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Wei Ni, Zhizhong Ma, Tao Bai, Wei Wang, Peking University Third Hospital Peking University Eye Center; Late postoperative opacification of hydrophilic acrylic intraocular lenses- A Clinicopathologic Study of Six Opacified Intraocular Lenses. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2521.
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To report clinical, ultrastructural, and spectrographic analyses of six hydrophilic acrylic intraocular lenses (IOLs) obtained from patients who had visual disturbances caused by postoperative lens opacification.
Six opacified hydrophilic IOLs were included in our study, five of which were explanted because of decreased visual acuity. The clinical details were obtained to identify possible risk factors for IOL opacification. The IOLs were subjected to gross examination, light microscopy (LM), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and energy-dispersive x-ray spectroscopy (EDS).
Microscopic analyses revealed multiple red cell-like granules of variable sizes on and within the substance of the opacified IOL in Case 1and Case4. Bicycle wheel-like deposits were found on the other two IOLs (case 2 and 3).Fish egg-like deposits were found on case 5 and 6. EDS of the IOL in case 1 and case 4 demonstrated the presence of calcium and phosphate within the opacifications. In contrast, only peaks of carbon, oxygen and sodium were presented on the surface of the IOL in case 2 and case 5.In case 6, only peaks of carbon and oxygen were presented on the surface of the opacified IOL.
Our findings suggest a possibility that the IOL material may responsible for the formation of the opacification inside the substance of IOLs. Host-related factors, such as postoperative inflammation, might also be involved in the process of this formation. Therefore, ophthalmologic practitioners need to stay aware of this complication and carefully follow clinical outcomes in order to prevent patients from undergoing potentially avoidable procedures and complications. The mechanism of the calcification process requires further investigation.
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