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 Table of Contents    
LETTER TO THE EDITOR
Year : 2012  |  Volume : 5  |  Issue : 3  |  Page : 206-207  

Calcification of hydrophilic acrylic intraocular lens


North Middlesex Hospital, Edmonton, London N18 1QX, United Kingdom

Date of Web Publication15-Jan-2013

Correspondence Address:
Waseem Qureshi
Specialty Doctor Ophthalmology, North Middlesex Hospital, Edmonton, London, N18 1QX
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.106113

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How to cite this article:
Qureshi W, Obikpo R. Calcification of hydrophilic acrylic intraocular lens. Oman J Ophthalmol 2012;5:206-7

How to cite this URL:
Qureshi W, Obikpo R. Calcification of hydrophilic acrylic intraocular lens. Oman J Ophthalmol [serial online] 2012 [cited 2020 May 30];5:206-7. Available from: http://www.ojoonline.org/text.asp?2012/5/3/206/106113

Sir,

A seventy nine year old gentleman was referred by his optician with posterior capsular opacification (PCO) seen in the right eye (OD). The patient had history of right cataract surgery six years ago, with a +18.0 D Akreos® Adapt acrylic intraocular lens (IOL) implant and left cataract surgery six months later with a +18.0 D Akreos® Adapt IOL. He had undergone right YAG capsulotomy two years after surgery and YAG capsulotomy in his left eye (OS) five years after surgery. Past medical history was unremarkable; in particular there was no history of any chronic medical illness or treatment predisposing to hypercalcemia.

Ophthalmic examination revealed best corrected visual acuity of 6/6 OD and 6/6 OS. Intraocular pressure was 10 mmHg in both eyes (OU). The cornea was clear, anterior chamber deep and quiet, and posterior chamber IOL was seen in the bag OU. White crystalline granular deposits were observed on the IOL OU. The location of these deposits was in the periphery, some discrete and some confluent [Figure 1] and [Figure 2]. The visual axis was clear. Fundus examination was unremarkable with a cup to disc ratio of 0.3-0.4.
Figure 1: Intraocular lens implant deposits under high magnification

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Figure 2: Intraocular lens implant deposits under low magnification

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No intervention was advised due to good visual acuity of 6/6. Removal of IOL is planned in case of progression or impairment in visual acuity.

Flexible IOLs may be silicone, acrylic or hydrogel.

  • Both three-piece loop and one-piece plate haptics silicone IOLs are associated with lower rates of PCO than PMMA lenses. They are more likely to be associated with contraction of the anterior capsule than soft acrylic IOLs.
  • Three-piece or one-piece acrylic IOLs, may be hydrophobic (water content < 1%) or hydrophilic (water content 18-35%). Hydrophobic acrylic IOLs have a sharp edge to the optic which inhibit PCO. Hydrophobic materials have a much higher refractive index than hydrophilic lenses and are subsequently thinner.
  • Hydrogel IOLs are similar to hydrophilic acrylic IOLs but have a high water content and tend to have a much higher incidence of PCO.


Akreos® Adapt is a flexible hydrophilic acrylic intraocular lens implant. This is the third occasion where calcification has been reported.[1],[2]

The deposits seen in our patient were different from typical PCO, which are seen as pearls or whorls. The location of calcific deposits and effect on vision is variable.[3]

Contamination of surface with silicone oil, role of anterior uveitis, PC tear, and phacovitrectomy procedure have been named previously as probable risk factors. Role of YAG capsulotomy in inducing calcific deposits is uncertain.

 
   References Top

1.Mak ST, Wong AC, Tsui WM, Tse RK. Calcification of a hydrophilic acrylic intraocular lens: Clinicopathological report. J Cataract Refract Surg. 2008;34:2166-9.  Back to cited text no. 1
[PUBMED]    
2.Walker NJ, Saldanha MJ, Sharp JA, Porooshani H, McDonald BM, Ferguson DJ, et al. Calcification of hydrophilic acrylic intraocular lenses in combined phacovitrectomy surgery. J Cataract Refract Surg 2010;36:1427-31.  Back to cited text no. 2
[PUBMED]    
3.Neuhann IM, Kleinmann G, Apple DJ. A new classification of calcification of intraocular lenses. Ophthalmology 2008;115:73-9.  Back to cited text no. 3
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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