Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 3623
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO EDITOR
Year : 2006  |  Volume : 54  |  Issue : 4  |  Page : 281-282

Delayed central opacification of hydrophilic acrylic lens


Vitreo Retina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, Ansari Nagar, New Delhi - 110 029, India

Correspondence Address:
Deependra Vikram Singh
Vitreo Retina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.27960

Rights and Permissions

How to cite this article:
Singh DV, Azad RV, Sharma YR, Sujith V, Chandra P, Pal N. Delayed central opacification of hydrophilic acrylic lens. Indian J Ophthalmol 2006;54:281-2

How to cite this URL:
Singh DV, Azad RV, Sharma YR, Sujith V, Chandra P, Pal N. Delayed central opacification of hydrophilic acrylic lens. Indian J Ophthalmol [serial online] 2006 [cited 2020 Dec 3];54:281-2. Available from: https://www.ijo.in/text.asp?2006/54/4/281/27960

Dear Editor,

Various types of optic opacification of intra ocular lenses (IOL) have been reported. [1],[2],[3],[4] We report evaluation of an explanted single-piece hydrophilic acrylic lens (SC60B-OUV) following opacification. A 62-year-old nondiabetic female presented with complaints of gradual diminution of vision in the right eye for the last three months. She had undergone uneventful phacoemulsification and implantation of foldable hydrophilic acrylic IOL (SC60B-OUV) for senile cataract in the right eye five years back. On examination best corrected visual acuity (BCVA) in right eye was found to be 20/400. A grayish opalescence was seen involving the optic of the IOL [Figure - 1]A. Fundus examination and intraocular pressure were normal. The left eye was pseudophakic with polymethyl methacrylate intra ocular lens (PMMA IOL) and BCVA of 20/20.

After informed consent, the patient underwent uneventful IOL explantation and exchange with a PMMA IOL.The adhesion between IOL and ocular tissues was released by visco dissection. A 5.5 mm optic PMMA IOL (Cee on from AMO Allergan) was implanted through a 5.5 mm incision after explanting the opacified IOL. The postoperative period was uneventful with BCVA in right eye improving to 20/20 at six weeks [Figure - 1]B.

A detailed examination of the explanted IOL revealed that the opacification was confined to the central portion of the optic of the IOL, with haptics and edges being clear [Figure - 1]C and D. Electron microscopy (LEO 435 VP) revealed no abnormal deposits on the IOL surface [Figure - 2]A. After sectioning the IOL into 1 x 2 mm blocks, the saggital surface evaluation [Figure - 2]B by scanning electron microscope showed electron dense deposits in the opacified portion only [Figure - 2]C. The central opacified disc was surrounded by a clear zone of 220 to 250 m thickness [Figure - 2]D.

Characteristic opacification involving the central part of the optic with clear edges of SC60B-OUV lens has been described by many researchers. [1],[2],[3],[4]Opacification is attributed to the presence of granules in the optic which are supposed to be composed of calcium as suggested by staining with alizarin red and energy dispersive radiograph analysis.[1],[2],[4] We analyzed and compared the clear and opacified areas of IOL explanted 56 months after implantation and found that the electron dense deposits of variable sizes were only limited to the central portion of the opacified areas. Despite being intraocular for five years, the peripheral areas of the lens remained clear which suggests that the opacification starts from the centre of IOL and the aqueous humor probably might have a protective role. Although the mobile ions in aqueous have been reported to be similar in diabetics and controls, the total opacification of a similar model reported in a diabetic patient[2] may be the result of altered flow dynamics of aqueous humor and blood-ocular barrier breakdown in diabetics.[5] Exact cause of opacification is yet unknown and the hypothesis suggested is based on clinicopathological observation. We recommend the analysis of aqueous in all patients with IOL opacification. The different patterns of calcium precipitation have also been attributed to the differences in the water content of the hydrophilic acrylic materials.[4] This report is different from the earlier ones as this is the longest interval between surgery and IOL explantation without total opacification of IOL optic.


  Acknowledgments Top


Authors would like to thank Mr. Rakesh Pathania [Faculty: Sophisticated Analytical Instrument Facility, AIIMS, New Delhi] who helped us in analyzing the lens surface under scanning electron microscope.



 
  References Top

1.
Werner L, Apple DJ, Kaskaloglu M, Pandey SK. Dense opacification of the optical component of a hydrophilic intraocular lens: A clinicopathological analysis of 9 explanted lenses. J Cataract Refract Surg 2001;27:1485-92.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.
Pandey SK, Werner L, Apple DJ, Kaskaloglu M. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: Bilateral case report and clinicopathologic correlation. Ophthalmology 2002;109:2042-51.  Back to cited text no. 2
[PUBMED]    
3.
Joseph A, Dua HS. Late opacification of SC60B-OUV acrylic intraocular lenses. Br J Ophthalmol 2002;86:484-5.  Back to cited text no. 3
    
4.
Pandey SK, Werner L, Apple DJ, Kaskaloglu M. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: Bilateral case report and clinicopathologic correlation. Ophthalmology 2002;109:2042-51.  Back to cited text no. 4
[PUBMED]    
5.
Larsson LI, Pach JM, Brubaker RF. Aqueous humor dynamics in patients with diabetes mellitus. Am J Ophthalmol 1995;120:362-7.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure - 1], [Figure - 2]


This article has been cited by
1 Opacification of AcriFlex 50CSE hydrophilic acrylic intraocular lenses
Andrew Keat Eu Lim, Pik Pin Goh, Ramlee Azura, Ismail Mariam
Journal of Cataract & Refractive Surgery. 2011; 37(4): 655
[VIEW] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Acknowledgments
References
Article Figures

 Article Access Statistics
    Viewed3265    
    Printed66    
    Emailed0    
    PDF Downloaded192    
    Comments [Add]    
    Cited by others 1    

Recommend this journal