Cases of intraocular lens opacification in pseudophakic eyes: analysis of the results of microstructural studies

Abstract

Relevance. Currently, all over the world, during cataract surgeries, a huge number of intraocular lenses (IOLs) made of different materials are implanted. Alongside with the development of modern IOL materials and designs, publications about their opacities appear. The nature and the localization of IOL opacities mainly depend on the properties of the material out of which the lens is made. Polymethyl methacrylate (PMMA) currently rarely used to manufacture IOLs, tends to cloud in the optical center due to structural breakdown, forming “snowflake”-like cracks. Opacities of acrylic IOLs depend on the degree of hydrophilic properties of the material. The deposition of crystalline deposits in the optical zone of hydrophilic acrylic lenses leads to a significant decrease in visual acuity and requires IOL explantation. There is a definite dependence of the occurrence of opacities in hydrophilic acryl on the patient’s concomitant diseases. In hydrophobic acrylic IOLs, vacuoles form, and glistenings occurs. Herewith, visual functions, as a rule, do not suffer.

Purpose: to find out what structural changes in the IOL led to the need to remove them from pseudophakic eyes due to a decrease in visual acuity.

Materials and methods. Four clouded IOLs made from different materials were examined. The lenses were studied using a SUPRA 55VP scanning electron microscope (Carl Zeiss, Germany) using a secondary electron detector. Element distribution maps on the surface and inside the lenses were collected using an X-max 80 mm² energy dispersive X-ray analysis detector (Oxford Instruments, UK).

Results. A hydrophilic lens with hydrophobic coating became cloudy 5 years after implantation. Hydroxyapatite crystals were found on all parts of the IOL along its surface. In a hydrophobic acrylic IOL, microvacuoles and cavities in the optical center were found using scanning electron microscopy. Two PMMA IOLs underwent self-destruction within 8 years after implantation. Chemical analysis of PMMA lenses did not reveal any inorganic compounds.

Conclusion. One of the complications of IOL implantation is an impairment of their transparency. Factors associated with IOL material and manufacturing, as well as the patient’s comorbidities, can lead to lens opacification at various terms after surgery.

Keywords

intraocular lens / intraocular lens opacification / opacity / acrylic / hydrophilic / hydrophobic / polymethyl methacrylate / hydrophobic coating / hydroxyapatite / crystals

References

[1] Mamalis N, Brubaker J, Davis D, Werner L. Complications of foldable intraocular lenses requiring explantation or secondary intervention — 2007 survey update. J Cataract Refract Surg. 2008;34(9):1584-1591. https://doi.org/10.1016/j.jcrs. 2008.05.046.

[2] Mackey TA, Werner L, Soliman MM, et al. Opacification of two Hydrophilic acrylic intraocular lenses 3 months after implantation. Ophthalmic Surg Lasers Imaging. 2003;34(3):197-202. https://doi.org/10.3928/1542-8877-20030501-06.

[3] Neuhan IM, Stoduka P, Werner L, et al. Two opacification patterns of the same hydrophilic acrylic polymer: case reports and clinicopathological correlation. J Cataract Refract Surg. 2006;32(5): 879-886. https://doi.org/10.1016/j.jcrs.2006.01.076.

[4] Kim SM, Choi S. Clinical efficacy and complications of intraocular lens exchange for opacified intraocular lenses. Korean J Ophthalmol. 2008;22(4):228-235. https://doi.org/10.3341/kjo.2008.22.4.228.

[5] Гамидов А.А., Сипливый В.И., Федорук Н.А., и др. Помутнения интраокулярных линз: рабочая классификация с обзором проблемы // Офтальмология. Восточная Европа. – 2018. – Т. 8. – № 4. – С. 575–585. [Gamidov A, Siplivyi V, Fedoruk N, et al. Intraocular lens opacification: a working classification and review of the problem. Oftal’mologiya. Vostochnaya Evropa. 2018;8(4): 575-585. (In Russ.)]

[6] Аветисов С.Э., Гамидов А.А., Новиков И.А., и др. Химический микроанализ минеральных депозитов на поверхности эксплантированных интраокулярных линз из гидрофильного акрила // Вестник офтальмологии. – 2015. – Т. 131. – № 4. – С. 74–78. [Avetisov SE, Gamidov AA, Novikov IA, et al. Chemical microanalysis of mineral deposits on explanted hydrophilic acrylic intraocular lenses. Russian Annals of ophthalmology. 2015;131(4):74-78. (In Russ.)]. https://doi.org/10.17116/oftalma2015131474-78.

[7] Amar А, Soosan J. Complications in ocular surgery: a guide to managing the most common challenges. ISBNS.co.tt. Trinidad and Tobago; 2012. P. 343.

[8] Труфанов С.В., Текеева Л.Ю., Саловарова Е.П., и др. Дистрофии роговицы // Вестник офтальмологии. – 2018. – Т. 134. – № 5. – С. 118–125. [Trufanov SV, Tekeyeva LYu, Salovarova EP, et al. Corneal dystrophies. Russian Annals of Ophthalmology. 2018;134(5):118-125. (In Russ.)]. https://doi.org/10.17116/oftalma2018134051118.

[9] Труфанов С.В., Саловарова Е.П., Маложен С.А., Баг Р.З. Эндотелиальная дистрофия роговицы Фукса // Вестник офтальмологии. – 2017. – Т. 133. – № 6. – С. 106–112. [Trufanov SV, Salovarova EP, Malozhen SA, Bagh RZ. Fuchs endothelial corneal dystrophy. Russian Annals of Ophthalmology. 2017;133(6):106-112. (In Russ.)]. https://doi.org/10.17116/oftalma20171336106-112.

[10] Werner L. Glistenings and surface light scattering in intraocular lenses. J Cataract Refract Surg. 2010;36(8):1398-1420. https://doi.org/10.1016/j.jcrs.2010.06.003.

[11] Dahle N, Werner L, Fry L, Mamalis N. Localized, central optic snowflake degeneration of a PMMA intraocular lens: сlinical report with pathological correlation. Arch Ophthalmol. 2006;124(9): 1350-1353. https://doi.org/10.1001/archopht.124.9.1350.

RIGHTS & PERMISSIONS

Riks I.A., Astakhov S.Y., Ivankova E.М., Kuzmina I.E., Papanyan S.S., Boutaba R., Ezugbaya M.B., Akopov E.L.