Hydrogel Intraocular Lens Exchange: Five-Year Experience

P E Theoulakis; C K Brinkmann; I K Petropoulos; M I Gatzogias; J M Katsimpris

doi:10.1055/s-0028-1109302

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2009; 226(4): 254-257
DOI: 10.1055/s-0028-1109302

Originalarbeit

Hydrogel Intraocular Lens Exchange: Five-Year Experience

Hydrogel-Intraokularlinsen-Austausch: Erfahrungen aus 5 JahrenP. E. Theoulakis¹ , C. K. Brinkmann¹ , I. K. Petropoulos² , M. I. Gatzogias³ , J. M. Katsimpris³

¹University Eye Clinic, Inselspital Bern, Bern, Switzerland (Chairman: Prof. Dr. med. S. Wolf)
²Ophthalmological Center of Terrassière, Geneva, Switzerland (Chairmen: Dr. med. P. M. Desmangles, Dr. med. M. A. Matter)
³Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece (Chairman: Dr. med. D. Feretis)

Abstract

Zusammenfassung

Hintergrund: Beurteilung der Visuswerte (BCVA) prä- und postoperativ unter Berücksichtigung peri- und postoperativer Komplikationen. Patienten und Methoden: An 55 Patienten (55 Augen) wurden eingetrübte Hydrogel-Intraokularlinsen (IOLs) (Hydroview® H 60 M, Bausch & Lomb) ausgetauscht. Prä- und postoperative BCVA sowie peri- und postoperative Komplikationen wurden im Zeitraum von 3 – 24 Monaten erfasst. Ergebnisse: Durchschnittliche BCVA verbesserte sich statistisch signifikant von 0,05 präoperativ auf 0,4 nach 3 Monaten sowie 0,2 am Ende der Beobachtungszeit. 40 Patienten (72,2 %) erreichten eine Visusbesserung. Keine Komplikationen waren bei 30 Augen (54,5 %) mit kompletter Entfernung der eingetrübten Optik und der Haptik zu verzeichnen. Perioperative Komplikationen umfassten Zonuladehiszenz bei 10 (18,2 %), En-Block-kapsuläre-IOL-Extraktion bei 2 (3,6 %), hintere Kapselruptur bei 2 (3,6 %), Hyphäma bei 3 Augen (5,5 %) sowie Haptik-Einklemmung bei 8 Augen (14,5 %). Postoperativ kam es zu Hornhautdekompensation bei 5 (9,1 %), zystoidem Makulaödem bei 15 (27,3 %), erhöhtem Intraokulardruck bei 6 (10,9 %) sowie Netzhautablösung bei einem Auge (1,8 %). Schlussfolgerung: Obwohl Sehschärfe sich nach IOL-Austausch verbessert, können okuläre Begleiterkrankungen und postoperative Komplikationen das erwartete Endergebnis beeinflussen. Ausführliche Patientenaufklärung ist daher unverzichtbar.

Abstract

Background: This study presents an evaluation of the preoperative and postoperative best corrected visual acuity (BCVA), as well as of the incidence of perioperative and postoperative complications after opacified hydrogel intraocular lens (IOL) exchange. Patients and Methods: We exchanged opacified hydrogel IOLs (Hydroview® H 60 M, Bausch & Lomb) in 55 patients (55 eyes). Preoperative and postoperative BCVA were compared. Intraoperative and postoperative complications were recorded. Follow-up period ranged from 3 months to 24 months. Results: Mean BCVA improved significantly from 0.05 preoperatively to 0.4 at 3 months postoperatively and to 0.2 at the end of the follow-up period. Forty patients (72.7 %) reported visual improvement. The procedure was uneventful in 30 eyes (54.5 %) with complete removal of the opacified IOL optics and haptics. Intraoperative complications included partial zonular dehiscence in 10 eyes (18.2 %), en block capsular bag-IOL extraction in 2 eyes (3.6 %), posterior capsule rupture in 2 eyes (3.6 %), hyphema in 3 eyes (5.5 %), retained haptics in 8 eyes (14.5 %). Postoperative complications included corneal decompensation in 5 eyes (9.1 %), cystoid macular edema in 15 eyes (27.3 %), elevated intraocular pressure in 6 eyes (10.9 %), and retinal detachment in 1 eye (1.8 %). Conclusions: Visual acuity improved after opacified hydrogel IOL exchange, however, coexistent ocular morbidity as well as the appearance of serious postoperative complications may not yield the expected results. For these reasons extensive informed consent is mandatory.

