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P. A. Steinfeld, R. Dahlmann, B. Mazinani, S. Kaempf, P. Walter, G. Thumann; IOL Opacification Following Retinal Surgery Combined With Intraocular Silicone Oil Endotamponade. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5960.
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Hydrophilic acrylic IOLs are widely used in cataract surgery due to their good biocompatibility. However, hydrophilic acrylic lenses show a high incidence of explantation as a result of opacification within the lens optics. Here we report that hydrophobic IOLs are also prone to opacification within a short time following vitreoretinal surgery with silicone oil endotamponade.
Hydrophobic IOLs were explanted due to opacification following silicone oil endotamponade for 3-4 months in 2 patients with a complex ocular surgical history. Analysis of the IOLs was performed using light microscopy, scanning electron microscopy and dispersive x-ray spectroscopy (EDX) analysis.
An IOL (AcriTec® 44S), explanted from a patient with 5000 silicone oil (Siluron 5000, Geuder®) endotamponade for 3 months showed massive calcium deposits identified by EDX scattered on the anterior surface of the IOL. However the surface that had been covered by the lens capsule did not show any signs of opacification with a sharp line of demarcation at the rhexis defect. The second IOL (AcrySof® SN60 AT UV), explanted from a patient with heavy silicone oil endotamponade (Oxane, Bausch&Lomb®) for 4 months, displayed a diffuse vacuolation ("glistenings") of the entire lens body and haptics. The anterior surface of the IOL showed a granular appearance due to the presence of vacuoles, however the posterior surface that was protected by the lens capsule showed smooth surface.
It has been widely described that the hydrophilic acrylic IOL materials, have a tendency to calcify leading to explantation in patients with risk factors such as uveitis, diabetes and glaucoma. However hydrophobic polymers may also be prone to opacification at least in the presence of silicone oil. More research will be necessary to establish those conditions leading to lens opacification to avoid unnecessary intervention in patients with complicated surgical records.
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