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      • Record: found
      • Abstract: found
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      Is Open Access

      Hydrophilic Lens Opacification after Intravitreal Anti-VEGF Injections: A Case Series

      case-report

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          Abstract

          Our objective in this retrospective case series was to report 4 cases of hydrophilic intraocular lens (IOL) opacifications after repeated intravitreal bevacizumab injections. This is a retrospective analysis of all the cases of IOL opacifications presenting to a tertiary referral ophthalmic center in Beirut between January 2013 and January 2019. Four cases were included in the study, of which one was treated for vitreal hemorrhage, the other for macular edema secondary to wet age-related macular edema, and the rest for macular edema secondary to diabetic retinopathy. The mean age of the patients was 71 years with a male predominance and a mean of 5 injections. The IOL opacifications appeared approximately 24 months after first bevacizumab injection. The opacification could be explained by multiple theories such as a possible anterior or posterior segment subclinical inflammation secondary to intraocular interventions, interaction between the hydrophilic properties of the IOLs and anti-vascular endothelial growth factor injection's content, impurities transmission during injection, or faulty IOL manufacturing.

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          Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature.

          K Ghasemi Falavarjani, Anna Nguyen (2013)
          Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases, including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with systemic adverse events and devastating ocular complications. In this review, we provide an overview of safety data for intravitreal injection of common anti-VEGF agents.
          Article 0 comments Cited 281 times – based on 0 reviews     Review now
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            A new classification of calcification of intraocular lenses.

            Irmingard M Neuhann, Guy Kleinmann, Rima D Apple (2007)
            To define and classify the major types of intraocular lens (IOL) calcification. Retrospective observational case series with clinicopathologic correlation. More than 400 IOLs explanted because of opacification. The authors reviewed the clinical information and histologic findings of all IOLs that had been explanted because of opacification or calcification of the IOLs accessioned in their laboratory between January 1999 and December 2004. The proposed mechanism that led to calcification of each IOL design. Three major types of calcification were identified: (1) primary calcification, (2) secondary calcification, and (3) false-positive calcification or pseudocalcification. The primary form refers to calcification that is inherent in the IOL, that is, is based on possible inadequate formulation of the polymer, fabrication of the IOL, or issues with its packaging process. The calcification presumably occurs in otherwise normal eyes and generally is not associated with preexisting diseases. The secondary form refers to deposition of calcium onto the surface of the IOL most likely the result of environmental circumstances (e.g., changes in the aqueous milieu surrounding the implanted IOL associated with preexisting or concurrent diseases or indeed any condition that has disrupted the blood-aqueous barrier). By definition, it is not related to any problem with the IOL itself. The false-positive or pseudocalcification refers to those cases in which other pathology is mistaken for calcification or false-positive staining for calcium occurs. When evaluating the pathogenesis and nature of IOL calcification in or on any given design, one should categorize it according to these types. Primary calcification is IOL related and the IOL should be withdrawn or modified to correct the problem. After the cause is identified and the lens is implanted again, patients should be followed up for up to 2 years to be sure the problem is alleviated. Secondary calcification is by definition not IOL related; it may occur with virtually all IOL designs implanted under various adverse circumstances. No IOL, hydrophilic or hydrophobic, is immune to secondary calcification. The false-positive form is recognized readily in the laboratory and this erroneous diagnosis is avoided.
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              Causes of intraocular lens opacification or discoloration.

              Liliana Werner (2007)
              Various pathologic processes may lead to clinically significant opacification or discoloration of the optic component of intraocular lenses (IOLs) manufactured from different biomaterials and in different designs. Factors such as the patient's associated conditions, the manufacturing process, the method of IOL storage, the surgical technique and adjuvants, or a combination of these may be involved. The complication may be observed intraoperatively or postoperatively from a few hours after implantation to many years after surgery, depending on the processes involved. Based on a review of the literature as well as our own laboratory analyses, the following types of processes were identified: formation of deposits/precipitates on the IOL surface or within the IOL substance; opacification by excess influx of water in hydrophobic materials; direct discoloration by capsular dyes or medications; coating by substances such as ophthalmic ointment and silicone oil; and a slow, progressive degradation of the IOL biomaterial.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Ophthalmol
                Journal ID (iso-abbrev): Case Rep Ophthalmol
                Journal ID (publisher-id): COP
                Title: Case Reports in Ophthalmology
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                ISSN (Electronic): 1663-2699
                Publication date Collection: Jan-Apr 2022
                Publication date (Electronic): 17 March 2022
                Publication date PMC-release: 17 March 2022
                Volume: 13
                Issue: 1
                Pages: 134-140
                Affiliations
                Department of Ophthalmology, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon
                Author notes
                Article
                Publisher ID: cop-0013-0134
                DOI: 10.1159/000520356
                PMC ID: 9082158
                PubMed ID: 35611019
                SO-VID: bed59a1e-4cf2-44fc-a27d-daba2f3a255c
                Copyright © Copyright © 2022 by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                Date received : 27 May 2021
                Date accepted : 13 October 2021
                Date: 2022
                Page count
                Figures: 2, References: 15, Pages: 7
                Categories
                Subject: Case Report

                Keywords: bevacizumab (avastin),intraocular lens opacifications,intravitreal injection,hydrophilic intraocular lens
                Data availability:
                Keywords: bevacizumab (avastin), intraocular lens opacifications, intravitreal injection, hydrophilic intraocular lens

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