Opacification Of Intraocular Lenses Following Combined Or Secondary Intraocular Procedures - A Systematic Review
Published 2026 - 44th Congress of the ESCRS
Reference: FP24.07 | Type: Free paper | DOI: 10.82333/f8y3-jj75
Authors: Ms Lu Jing Tan* 1 , A/Prof. Sathish Srinivasan 1 , A/Prof. Liliana Werner 2
1Ophthalmology,University Hospital Ayr,Ayr,United Kingdom, 2Ophthalmology,Moran Eye Center, University of Utah, Salt Lake City ,Utah,United States
Purpose
The aim of this review is to analyse the incidence, risk factors and the pathology following secondary opacification of all types of IOL following endothelial keratoplasty or other intraocular procedures
Setting
University Hospital Ayr, Ayr, Scotland
Methods
A systematic literature search of peer-reviewed publications was undertaken following PRISMA guidelines on Medline and Embase databases from 2000 up to September 2025. We used the search terms (“opacification” OR “calcification” OR “discolouration”) AND (“intraocular lenses”) AND (“eye surgery” OR “intraocular surgery” OR “intraocular procedure” OR “intraocular treatment” OR “keratoplasty” OR “vitrectomy”). Reference lists were screened for additional and relevant articles. A total of 63 articles were identified in Medline and Embase searches, After removing 12 duplicates and excluding 35 based on abstract and full-text review, 25 studies were included in the final analysis
Results
A total of 171 eyes were included. The mean age at IOL opacification was 72 ± 6 years. 35% of the cohort were female. Out of 172 IOLs included, 116 IOLs were explanted and analysed. The IOLs were from 24 different brands of manufacturers. The most common opacified IOL’s were from Rayner followed by Bausch and Lomb and Zeiss. 87% were hydrophilic acrylic, 11% were hydrophilic acrylic with hydrophobic surface and 2% were hydrophobic acrylic. 80% of opacification localized to only the anterior surface where 76% of this was within the pupillary area while 4 % was outside the pupillary area. Histopathological analysis showed deposition of calcium and phosphate.
Conclusions
Opacification of IOLs occur predominantly after secondary intraocular procedures rather than in cases where cataract surgery was combined with another procedure. Second, endothelial keratoplasty (EK) and pars plana vitrectomy (PPV) were the most associated procedures with secondary IOL opacification. Hydrophilic IOLs have the highes risk of developing opacification following secondary intraocular procedures and this risk increasing with increasing water content of the hydrophilic lenses.