The Clinical Outcomes of Lens Exchange in Patients with Opacified Posterior Chamber Lens

Jeong Hun Seo; Sungmin Hyung

doi:10.3341/jkos.2008.49.8.1226

Journal List > J Korean Ophthalmol Soc > v.49(8) > 1008040

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Seo and Hyung: The Clinical Outcomes of Lens Exchange in Patients with Opacified Posterior Chamber Lens

Original Article

J Korean Ophthalmol Soc 2008;49(8):1226-1234.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.8.1226

The Clinical Outcomes of Lens Exchange in Patients with Opacified Posterior Chamber Lens

Jeong Hun Seo, M.D, Sungmin Hyung, M.D., Ph.D.

Department of Ophthalmology, School of Medicine Chungbuk National University, Chungbuk, Korea

Address reprint requests to Sungmin Hyung, M.D., Ph.D. Department of Ophthalmology, Chungbuk National University Hospital #410 Sungbong-ro, Heungduk-gu, Cheongju, Chungbuk 361-711, Korea Tel: 82-43-269-6368, Fax: 82-43-264-5263, E-mail: smh@chungbuk.ac.kr

Received 15 April 2008 Accepted 30 August 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the outcomes of posterior chamber lens (PCL) exchange in patients with opacified foldable PCLs.

Methods

This study consisted of 31 patients (35 eyes) who had received phacoemulsification and implantation of foldable intraocular lenses in the bag or sulcus and developed late opacification of the PCL. All patients reported a reduction of visual acuity and deterioration in vision. The PCLs were explanted and replaced with new PMMA lenses. The perioperative complications and the best corrected visual acuities (BCVAs) before and after surgery were evaluated.

Results

The mean visual acuities (logMAR value) before and after IOL exchange were 0.59±0.80 and 0.21±0.27, respectively. The difference was statistically significant (p=0.005, paired t-test). Intraoperative complications included posterior capsule rupture in six patients, zonular dehiscence in three patients, and both in one patient. Postoperative complications included intraocular pressure elevation in five patients and cystoid macular edema in two patients. One patient showed hypopyon at 6 days postoperatively, which lasted for 3 months, but she showed good visual acuity.

Conclusions

Intraocular lens exchange was a safe and effective treatment for patients whose PCLs were opacified.

Keywords: Exchange of PCL, Foldable posterior chamber lens (PCL), Opacification of PCL

References

1. Kohnen T. The variety of foldable intraocular lens materials. J Cataract Refract Surg. 1996; 22:1255–8.

2. Apple DJ, Mamalis N, Loftfield K. . Complications of intraocular lenses. A historical and histopathological review. Surv Ophthalmol. 1984; 29:1–54.

3. Yu AK, Shek TW. Hydroxyapatite formation on implanted hydrogel intraocular lenses. Arch Ophthalmol. 2001; 119:611–4.

4. Ursell PG, Spalton DJ, Pande MV. . Relationship between intraocular lens biomaterials and posterior capsule opacification. J Cataract Refract Surg. 1998; 24:352–60.

5. Lyle WA, Jin JC. An analysis of intraocular lens exchange. Ophthalmic Surg. 1992; 23:453–8.

6. Mamalis N, Crandall AS, Pulsipher MW. . Intraocular lens explantation and exchange; a review of lens styles, clinical indications, clinical results, and visual outcome. J Cataract Refract Surg. 1991; 17:811–8.

7. Doren GS, Stern GA, Driebe WT. Indications for and results of intraocular lens explantation. J Cataract Refract Surg. 1992; 18:79–85.

8. Sinskey RM, Amin P, Stoppel JO. Indications for and results a large series of intraocular lens exchanges. J Cataract Refract Surg. 1993; 19:68–71.

9. Tappin MJ, Larkin DK. Factors leading to lens implant decentration and exchange. Eye. 2000; 14:773–6.

10. Farbowitz MA, Zabriskie NA, Crandall AS. . Visual complaints associated with the acrysof acrylic intraocular lens. J Cataract Refract Surg. 2000; 26:1339–45.

