Main Article Content
Abstract
PURPOSE
To report a case of late calcification of a hydrophilic acrylic IOL (Intraocular Lens) eight years after uncomplicated cataract surgery, highlighting its clinical presentation, management, and histopathological features.
CASE REPORT
A 54-year-old female presented with a three-year history of progressive, painless diminution of vision in the right eye. She had undergone bilateral cataract surgery eight years earlier, with no systemic comorbidities or additional ocular procedures. Best-corrected visual acuity (BCVA) was 2/60 in the right eye and 6/9 in the left eye. Slit-lamp examination revealed complete opacification of the right eye IOL with absent red reflex, while the left IOL was clear. Routine systemic investigations were normal.
RESULTS
The patient underwent right eye IOL exchange. A 6-mm scleral tunnel was created, and the opacified hydrophilic IOL was explanted intact. A rigid PMMA IOL was implanted in the capsular bag. Postoperatively, the patient was treated with topical corticosteroids, non-steroidal anti-inflammatory drugs, and intraocular pressure–lowering agents. On day one, BCVA improved to 6/9 in the operated eye. Histopathological analysis of the explanted IOL revealed calcium deposits on both anterior and posterior surfaces, consistent with late calcification.
CONCLUSION
Late IOL calcification is a rare but significant cause of postoperative visual decline, particularly with hydrophilic acrylic lenses. Diagnosis requires clinical suspicion and histopathological confirmation. Since no medical treatment is effective, the definitive management involves surgical explantation and exchange. Case documentation is essential to enhance understanding of risk factors and inform IOL material selection in cataract surgery.
Article Details
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References
- Neuhann T, Kleinmann G, Apple DJ. A new classification of calcification of intraocular lenses. Ophthalmology 2008;115(1):73-9.
- Werner L. Glistening and surface light scattering in intraocular lenses. J Cataract Refract Surg 2010;36(8):1398-420.
- Mamalis N, Brubaker J, Davis D, et al. Pathology of intraocular lenses explanted because of optic opacification. J Cataract Refract Surg 2004;30(7):1451-61.
- Werner L, Apple DJ, Escobar-Gomez M, et al. Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens. Ophthalmology 2000;107(12):2179-85.
- Ng JY, Ruddock K, Moore N, et al. Opacification of hydrophilic acrylic IOL following vitrectomy with silicone oil tamponade: case series. Can J Ophthalmol 2021;56(1): e11-5.
- Bompastor-Ramos P, Neves A, Rosa AM, et al. Intraocular lens opacification: clinical study and literature review. Eur J Ophthalmol 2019;29(2):126-32.
- Purbrick RMJ, Stavrakas P, Porooshani H, et al. Calcification of a Rayner Centerflex 570H hydrophilic acrylic intraocular lens following vitrectomy for retinal detachment: a clinicopathologic report. Eye (Lond) 2010;24(4):799-801.
- Dhaliwal DK, Mamalis N, Olson RJ, et al. Visual significance of glistening seen in the AcrySof intraocular lens. J Cataract Refract Surg 1996;22(4):452-7.
- Rezaei-Kanavi M, Javadi MA, Tabatabaei H, et al. Intraocular lens calcification: clinicopathological report. J Ophthalmic Vis Res 2012;7(1):71-4.
- Mak ST, Wong AC, Leung AT, et al. Calcification of a hydrophilic acrylic intraocular lens: clinicopathological report. J Cataract Refract Surg 2008;34(12):2166-9.
- Gartaganis SP, Kanellopoulou DG, Mela EK, et al. Opacification of hydrophilic acrylic intraocular lens attributable to calcification: investigation on mechanism. Am J Ophthalmol 2008;146(3):395-403.
- Grzybowski A, Markeviciute A, Zemaitiene R. A narrative review of intraocular lens opacifications: update 2020. Ann Transl Med 2020;8(22):1547.
- Łabuz G, Reus NJ, van den Berg TJ, et al. Intraocular lens opacification: laboratory investigations and clinical findings. Acta Ophthalmol 2019;97(5):498-506.
- Darcy K, Apel A, Donaldson M, et al. Calcification of hydrophilic acrylic intraocular lenses following intraocular surgery. Br J Ophthalmol 2019;103(12):1700-3.
- Bala C, Păunescu G, Mănescu R, et al. Management of opacified intraocular lenses: outcomes after explantation and exchange. Rom J Ophthalmol 2018;62(1):29-35.
References
Neuhann T, Kleinmann G, Apple DJ. A new classification of calcification of intraocular lenses. Ophthalmology 2008;115(1):73-9.
Werner L. Glistening and surface light scattering in intraocular lenses. J Cataract Refract Surg 2010;36(8):1398-420.
Mamalis N, Brubaker J, Davis D, et al. Pathology of intraocular lenses explanted because of optic opacification. J Cataract Refract Surg 2004;30(7):1451-61.
Werner L, Apple DJ, Escobar-Gomez M, et al. Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens. Ophthalmology 2000;107(12):2179-85.
Ng JY, Ruddock K, Moore N, et al. Opacification of hydrophilic acrylic IOL following vitrectomy with silicone oil tamponade: case series. Can J Ophthalmol 2021;56(1): e11-5.
Bompastor-Ramos P, Neves A, Rosa AM, et al. Intraocular lens opacification: clinical study and literature review. Eur J Ophthalmol 2019;29(2):126-32.
Purbrick RMJ, Stavrakas P, Porooshani H, et al. Calcification of a Rayner Centerflex 570H hydrophilic acrylic intraocular lens following vitrectomy for retinal detachment: a clinicopathologic report. Eye (Lond) 2010;24(4):799-801.
Dhaliwal DK, Mamalis N, Olson RJ, et al. Visual significance of glistening seen in the AcrySof intraocular lens. J Cataract Refract Surg 1996;22(4):452-7.
Rezaei-Kanavi M, Javadi MA, Tabatabaei H, et al. Intraocular lens calcification: clinicopathological report. J Ophthalmic Vis Res 2012;7(1):71-4.
Mak ST, Wong AC, Leung AT, et al. Calcification of a hydrophilic acrylic intraocular lens: clinicopathological report. J Cataract Refract Surg 2008;34(12):2166-9.
Gartaganis SP, Kanellopoulou DG, Mela EK, et al. Opacification of hydrophilic acrylic intraocular lens attributable to calcification: investigation on mechanism. Am J Ophthalmol 2008;146(3):395-403.
Grzybowski A, Markeviciute A, Zemaitiene R. A narrative review of intraocular lens opacifications: update 2020. Ann Transl Med 2020;8(22):1547.
Łabuz G, Reus NJ, van den Berg TJ, et al. Intraocular lens opacification: laboratory investigations and clinical findings. Acta Ophthalmol 2019;97(5):498-506.
Darcy K, Apel A, Donaldson M, et al. Calcification of hydrophilic acrylic intraocular lenses following intraocular surgery. Br J Ophthalmol 2019;103(12):1700-3.
Bala C, Păunescu G, Mănescu R, et al. Management of opacified intraocular lenses: outcomes after explantation and exchange. Rom J Ophthalmol 2018;62(1):29-35.