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First Author: A.Saklamaz TURKEY
Co Author(s): A. Maden S. Yilmaz M. Helvacioglu M. Ture
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We report the clinical, pathological and ultrastructural analyses of two cases of three-piece hydrophilic acrylic intraocular lenses (IOLs) that presented with surface irregularities.
A retrospective review of two eyes.
The hydrophilic acrylic lOLs (AcryFlex, model AF605) were examined under light microscopy, and with scanning electron microscopy (SEM) equipped with an energy-dispersive x-ray spectroscopy detector with light-element capabilities (EDS). A neodymium:YAG (Nd:YAG) laser posterior capsulotomy was performed for the decrease in visual acuity in both patients. Under light microscopy, honeycomb-like irregularities were observed on the anterior surface of the lenses. The SEM and EDS analyses showed that the crystals on the surface of the IOLs contained calcium and phosphorus, presumably calcium phosphate.
The results obtained suggest that the surface irregularities have resulted from the deposition of calcium and phosphate crystallites.
Late postoperative IOL opacification causes a severe loss of VA. The mechanism is not yet clear but it seems to be related to the super saturation of the aqueous humor with respect to calcium phosphates. The nature of the materials used for the construction of the IOL and inadequate cortex cleaning from the capsular bag during surgery may influence the formation of crystallines. It is unknown if the Nd:YAG capsulotomy, too, is a contributing risk factor. The only available therapeutic option for these and other such patients at the present time is an IOL exchange.