11. Saika S, Miyamoto T, Ohnishi Y. Histology of anterior capsule opacification with a poly HEMA/HOHEXMA hydrophilic hydrogel intraocular lens compared to poly(methyl methacrylate), silicone, and acrylic lenses. J Cataract Refract Surg. 2003; 29:1198–203.

12. Apple DJ, Werner L, Escobar-Gomez M, Pandey SK. Deposits on the optical surfaces of hydroview intraocular lenses. J Cataract Refract Surg. 2000; 26:796–7.

13. Murray RI. Two cases of late opacification of the hydroview hydrogel intraocular lens. J Cataract Refract Surg. 2000; 26:1272–3.

14. Apple DJ, Werner L, Pandey SK. Newly recognized complications of posterior chamber intraocular lenses. Arch Ophthalmol. 2001; 119:581–2.

15. Chang BY, Davey KG, Gupta M, Hutchinson C. Late clouding of an acrylic intraocular lens following routine phacoemul- sification. Eye. 1999; 13:807–8.

16. Lee JY, Joo KM, Kim SH. Late opacification of hydrophilic acrylic intraocular lenses. J Korean Ophthalmol Soc. 2002; 43:2419–29.

17. Kim HG, Lee SH, Choi YJ. Late postoperative opacification of the foldable hydrophilic acrylic intraocular lens, ACRL-160. J Korean Ophthalmol Soc. 2003; 44:315–20.

18. Kim JC, Kim CS, Choi SH. . Clinical characteristics of patients with opacification of hydrophilic acrylic intraocular lens after cataract surgery. J Korean Ophthalmol. 2005; 46:1281–90.

19. Yu AK, Nq AS. Complications and clinical outcomes of intraocular lens exchange in patients with calcified hydrogel lenses. J Cataract Refract Surg. 2002; 28:1217–22.

20. Altaie RW, Costigan T, Donegan S. . Investigation and management of an epidemic of hydroview intraocular lens opacification. Graefes Arch Clin Exp Ophthalmol. 2005; 243:1124–33.

21. Dagres E, Khan MA, Kyle GM, Clark D. Perioperative complications of intraocular lens exchange in patients with opacified Aqua-Sense lenses. J Cataract Refract Surg. 2004; 30:2569–73.

22. Moesen I, Maudgal PC, Foets B. Late opacification of hydroview intraocular lenses: report of 11 cases. Bull Soc Belge Ophthalmol. 2006; 299:13–8.

23. van Looveren J, Tassignon MJ. Intraocular lens exchange for late-onset opacification. Bull Soc Belge Ophthalmol. 2004; 293:61–8.

24. Werner L, Apple DJ, Kaskalglu M, Pandey SK. Dense opacification of the optical component of a hydrophilic acrylic intraocular lens. J Cataract Refract Surg. 2001; 27:1485–92.

25. Dorey MW, Brownstein S, Hill VE. . Proposed pathogenesis for the delayed postoperative opacification of the hydroview hydrogel intraocular lens. Am J Ophthalmol. 2003; 135:591–8.

26. Trivedi RH, Werner L, Apple DJ. . Post cataract intraocular lens(IOL) surgery opacification. Eye. 2002; 16:217–41.

27. Werner L, Apple DJ, Escobar-Gometz M. . Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens. Ophthalmology. 2000; 107:2179–85.

28. Lee DH, Seo Y, Joo CK. Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients. J Cataract Refract Surg. 2002; 28:1271–5.

29. Frohn A, Dick HB, Augustin AJ, Grus FH. Late opacification of the foldable hydrophilic acrylic lens SC60B-OUV. Ophthalmology. 2001; 108:1999–2004.

