Analysis of Opacified Hydrophilic IOLs After DSAEK

Khoramnia, Ramin

Analysis of Opacified Hydrophilic IOLs After DSAEK

Friday, April 25, 2014

KIOSKS (Boston Convention and Exhibition Center)

Ramin Khoramnia, MD, David J Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany

Romain De Cock, FRCOphth, Kent & Canterbury Hospital, Canterbury, United Kingdom

Martin Emesz, MD, Paracelsus Medizinische Privatuniversität, Salzburg, Austria

Gerd U. Auffarth, MD, David J Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre, University of Heidelberg, Heidelberg, Germany

Narrative Responses:

Purpose
We report about the findings in opacified IOLs after DSAEK using light and scanning electron microscopy as well as x-ray spectroscopy.

Methods
Seven hydrophilic IOLs with opacification after DSAEK have been evaluated in this ongoing analysis so far. The explanted IOLs were cut in half. One half was stained (Alizarin red and von Kossa) and examined using light microscopy. The other half was examined using scanning electron microscopy. The composition of the deposits was analyzed by means of x-ray spectroscopy.

Results
Macroscopically, all IOLs showed opacifications mostly in the center of the optic. In all IOLs, light and scanning electron microscopy revealed numerous fine, granular, crystalline-like deposits below the anterior surface of the IOL. These deposits caused an elevation of the surface of the IOL. X-ray spectroscopy could prove the deposits to consist of calcium and phosphate. Examination of the posterior surface did not reveal deposits in any of the lenses.

Conclusion
The calcification of hydrophilic IOLs only occurs rarely. However, the injection of intracameral gas during DSAEK seems to increase the risk for IOL opacification. Granular deposits below the anterior surface of the IOLs can be responsible for such a decrease in visual acuity that patients require IOL exchange.