Anterior Surface Opacification of IOLs After Descemet-Stripping Endothelial Keratoplasty
Purpose
To report four cases of unexplained anterior intraocular lens (IOL) opacification after Descemet stripping endothelial keratoplasty (DSEK) for Fuch’s endothelial dystrophy.
Methods
Observational case series involving the collection of clinical data of three cases of hydrophilic IOL opacification and one case of opacification of a hydrophilic IOL with a hydrophobic surface in patients who underwent DSEK.
Results
In all cases, the opacification interfered with visual acuity. Post-operative graft displacement occurred in three cases requiring repositioning. A redo DSEK was later required in two of these cases. A redo DSEK alone was required in another case. Attempted removal of the opacification in one case with Neodymium YAG (Nd: YAG) and by surgical means was unsuccessful. IOL explantation was required in three cases and ultrastructural analysis is currently being undertaken on two of these lenses.
Conclusion
Anterior IOL opacification is becoming apparent in patients who have undergone DSEK performed either concurrently or after earlier phacoemulsification and IOL insertion. The process of opacification may be mediated by repeated intracameral injections of air, a breakdown in the blood aqueous barrier (BAB) or a prolonged inflammatory reaction due to multiple procedures.