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Opacification of the optic of an Akeos Adapt ® intraocular lens

Opacification of the optic of an Akeos Adapt ® intraocular lens. Chong Eun Lee, MD, Sung Dong Chang, MD, PhD Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea. The authors have no financial interest. INTRODUCTION.

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Opacification of the optic of an Akeos Adapt ® intraocular lens

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  1. Opacification of the optic ofan Akeos Adapt® intraocular lens Chong Eun Lee, MD, Sung Dong Chang, MD, PhD Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea The authors have no financial interest

  2. INTRODUCTION • The opacifications of intraocular lens, causing the removal or exchange of implanted intraocular lens, have been reported to occur in some hydrophilic acrylic intraocular lens (IOL) • We experienced a case of the opacification of hydrophillic intraocular lens (Akreos Adapt ®, Bausch & Lomb) • To our knowledge, there was no prior report of an opacification in that IOL

  3. CASE REPORT • 55-year-old man • 28-year-history of diabetes mellitus (DM) • Also receiving peritoneal dialysis for chronic renal failure • Two months before, at other eye hostpital • pars planavitrectomy, panretinal photocoagulation (for proliferative diabetic retinopathy) • phacoemulsification & implantation of hydrophillic acryl intraocular lens in the capsular bag (Akreos Adapt ®, Bausch & Lomb)

  4. CASE REPORT • At the time of the first visit, the patient presented with proliferative diabetic retinopathy in both eyes and clinically significant macular edema • Initial best corrected visual acuity (OD) : 0.08 • Four months later • BCVA (OD) finger count 10 cm • Intraocular pressure (OD) 38 mmHg • Rubeosis c hyphema in the right eye • Dx. : neovascular glaucoma (OD)

  5. CASE REPORT • Ahmed valve implantation(OD) through pars plana, at our hospital • 5 months following the surgery of glaucoma (10 months following the implantation of IOL) • BCVA (OD) 0.08 • Microhyphema still present • IOL opacification found

  6. CASE REPORT • 45 months following the implantation of IOL • BCVA (OD) hand motion • disappearance of hyphma • IOL opacification causing a decreased VA was found (Figure 1) • IOL was explanted from the right eye & Hydrophobic acrylic IOL, YA-60BB (HOYA®, Japan), was implanted into the sulcus

  7. Figure 1. Intraoperative photograph of the right eye showing opacification of Akreos Adapt ® IOL. The arrows show the edges of the opacified area of IOL.

  8. CASE REPORT • Postoperatively, the patient did not exhibit specific complications and the visual acuity was improved to 0.04 • 6 months postoperatively, the corrected visual acuity was maintained as 0.06 due to macular edema

  9. DISCUSSION • Exchange of IOL d/t the postoperative opacification has been reported • Hydroview® (Bausch & Lomb) • ACRL-60 (Ophthalmed Inc.) • MemoryLens® (Ciba Vision) • AquaSense® (Ophthalmic Innovations International) • SC60B-OUV (Medical Developmental Research) • Centerflex® 570H (Rayner) * Akros Fit® (Bausch & Lomb) : no clinically notable decrease of VA, exchange of IOL was not performed

  10. DISCUSSION • Unfortunately histopathological assessments was not performed • Deposition of minerals including Ca2+ on the surface of optical part is assumed to be the causative factor • 28-year-history of diabetes & inflammatory responses due to hyphema developed during the clinical course of patients affected the opacification of IOLs

  11. CONCLUSION • We report our case of the opacification of hydrophillic IOLs (Akreos Adapt®, Bausch & Lomb) which was not reported previously • In patients with DM, the substances forming IOLs must be considered for cataract surgery • Further histopathological studies are warranted to analyze the causes of opacification of hydrophilic Akreos intraocular lens

  12. REFERENCES Werner L. Causes of intaocular lens opacification or discoloration. J Cataract Refract Surg 2007;33:713-726 Kim HG, Lee SH, Choi YJ. Late Postoperative Opacification of the Foldable Hydrophilic Acrylic Intraocular Lens, ACRL-160. J Korean Ophthalmol Soc 2003;44(2):315-320 Pandey SK, Werner L, Apple DJ, Gravel J-P. Calium precipitation on the optical surfaces of a foldable intraocular lens: a clinicopathological correlation. Arch Ophthalmol 2002;120:391-393 Ha MS, Kang BD, Myung NH, Chang MH. Postoperative Deposition of Calcium on the Surface of a Hydrophilic Acrylic IOL in the Diabetic Patients. J Korean Ophthalmol Soc 2002;43(2):375-380 Pombo C, Bokser L, Casabiell X. Partial characterization of a putative new growth factor present in pathological human vitreous. Graefe’s Arch Clin Exp Ophthalmol 1996;234:155-163

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