30. Kim CY, Kang SJ, Lee SJ. . Opacification of a hydrophilic acrylic lens with exacerbation of Behcet's uveitis. J Cataract Refract Surg. 2002; 28:1276–8.

31. Oner HE, Durak I, Saatci OA. Late postoperative opacification of hydrophilic acrylic intraocular lenses. Ophthalmic Surg Lasers. 2002; 33:304–8.

32. Fernado GT, Crayford BB. Visually significant calcification of hydrogel intraocular lenses necessitating explantation. Clin Experiment Ophthalmol. 2000; 28:280–6.

33. Olson RJ, Caldwell KD, Crandall AS. . Intraoperative crystallization on the intraocular lens surface. Am J Ophthalmol. 1998; 126:177–84.

34. Farbowitz MA, Zabriskie NA, Crandall AS. . Visual complaints associated with the AcrySof acrylic intraocular lens. J Cataract Refract Surg. 2000; 26:1339–45.

35. Dhaliwal DK, Mamalis N, Olson RJ. . Visual significance of glistenings seen in the AcrySof intraocular lens. J Cataract Refract Surg. 1996; 22:452–7.

36. Busin M, Arffa RC, McDonald MB, Kaufman HE. Intraocular lens removal during penetrating keratoplasty for pseudophakic bullous keratopathy. Ophthalmology. 1987; 94:505–9.

37. Brown DC, Snead JW. Intraocular lens implant exchanges. J Am Intraocul Implant Soc. 1985; 11:376–9.

38. Poort-van Nouhuijs HM, Handrickx KH, van Marle WF. . Corneal astigmatism after clear corneal and corneoscleral incisions for cataract surgery. J Cataract Refract Surg. 1997; 23:758–60.

39. Mendívil A. Frequency of induced astigmatism following phacoemulsification with suturing versuswithout suturing. Ophthalmic Surg Lasers. 1997; 28:377–81.

40. Müller-Jensen K, Barlinn B, Zimmerman H. Astigmatism reduction: no stitch 4.0 mm versus sutured 12.0 mm clear corneal incisions. J Cataract Refract Surg. 1997; 22:1108–12.

41. Grabow HB. Early results of 500 cases of no stitch cataract surgery. J Cataract Refract Surg. 1991; 17:726–30.

42. Ahn DG, Hyung SM, Kim SK. The change of corneal astigmatism after extracapsular cataract extraction with 7 mm scleral tunnel incision. J Korean Ophthalmol Soc. 2000; 41:1344–52.

Figure 1.

Scattergram depiciting visual acuity before and after exchange of an opaque posterior chamber lens. At the last follow-up, BCVA improved in all eyes except 3 patients (2 with cystoid macular edema, 1 with posterior capsule opacity).* BCVA=best-corrected visual acuity=(logMAR).

Table 1.

Basal characteristics I

Characteritics
Age (years: Mean±SD)	71.5±11.5
Male: Female	10:21
Laterality (Right eyes: Left eyes)	17:18
Interval between original IOL implant and IOL exchange (month)	38.4±17.7
Follow-up period (Range, month)	16.6±12.3 (3-49)

Table 2.

Basal characteristics II

Ocular comorbidity	No. of patients	Systemic illness	No. of patients
Diabetic retinopathy	3	DM^‡	2
AMD*	1	HT^§	8
Glaucoma	5	DM & HT	4
RVO^†	0	Ischemic heart disease	1
HT retinopathy	0	Intracerebral hemorrhage	1
Total	10	Total	16

^* AMD=age-related macular degeneration;

^† RVO=retinal vascular occlusion;

^‡ DM=diabetes mellitus;

^§ HT=hypertension.

Table 3.

Intraoperative complications

Complication	No. of eyes (%)
Posterior capsular defect	6 (17.0%)
Zonulysis	3 (8.6%)
Posterior capsular defect & zonulysis	1 (2.9%)

Total	10 (28.5%)

Table 4.

