Calcification of Hydrophilic Acrylic Intraocular Lenses with a Hydrophobic Surface Following Uneventful Descemet’s Stripping Automated Endothelial Keratoplasty

Abstract

Purpose: This is a retrospective, observational case series of 43 patients who underwent Descemet’s striping automated endothelial keratoplasty with implants of hydrophilic acrylic intraocular lenses with hydrophobic surface (Lentis LS-302-Y or Lentis L-302-1). Methods: Patients diagnosed with intraocular lens opacification after Descemet’s striping automated endothelial keratoplasty were identified from clinic records, with minimal 18-month postoperative follow-up guaranteed in 36 eyes. Analysis included demographic data, indication for Descemet’s striping automated endothelial keratoplasty, ocular comorbidities, intraocular lens specification, complications, postoperative course, incidence of lens exchange due to intraocular lens opacification, and corrected distance visual acuity (Snellen) before surgery and before and after intraocular lens opacification. Two explanted intraocular lenses were subjected to detailed light microscopy, optical profilometry, and scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/ EDS). Results: Opacification occurred in 81% of Lentis LS-302-Y (25/31) and in 92% of Lentis L-302-1 (11/12) intraocular lenses. The morphology of surface irregularity indicates that formation begins inside the intraocular lens material, with deformation of the polymer surface is secondary to the growth of crystal granules in the anterior subsurface area. SEM/ EDS analysis revealed significant peaks for calcium and phosphate. The presence of silicon in the examined areas of an opacified intraocular lens is worth noting. The high incidence of this complication with this particular type of intraocular lens after Descemet’s striping automated endothelial keratoplasty suggests that material-related factors may play an important role in the development of calcification. Conclusion: Because of the increased risk of opacification after Descemet’s striping automated endothelial keratoplasty, hydrophilic and hydrophilic-hydrophobic acrylic intraocular lenses should be avoided in patients with endothelial cell disorders.

Keywords

• descemet's stripping automated endothelial keratoplasty (dsaek)
• intraocular lens (iol)
• intraocular lens explantation
• opacification