Posters

Opacification of hydrophilic intraocular lenses after deep anterior lamellar keratoplasty (DALK)

Poster Details

First Author: M.Lippera ITALY

Co Author(s):    S. Lippera   A. Iannone   G. Pallotta   P. Ferroni   S. Morodei        

Abstract Details

Purpose:

This study examined three cases of hydrophilic intraocular lense (IOL) opacification following deep anterior lamellar keratoplasty (DALK). The opacification of hydrophilic IOLs is well-known in posterior lamellar keratoplasty (Descemet’s membrane and Descemet’s stripping endothelial keratoplasty, DMEK / DSAEK). It is caused by an accumulation of calcium phosphate probably due to the injection of air or gas into the anterior chamber during surgery. Hydrophilic IOL opacification is also reported after vitrectomy, arguably associated with IOL dehydration or with the passage of air from the vitreous to anterior chamber. No cases have so far been examined of hydrophilic IOL opacification after DALK.

Setting:

In total, three IOLs were examined for clinically significant opacification after DALK. The initial cataract surgery, the DALK surgery and the eventual IOL explantation and reimplantation of a different IOL were all performed at the Department of Ophthalmology in Fabriano, Marche, Italy.

Methods:

Three cases of hydrophilic IOLs that opacified following DALK were examined. Cataract surgery was performed on all three patients in 2013. In addition, case two later underwent a vitrectomy, tamponaded with Densiron, because of retinal detachment, and case three a vitrectomy, followed by an injection of intraocular 20% sulfur hexafluoride (SF6), because of a vitreous haemorrhage. The patients underwent DALK surgery because of corneal leukoma, which developed during the years 2014-2015, due to a neurotrophic keratopathy in two cases and to a ulcerative herpetic keratitis in the other.

Results:

The opacification of the hydrophilic acrylic IOLs occurred in the late postoperative period: two years after DALK surgery in case one; initial opacification three years after, in 2018, in case two; and three years after in case three. The opacification of the IOL caused a reduction in visual acuity in two out of the three cases. Only in case three was the hydrophilic lens explanted and a retropupillary iris-claw lens implanted, resulting in an improvement of visual acuity. Case one refused to undergo surgery, and, in case two, the initial opacification didn’t require a surgical approach until only recently.

Conclusions:

Hydrophilic IOLs can opacify years after DALK. This may be due to the injection of air in the anterior chamber during the bubble test. Alternatively, it may be hypothesized that the mechanism is air entering the anterior chamber, passing from the corneal stroma through the Schlemm’s canal and the trabecular meshwork during the deep stromal air injection when attempting to achieve the big bubble. In conclusion, it is recommended that physicians avoid using hydrophilic IOLs in all complex cases where other types of surgery, such as vitrectomy and both anterior and posterior lamellar keratoplasty, can be predicted.

Financial Disclosure:

None