Post-operative complications

Complications	No of eyes (%)
IOP elevation	5 (14.0%)
Cystoid macular edema	2 (5.7%)
Hypopyon	1 (2.9%)
PC opacity	1 (2.9%)
Hyphema	0 (0.0%)

Total	10 (28.5%)

Table 5.

Patient data

Pt	Sex/ Age	Eye	Time: Surgery to exchange (Mo)	VA (Decimal)			Number of cut (remaine d haptic)	Vit. loss	IOL position	n Cx	Ocular disease
Pt	Sex/ Age	Eye	Time: Surgery to exchange (Mo)	Before	After	F/U (Mo)	Number of cut (remaine d haptic)	Vit. loss	IOL position	n Cx	Ocular disease
1	F/82	L	51	0.7	1.0	9	1	-	B	-	-
2	F/71	R	46	HM	0.1	7	0	-	B	-	AMD
3	M/51	R	22	0.5	0.6	18	0	-	B	-	-
4	F/69	R	12	0.6	0.8	24	0	-	B	-	DMR
5	M/77	R	28	1	1	20	0	-	B	-	POAG
6	M/76	L	24	0.8	1.2	21	0	-	B	-
7	F/79	R	24	0.3	0.7	26	0	-	B	Zon	POAG
8	F/71	L	27	0.8	1.0	24	0	-	B	-	-
9	F/80	R	34	0.3	0.5	12	1	-	B	Zon	-
10	F/80	L	34	0.3	0.5	12	2	-	S	-	-
11	F/73	R	21	0.3	0.9	41	0	-	B	-	-
12	F/76	L	59	1	1	3	2	-	S	PC	-
13	M/87	R	81	0.1	0.6	22	2	-	S	-	-
14	M/61	L	55	0.2	0.5	38	0	+	S	-	-
15	M/77	L	85	0.9	0.4	13	2	-	S	-	PCO
16	F/75	R	50	0.2	0.4	8	0	+	S	PC	-
17	F/79	L	37	HM	0.9	14	0	-	S	-	-
18	F/70	R	56	0.15	0.7	4	2	-	S	-	IIOP
19	M/56	R	61	0.2	0.2	6	1	-	S	-	CME
20	F/54	L	12	0.8	1.0	21	1	+	S	PC	IIOP
21	F/71	L	33	0.7	0.6	18	2	-	S	-	DMR
22	M/76	R	45	0.5	1.2	11	1	-	S	-	DMR
23	M/37	L	30	0.4	1.0	6	2	-	S	-	-
24	F/65	L	49	0.4	0.9	4	1	-	S	-	Hypop
25	F/64	R	47	0.15	0.7	3	1	-	S	-	-
26	F/81	L	25	0.4	0.7	21	0	-	S	-	IIOP
27	F/68	L	31	0.9	0.9	49	0	+	S	PC, ZON	NTG
28	F/72	L	34	0.9	0.9	37	2	+	S	PC	NTG
29	M/44	R	47	0.5	1.0	4	2	-	S	-	-
30	F/85	R	74	0.3	0.1	8	1	-	S	- C	CME, POAG
31	F/80	R	12	0.4	0.4	5	0	+	S	PC	IIOP
32	F/76	L	49	0.5	1.0	4	1	+	S	PC	IIOP
33	F/85	R	36	HM	0.7	6	2	-	S	-	-
34	F/79	R	24	0.4	0.4	26	0	-	S	Zon	POAG
35	M/74	L	41	0.7	0.9	27	1	-	S	-	-

F/U=follow-up; Vit. Loss=vitreous loss; Cx=complication; HM=hand movement; AMD=age-related macular edema; DMR=diabetic mellitus retinopathy; POAG=primary open-angle glaucoma; PC=posterior capsule rupture; IIOP=increased intra-ocular pressure; CME=cystoid macular edema; Hypop=hypopyon; Zon=zonulysis; NTG=normal tension glaucoma.

TOOLS

Similar articles