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First Author: L.Gutierrez SPAIN
Co Author(s): D. Antolin P. Rodriguez
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we want to report an opacification intraocular lense case, during a normal cataract surgery, which became spontaneous transparent after 24 hours. We have reproduced similar conditions outside the eye and we have observed the same complete and homogenous opacification of the lens.
We introduce the case of an 80 year-old woman with a history of hypertension, type 2 diabetes mellitus and hypercholesterolemia who presented an advanced nuclear cataract in her left eye. She underwent coaxial phacoemulsification through a 1.8 mm micro-incision, with some difficulty due to positive vitreous pressure. After in-the-bag placement of a CT Spheris ® 204 (Carl Zeiss) intraocular lens (IOL), we observed rapid, homogenous and complete opacification of the lens. The patient was kept under observation after surgery; the IOL remained opaque for the two following hours and photographs were taken. At the 24 hours postoperative examination the IOL was transparent with no signs of opacification and the only findings were moderate corneal edema and mild remains of sub-incisional cortex. At the last postoperative visit one month after surgery, the IOL remained clear and the visual acuity was 20/20. We hypotesized this opacification to be due to a sudden temperature change and to be related to water condensation, which was confirmed by the performance of a simple experiment
The physical phenomenon of condensation is the change of the physical state of matter from gaseous to liquid phase, such as gas (or steam) to liquid. Condensation generally occurs when a vapor is cooled, but can also occur when the vapor is compressed (pressure increases), or subjected to a combination of cooling and compression. Water vapor in the air will only condense on a surface with a lower temperature or when its saturation limit is exceeded. In our case, although we suspect that this is what happened during surgery, we had never witnessed such IOL clouding that did not resolve within minutes inside the eye. Willing to reproduce the conditions that occurred during surgery, we performed a simple experiment: A CT 504 Spheris®IOL was kept cooled at 4ẃC during 24 hours. After that, it was placed in a recipient containing 37ẃC BSS solution. It was observed a rapid, homogenous and complete opacification of the IOL.The opacification occurred only on the optical surface and subsurface. This experiment confirms our main hypothesis.
: we have made an important review of the literature about another intraocular lenses opacification cases reported. We have not found any one related with condensation phenomenon as in our case.
Knowing this is of great utility, and implies taking precautions to avoid storing lenses in contact with cold surfaces before being implanted .Furthermore, in the event of rapid lens opacification during surgery or within a few hours, surgeons should consider delaying the explantation for a day or two as such early opacification, if due to condensation, may resolve spontaneously.