combined technique of intracameral gas injection and transcorneal suturing. Following resolution of this complication, intraocular lens opacification was observed.
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Affiliation(s)
- Manuel Roca Sanz
- Department of Ophthalmology, Hospital Provincial De Castellón, Castellón De La Plana, Castellón, Spain
| | - Marc Menezo Rallo
- Department of Ophthalmology, Hospital Provincial De Castellón, Castellón De La Plana, Castellón, Spain
| | - Arantxa García Gutierrez
- Department of Ophthalmology, Hospital Provincial De Castellón, Castellón De La Plana, Castellón, Spain
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7
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Akreos lens opacification under silicone oil. Can J Ophthalmol 2018; 53:e188-e190. [DOI: 10.1016/j.jcjo.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 11/20/2022]
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Santander-García D, Dapena I, Baydoun L, Melles GRJ. DMEK complications: current treatment and recommendations. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1429917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Diana Santander-García
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Gerrit R. J. Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Amnitrans Eye Bank Rotterdam, Rotterdam, The Netherlands
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9
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Shokoohi-Rad S, Zamani G, Doosti MR. Inflammatory Precipitates in an Air Bubble in the Aqueous Humor. J Ophthalmic Vis Res 2017; 12:445-446. [PMID: 29090060 PMCID: PMC5644417 DOI: 10.4103/jovr.jovr_29_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Saeed Shokoohi-Rad
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghodsieh Zamani
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Giers BC, Tandogan T, Auffarth GU, Choi CY, Auerbach FN, Sel S, Mayer C, Khoramnia R. Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty - a material analysis with special reference to optical quality assessment. BMC Ophthalmol 2017; 17:150. [PMID: 28830376 PMCID: PMC5568293 DOI: 10.1186/s12886-017-0546-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Laboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK). Methods Thirteen opacified IOLs after posterior lamellar keratoplasty, 8 after descemet stripping automated endothelial keratoplasty (DSAEK), 3 after descemet membrane endothelial keratoplasty (DMEK) and 2 after both DSAEK and DMEK were analysed in our laboratory. Analyses included optical bench assessment for optical quality, light microscopy, scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS). Results In all IOLs the opacification was caused by a thin layer of calciumphosphate that had accumulated underneath the anterior optical surface of the IOLs in the area spared by the pupil/anterior capsulorhexis. The calcifications lead to a significant deterioration of the modulation transfer function across all spatial frequencies of the affected IOLs. Conclusions The instillation of exogenous material such as air or gas into the anterior chamber increases the risk for opacification of hydrophilic IOLs irrespective of the manufacturer or the exact composition of the hydrophilic lens material. It is recommended to avoid the use of hydrophilic acrylic IOLs in patients with endothelial dystrophy that will likely require procedures involving the intracameral instillation of air or gas, such as DMEK or DS(A)EK.
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Affiliation(s)
- Bert C Giers
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Tamer Tandogan
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Chul Y Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Florian N Auerbach
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Saadettin Sel
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Christian Mayer
- Eye Clinic, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre and the David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
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11
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Lee MS, Tsai IL, Tsai CY, Kuo LL, Liou SW, Woung LC. Intraocular lens opacification after Descemet's stripping automated endothelial keratoplasty. Taiwan J Ophthalmol 2017; 7:160-163. [PMID: 29034156 PMCID: PMC5637382 DOI: 10.4103/tjo.tjo_54_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Compared with conventional penetrating keratoplasty, Descemet's stripping automated endothelial keratoplasty (DSAEK) more effectively maintain global integrity and rapid vision rehabilitation with less ocular surface disorders in patients with endothelial dysfunction. Here, we report a case of a 76-year-old woman who experienced opacification of a hydrophilic intraocular lens (IOL) approximately 10 months after DSAEK. The patient with no history of systemic disease developed pseudophakic bullous keratopathy in the right eye 2 years after undergoing cataract surgery. The best-corrected visual acuity (BCVA) of the right eye was Snellen 0.01 when presented to our hospital. DSAEK was arranged and performed smoothly. However, the graft detached over the upper part of the cornea on postoperative day 1. Thus, rebubbling was performed immediately. After the procedure, the graft was well attached, and the cornea became clear gradually. The BCVA returned to Snellen 0.6. However, progressive opacification over the anterior surface of the IOL was observed 10 months postoperatively. Vision deteriorated to 0.5 with various refractive errors during 2-year follow-up. IOL exchange may be considered if the vision is getting worse. IOL opacification may result from a direct contact between the IOL surface and exogenous air, particularly in a hydrophilic IOL, and can be a rare but significant complication after DSAEK. Clinicians planning to perform DSAEK should consider the composition of the IOL, the amount of intracameral air, duration of air filling, and high intraocular pressure.
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Affiliation(s)
- Meng-Sheng Lee
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - I-Lun Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Li-Lin Kuo
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shiow-Wen Liou
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Ophthalmology, Taipei Medical University, Taipei, Taiwan.,Department of Ophthalmology, Taiwan University Hospital, Taipei, Taiwan
| | - Lin-Chung Woung
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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