Pathological assessment of complications with asymmetric or sulcus fixation of square-edged hydrophobic acrylic intraocular lenses

Poster Details

First Author: L.Werner USA

Co Author(s):    K. Kirk   R. Jaber   S. Strenk   L. Strenk   N. Mamalis  

Abstract Details

Purpose:

One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation. Complications may also be observed with 3-piece lenses having a square optic edge on the anterior surface. We provide pathological evidences of complications concerning out-of-the-bag 1 and 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges.

Setting:

John A. Moran Eye Center, University of Utah.

Methods:

661 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs underwent anterior segment scanning of whole eyes with a high-frequency ultrasound system, or a high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathological analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses. Findings from imaging, gross, and histopathological evaluation that could be related to out-of-the-bag fixation of the lenses were tabulated and compared to control eyes.

Results:

256 eyes were implanted with hydrophobic acrylic IOLs; 18 with asymmetric or sulcus IOL fixation (six 1-piece, and twelve 3-piece IOLs) were compared to contralateral eyes with symmetric in-the-bag fixation. Pathological findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, thinning, and atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the contralateral eyes. The majority of eyes with 3-piece lenses showed signs of complicated surgery.

Conclusions:

We provide pathological correlation of complications clinically reported in the peer-reviewed literature in relation to sulcus fixation of 1-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidences of complicated surgery; therefore all pathological findings in those cases may not be strictly attributed to the out-of-the-bag IOL fixation. FINANCIAL DISCLOSURE?: No