Dense opacification of the optical component of a hydrophilic acrylic intraocular lens - A clinicopathological analysis of 9 explanted lenses

Purpose: To report clinical, pathological, histochemical, ultrastructural, and spectrographic analyses of explanted hydrophilic acrylic intraocular le nses (IOLs) obtained from patients who had visual disturbances caused by po stoperative opacification of the lens optics. Setting. Center for Research on Ocular Therapeutics and Biodevices, Storm E ye Institute, Medical University of South Carolina, Charleston, South Carol ina, USA, and Ege University, Alsancak Izmir, Turkey. Methods: Nine hydrophilic IOLs (SC60B-OUV, MDR Inc.) were explanted from 9 patients with decreased visual acuity. Most patients became symptomatic app roximately 24 months after uneventful phacoemulsification and IOL implantat ion. Opacification was noted and appeared clinically to be associated with a fine granularity within the substance of the IOL optic. The IOLs were for warded to the center and examined by gross and light microscopy. Full-thick ness cut sections of the optics were stained with 1 % alizarin red and the vor Kossa method (special stairs for calcium), Some were submitted for scan ning electron microscopy and energy dispersive x-ray spectroscopy. Results: Microscopic analyses revealed multiple fine, granular deposits of variable sizes within the lens optics, usually distributed in a line parall el to the anterior and posterior curvatures of the optic, with a clear zone just beneath the optic surface. The deposits stained positive with alizari n red and the von Kossa method. Energy dispersive x-ray spectroscopy of the internal substance of sectioned IOLs demonstrated the presence of calcium within the deposits. Conclusion. This is the first clinicopathological report of optic opacifica tion occurring with this hydrophilic acrylic IOL model. Studies of similar cases with this lens should be done to determine the incidence and possible mechanisms of the phenomenon.