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CASE REPORT
Year : 2008  |  Volume : 1  |  Issue : 1  |  Page : 25-27 Table of Contents   

Calcium-phosphate deposits on a hydrophilic acrylic intraocular lens after silicon oil tamponade


1 Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
2 Acritec GmbH, Henningsdorf, Germany

Correspondence Address:
Rashid Alsaeidi
Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstr. 8, 80336 Munich
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.43317

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   Abstract 

We report a 52-year-old man who underwent uncomplicated cataract operation and posterior chamber lens implantation (hydrophilic acrylic lens) in his left eye 5 years prior to presentation. Two years after surgery he developed pseudophakic retinal detachment which was successfully treated with pars plana vitrectomy and silicon oil tamponade. The silicon oil was removed one year after surgery. A year later he complained of increasing blurred vision in the left eye. Clinical examination revealed vesicular alterations located superficially on the intraocular lens (IOL), which could not be removed by perflourocarbon-perflourohexloctane lavage. As the patient complained about increasing visual impairment, the IOL was removed. The IOL was investigated by electronmicroscopy and biochemical analysis. During electron microscopy and following biochemical analysis the observed alterations were identified as calcium-phosphate particles located on the superficial aspect of the IOL. The occurrence of calcium-phosphate deposits on a posterior chamber IOL after silicon oil tamponade is a rare complication and has not been described so far. As these deposits interfere with visual acuity, removal of the lens has to be considered.

Keywords: Intraocular lens, calcium-phosphate deposits, removal


How to cite this article:
Alsaeidi R, Priglinger SG, Jurgen N, Lackerbauer CA, Kampik A, Haritoglou C. Calcium-phosphate deposits on a hydrophilic acrylic intraocular lens after silicon oil tamponade. Oman J Ophthalmol 2008;1:25-7

How to cite this URL:
Alsaeidi R, Priglinger SG, Jurgen N, Lackerbauer CA, Kampik A, Haritoglou C. Calcium-phosphate deposits on a hydrophilic acrylic intraocular lens after silicon oil tamponade. Oman J Ophthalmol [serial online] 2008 [cited 2020 Apr 4];1:25-7. Available from: http://www.ojoonline.org/text.asp?2008/1/1/25/43317


   Introduction Top


Calcium-phosphate deposits are a rare complication following cataract surgery. We report on a patient who had developed vesicular chances on the posterior surface of the intraocular lens (IOL) after pars plana vitrectomy (PPV) and silicon oil tamponade.


   Case Report Top


A 52 year male patient underwent uncomplicated cataract extraction with implantation of a hydrophilic acrylic posterior chamber lens in the left eye (Lenstec, St. Petersburg, Florida, USA). Two years later, the patient was referred to our institution with pseudophakic retinal detachment in the left eye, which was successfully treated by pars plana vitrectomy and silicon oil tamponade. Silicon oil was removed after 12 months. A year later he presented with increasing blurred vision of the left eye. Best corrected visual acuity was 20/20 in the right and 20/500 in the left eye. Slit lamp examination revealed vesicular alterations located superficially on the IOL.They were evenly distributed and most pronounced in the central parts of the posterior part of the IOL. Besides these findings, no further pathology was seen in both eyes [Figure 1].

Due to the clinical appearance, we initially suspected silicon oil remnants on the IOL surface and a lavage with perflourocarbon-perflourohexloctane (PFHO) was performed but remained unsuccessful. Because the patient was considerably visually impaired we decided to remove the lens and implant an anterior chamber lens.

After IOL extraction electron microscopy and biochemical analysis were performed. With light microscopy the alterations appeared as shiny, yellowish vesicular structures on the lens surface [Figure 2a]. However, the Environmental Scanning Electron Microscopy (ESEM) photography [Figure 2b] coupled with the Energy Dispersive X-Ray Spectroscopy (EDX) (not shown) identified these deposits as calcium-phosphate deposits on the lens surface measuring approximately 10 m in diameter. These particles were densely packed and multilayered, but did not form a continuous layer which gave them a vesicular appearance clinically and during light microscopy. The smaller interspersed particles seen [Figure 2b] were identified as natrium-chloride, possibly as a result of the storage of the lens in saline solution. The presence of calcium was in addition confirmed by alizarin red stain [Figure 3].

Based on the findings obtained in the presented case, an identification of calcium-phosphate deposits was made. Differentiation from silicone oil deposits on the lens following silicone oil tamponade using biomicroscopy and light microscopy alone appeared difficult. The fact that the deposits observed in our patient could not be removed using PFHO, led to the assumption that the deposits might consist of a different material.


   Discussion Top


Neuhann and coworkers described calcium phosphate deposits in a large series of 106 patients after implantation of a hydrophilic acrylic lens. [1] The present case is in line with reports showing that hydrophilic acrylic IOLs can opacify even years after implantation. [1],[2] As in these reports the material was observed on the surface of the optics. Besides hydrophilic acrylic lenses such deposits were also seen in a silicone lens. [3] The pathogenesis of calcium phosphate deposits is not completely understood, but associations with conditions such as diabetes and glaucoma have been hypothesized. [1] However, in none of these reports these deposits were seen in correlation with or - possibly - as a result of intraocular silicone oil tamponade. Nevertheless, we have no satisfying explanation how silicone oil might contribute to the deposits observed in the case presented.

 
   References Top

1.Neuhann IM, Werner L, Izak AM, Pandey SK, Kleinmann G, Mamalis N, et al. Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: A clinicopathological analysis of 106 explants. Ophthalmology 2004;111:2094-101.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Tehrani M, Mamalis N, Wallin T, Dick HB, Stoffelns BM, Olson R, et al. Late postoperative opacification of Memory Lens hydrophilic acrylic intraocular lenses: case series and review. J Cataract Refract Surg 2004;30:115-22.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Wackernagel W, Ettinger K, Weitgasser U, Bakir BG, Schmut O, Goessler W, et al. Opacification of a silicone intraocular lens caused by calcium deposits on the optic. J Cataract Refract Surg 2004;30:517-20.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]


    Figures

  [Figure 1], [Figure 2a], [Figure 2b], [Figure 3]



 

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