Opacification of piggyback IOLs associated with an amorphous material attached to interlenticular surfaces

Purpose: To report the pathological and ultrastructural features and interv al surgical management of an atypical case of opacification between piggyba ck intraocular lenses (IOLs). Setting: Center for Research on Ocular Therapeutics and Biodevices, Storm E ye institute, Medical University of South Carolina, Charleston, South Carol ina, and Nature Coast Eye-Care Institute and Surgery Center, Perry, Florida , USA. Methods: Opacification between 2 acrylic piggyback lenses was observed 16 m onths after implantation, with decreased best corrected visual acuity and a hyperopic shift. Elschnig pearls were observed in the peripheral interface between the lenses, and the central interface was occupied by an amorphous material. The pearls were surgically aspirated, but attempts to remove the central material were unsuccessful. The lenses were explanted and sent to the laboratory. Staining with hematoxylin and eosin (H&E), examination unde r a light microscope, and scanning electron microscopic analysis were perfo rmed. Results: The surfaces of the anterior IOL were relatively clear. The amorph ous material, mostly attached to the center of the anterior surface of the posterior IOL, was homogeneously stained with H&E. No cell nucleus was obse rved in this region. Scanning electron micros copy showed that the IOL edge presented a smooth, regular surface relatively free of deposits. The most central region was covered by an irregular layer of an amorphous compact ma terial with some cracks, fissures, or both on its surface. Conclusions: Although the exact composition of the material between the len ses could not be established, hypotheses were advanced to understand the pa thological mechanism associated with this condition. This case is different from those in previous reports of opacification composed of cortex and cel ls between piggyback IOLs. J Cataract Refract Surg 2000; 26:1612-1619 (C) 2 000 ASCRS and ESCRS.