Crystalens intraocular lens opacification in a patient with asteroid hyalosis: a case report and review of the literature

Session Details

Session Title: Cataract Surgery Complications

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 17:36

Venue: Free Paper Forum: Podium 2

First Author: : D.Khair el Kareh LEBANON

Co Author(s): :    C. Torres-Quinones   R. Pineda II                          

Abstract Details

Purpose:

Dystrophic calcification of the intraocular lens (IOL) requiring explantation has been reported with several lens materials in patients with asteroid hyalosis (AH). Silicone lenses were thought to be resistant to secondary calcification in patients with AH. However, several cases have been reported with different silicone lens designs and manufacturers. We report findings in a patient with Crystalens IOL opacification in the context of AH and to review of the available literature on dystrophic calcification of silicone IOLs.

Setting:

A 57-year-old man with blurry vision presented to an academic center in Boston, MA. He was 14 years post cataract surgery with a Crystalens AOLens and complaining of reduced vision. He had a history AH and had a YAG Capsulotomy and vitrectomy. He was evaluated for possible IOL exchange OS

Methods:

An opacified Crystalens AO Lens OS was explanted along with the capsular bag and exchanged for Zeiss Lucia (Aaren Scienfic EC3-PAL hydrophobic acrylic) IOL. The new IOL was placed via the Yamane Technique (intrascleral fixation). Photos were taken before procedure, and explanted IOL was sent for electron microscopy, two-photon excitation microscopy and examination under Von Kassa and Alizerin Red stains. Additionally, the literature was reviewed for reports of silicone IOL opacification in the context of AH.

Results:

Pathology report on the explanted IOL confirmed the presence of calcium. Through our review of the literature, we found 37 other cases (eyes) with dystrophic calcification in the context of AH. Various lens designs and manufacturers were reported. Of the 37 cases reported, none included the Crystalens AO silicone IOL implant.

Conclusions:

Performance of cataract surgery is rarely influenced by AH, yet selection of IOL can be impacted by its presence. Based on our review, silicone IOLs are at risk for opacification and should be avoided or used under extreme caution in patients with AH. If opacification of a silicone IOL occurs as in our case, explantation with lens exchange remains the best option. However, novel approaches have been reported with promising results. Finally, a YAG-capsulotomy seems to hasten posterior lens calcification and renders exchange more challenging, and therefore is not advised.

Financial Disclosure:

None