Cataractogenous opacification of hydrophobic IOL

Session Details

Session Title: Cataract Surgery Complications. IOL Dislocations

Session Date/Time: Monday 07/09/2015 | 17:00-18:30

Paper Time: 18:08

Venue: Room 10

First Author: : J.Novak CZECH REPUBLIC

Co Author(s): :    V. Stoy   O. Zidek   M. Vlcek   H. Adamkova           

Abstract Details

Purpose:

Eight years after implantation of the IOLs AcriNova we have recorded an increase of their opacity from the initial level after implantation of {mean±SD, 8.63±2,29}% (measured by Pentacam) onto a higher level of their opacity of15-20% connected with the clinical significant decrease of contrast sensitivity in general and also with a slight decrease of visual acuity. Followed Nd:YAG capsulotomies in some cases were without any effect. Very interesting is a highly scattering effect of mentioned IOLs imaged by the spectralis(S)-OCT in vivo.

Setting:

NPK a.s. Regional Hospital Pardubice, University of Pardubice, Medicem Prague, Contipro Dolni Dobrouc, Czech Republic.

Methods:

One eye with the 3-pcs IOL AcriNova 10years after cataract surgery was propounded for IOL exchange. New one piece IOL ZCB00-Tecnis was implanted into the capsule. The IOL after explantation was examined using scanning electron microscopy (SEM) and Energy-dispersive X-ray spectroscopy ( EDX). S-OCT image of the IOL in vivo before explantation was compared with the S-OCT images of the other IOLs including the new implant.

Results:

IOL opacity in vivo (PentacamHR) was 21%, BCVA 0,63, CSV1000 A0B0C0D0 before surgery. OCT with the high scattering effect but no sign of glistenings. 14 days after surgery the opacity of ZCB00Tecnis (PentacamHR) was 3,2%, BCVA 1,0 and CSV1000 A2B3C2D1. 3 months after surgery corneal astigmatism decreased on the level of 0,2dpt (after the suture removal), UCVA was 1,0 and CSV1000 A4B4C4D4. We have documented no evidence of micro- or macroglistenings in magnification 20K (SEM). Using EDX there was no evidence of calcium or related elements. OCT image of new IOL was without scattering effect.

Conclusions:

Hydrophobic IOLs AcriNova have no optical stability of the raw material in time. The IOL opacity after 8 years can reach the level of significant cataractogenous effect in vivo. Increase of the IOL opacity in the mentioned period is not only in the superficial level of substance such as originates in the well known hydrophobic IOL of Acrysof or typical calcification. Explanation of this effect is only one: slow crystallization supported by photodegradation of acrylic gel.

Financial Interest:

One of the authors travel has been funded, fully or partially, by a competing company