To report the clinical, histopathologic, ultrastructural, and elemental features of
17 opacified Hydroview (Bausch and Lomb Surgical, Rochester, New York, USA) hydrogel
intraocular lenses (IOL) necessitating explantation and discuss from a clinicopathologic
perspective why these lenses became opacified. Interventional case series with clinicopathologic
correlation.
Seventeen hydrogel lenses were explanted from 17 different patients owing to decreased
visual acuity or quality of vision an average of 29 months after uneventful phacoemulsification
and IOL implantation and associated with a granular-appearing opacification superficially
within the optic. Lenses were examined by light microscopy, transmission electron
microscopy (TEM), and energy dispersion x-ray (EDX) spectroscopy. A control IOL was
included in our study.
All explanted lenses showed positive staining for calcium by light microscopy. Transmission
electron microscopy disclosed electron-dense crystalline deposits in the superficial
substance of the IOL optic. Energy dispersion x-ray spectra analyses showed the presence
of calcium and phosphorus mainly in the electron-dense periphery of the deposits in
all of the specimens and the presence of silicon mainly in the electron-lucent center
of the deposits in the majority of the specimens. No positive staining or deposits
were observed on the IOL control or in the haptics.
Our study is the first to demonstrate that the calcium deposits are associated with
silicon, which was presumably derived from the silicone gasket in the Surefold (Bausch
and Lomb Surgical, Rochester, New York, USA) packaging system, manufactured specifically
for this IOL. Silicon may act as a nidus for calcium deposition within the lens, which
is consistent with our findings. There may be other factors involved, and this important
clinical problem requires further study.