Acute clouding of trifocal lens during implantation: a case report

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Abstract

Background

Intraoperative IOLs clouding of several kinds of hydrophilic acrylic intraocular lenses (IOLs) have been reported due to temperature changes. This phenomenon reported previously occurred in cold countries and during the winter months. However, no clinical case was reported about trifocal IOL opacification during operation. We report a case in which acute opacification of the optical region occurred simultaneously when AT LISA tri 839mp(Carl Zeiss) was implanted into the eye.

Case presentation

A 79-year-old woman with a cortex and nucleus cataract was scheduled to undergo right eye phacoemulsification assisted by femtosecond technique. The trifocal lens (AT LISA tri 839mp), which is made of hydrophilic acrylic (25%) with hydrophobic surface properties, was chosen for implantation. As the IOL was implanted into the eye, it became cloudy immediately. Then it was replaced by another AT LISA tri 839mp, which was transferred from lens company outside, the same phenomenon was observed. These two lenses underwent the same temperature fluctuation from cold outside to operating room. Finally, a ZCB00 (Allergan) was implanted.

Conclusions

The acute intraoperative clouding of trifocal lens(AT LISA tri 839mp) results from fluctuation of temperature should be noticed.

Related collections

Most cited references 12

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Calcification of modern foldable hydrogel intraocular lens designs.

Rima D Apple, Andrea M Izak, Liliana Werner … (2003)

To report and compare clinical and pathological features of hydrophilic acrylic intraocular lenses (IOLs) of three major designs, explanted from patients who had visual disturbances caused by opacification of the lens optic. Eighty-seven hydrophilic acrylic IOLs (25 Hydroview, 54 SC60B-OUV, and 8 Aqua-Sense lenses) were explanted and sent to our center. Most patients became symptomatic during the second year after cataract surgery. A fine granularity was observed on the surface of the lens optic in the case of Hydroview. With the SC60B-OUV and Aqua-Sense lenses, the opacity resembled a nuclear cataract. Gross examination, light microscopy and staining with alizarin red and the von Kossa method (for calcium) were performed. Some lenses were submitted for scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Light microscopic and SEM analyses revealed the presence of irregular granular deposits on the external optical surfaces of Hydroview lenses. With the SC60B-OUV lenses, the opacity was caused by the presence of multiple fine, granular deposits within the lens optic, distributed in a line parallel to the anterior and posterior curvatures of the optic, with a clear zone just beneath its external surfaces. The Aqua-Sense lenses exhibited both patterns simultaneously. The deposits in all cases stained positive with alizarin red and von Kossa method. EDS also demonstrated the presence of calcium and phosphates within the deposits. Differences in the water content of the hydrophilic acrylic materials used in the manufacture of these three lens designs may be responsible for the different patterns of calcium precipitation. Careful clinical follow up of patients implanted with these lenses is necessary to determine if this phenomenon is rare and sporadic or may be more widespread.

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Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants.

Liliana Werner, Guy Kleinmann, Irmingard M Neuhann … (2004)

To report clinical, pathologic, histochemical, ultrastructural, and spectroscopic analyses of MemoryLens intraocular lenses (IOLs) explanted from patients who had visual disturbances caused by postoperative opacification of the lens optic. Noncomparative, large case series with clinicopathologic correlation. A total of 106 hydrophilic acrylic IOLs of the same design explanted from 106 different patients. All patients had decreased visual acuity at presentation approximately 2 years after cataract surgery, associated with a whitish fine granularity on the optical surfaces of the IOLs. The explanted IOLs were submitted to the John A. Moran Eye Center and were examined under light microscopy, histochemically, and with scanning electron microscopy (SEM) equipped with an energy dispersive x-ray spectroscopy detector with light element capabilities (EDS). The IOLs were examined for distribution, structure, and composition of the deposits causing opacification of their optic components. The average interval between lens implantation and opacification was 25.8+/-11.9 months. The most frequently associated medical and ophthalmic conditions were diabetes and glaucoma. However, some patients did not have any preexisting medical or ophthalmic conditions. Most of the IOLs had been implanted in 1999 and 2000. Microscopic analyses revealed the presence of multiple fine, granular deposits of variable sizes on the anterior and posterior optic surfaces, especially on the anterior surface. The deposits stained positive for calcium. The EDS confirmed the presence of calcium and phosphate within the deposits. The results obtained suggest the surface deposits to be composed, at least in part, by calcium and phosphate. A special polishing technique used in the manufacture of most of these IOLs may have caused changes in the lens surface leading to deposit formation. Further studies should be undertaken to confirm this hypothesis.

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Anterior chamber interleukin 1β, interleukin 6 and prostaglandin E2 in patients undergoing femtosecond laser-assisted cataract surgery.

Li WANG, Zhe Zhang, Douglas Koch … (2016)

To evaluate the interleukin (IL) 1β, IL-6 and prostaglandin E2 (PGE2) concentrations in aqueous humour in patients undergoing femtosecond laser-assisted cataract surgery.

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Author and article information

Contributors

Qian Liu: liuuqian@126.com

Suhua Zhang: 86-0351-8823009(0) , zhanggsuhua@126.com

Xiaogang Wang: movie6521@163.com

Weifang Cao: cwf990481@163.com

Yading Jia: yadingjia@163.com

Journal

Journal ID (nlm-ta): BMC Ophthalmol

Journal ID (iso-abbrev): BMC Ophthalmol

Title: BMC Ophthalmology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2415

Publication date (Electronic): 8 December 2017

Publication date PMC-release: 8 December 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 242

Affiliations

GRID grid.452728.e, Shanxi Eye Hospital, ; No. 100 Fudong Street, Taiyuan, Shanxi 030002 People’s Republic of China

Article

Publisher ID: 636

DOI: 10.1186/s12886-017-0636-7

PMC ID: 5721382

PubMed ID: 29216854

SO-VID: 2636ed6f-f189-46cc-b716-4d39e2017c7d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.