Schlüsselwörter

eingetrübte Hydrogel-Intraokularlinsen - IOL-Austausch - Komplikationen

Key words

opacified hydrogel intraocular lenses - IOL exchange - complications

Full Text

References

1 Abela-Fomanek C, Amon M, Schauersberger J. et al . Results of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in uveitic eyes with cataract, comparison to a control group. J Cataract Refract Surg. 2002; 28 1141-1152
2 Abela-Fomanek C, Amon M, Schauersberger J. et al . Uveal and capsular biocompatibility of 2 foldable acrylic intraocular lenses in patients with uveitis or pseudoexfoliation syndrome, comparison to a control group. J Cataract Refract Surg. 2002; 28 1160-1172
3 Abela-Formanek C, Amon M, Schild G. et al . Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses. J Cataract Refract Surg. 2002; 28 50-61
4 Allarakhia L, Knoll R, Lindstrom R L. Soft intraocular lenses. J Cataract Refract Surg. 1987; 13 607-620
5 Apple D J, Werner L, Escobar-Gomez M. et al . Deposits on the optical surfaces of Hydroview intraocular lenses (letter). J Cataract Refract Surg. 2000; 26 796-797
6 Baykal O. Late opacification of a hydrophilic acrylic intraocular lens. Acta Ophthalmol Scand. 2003; 81 79-80
7 Chang B YP, Davey K G, Gupta M. et al . Late clouding of an acrylic intraocular lens following routine phacoemulsification (letter). Eye. 1999; 13 807-808
8 Chehade M, Elder M J. Intraocular lens materials and styles: a review. Aust NZ J Ophthalmol. 1997; 25 255-263
9 Dahlmann A H, Dhingra N, Chawdhary S. Acrylic lens exchange for late opacification of the optic [correspondence]. J Cataract Refract Surg. 2002; 28 1713-1714
10 Dorey M W, Brownstein S, Hill V. et al . Proposed pathogenesis for the delayed postoperative opacification of the Hydroview Hydrogel intraocular lens. Am J Ophthalmol. 2003; 135 591-598
11 Fernando G T, Crayford B B. Visually significant calcification of hydrogel intraocular lenses necessitating explantation. Clin Exp Ophthalmol. 2000; 28 280-286
12 Frohn A, Dick B B, Augustin A J. et al . A late opacification of the foldable hydrophilic acrylic lens SC 60B-OUV. Ophthalmology. 2001; 108 1999-2004
13 Groh J M M, Schlötzer-Schrehardt U, Rummelt C. et al . Postoperative Kunstlinsen-Eintrübungen bei Hydrogel-Intraokularlinsen (Hydroview). Klin Monatsbl Augenheilkd. 2001; 218 645-648
14 Holladay J T, Prager T C, Chandler T Y. et al . A three-part system for refining intraocular lens power calculations. J Cataract Refract Surg. 1988; 14 17-24
15 Izak A M, Werner L, Pandey S K. et al . Calcification of modern foldable hydrogel intraocular lens designs. Eye. 2003; 17 393-406
16 Katsimpris J M, Koliakou N, Petropoulos I K. et al . Opacification of hydrophilic acrylic intraocular lenses: a clinical and ultrastructural analysis of three explanted lenses. Klin Monatsbl Augenheilkd. 2003; 220 165-169
17 Kocabora M S, Engin G, Kaya G. et al . Calcification of hydrophilic acrylic intraocular lenses: clinical and pathological aspects. J Fr Ophthalmol. 2004; 27 871-876
18 Koch H R. Lens bisector for silicone intraocular lens removal. J Cataract Refract Surg. 1996; 22 1379-1380
19 Kohnen T, Magdowsky G, Koch D D. Scanning electron microscopic analysis of foldable acrylic and hydrogel intraocular lenses. J Cataract Refract Surg. 1996; 22 1342-1350
20 Koo E Y, Lindsey P S, Soukiasian S H. Bisecting a foldable acrylic intraocular lens for explantation. J Cataract Refract Surg. 1996; 22 1381-1382
21 Legeais J M, Werner L, Werner L P. et al . Les matériaux pour implants intraoculaires. Partie III: les implants intraoculaires acryliques souples. J Fr Ophtalmol. 2001; 24 309-318
22 Mamalis N. Complications of foldable intraocular lenses requiring explantation or secondary intervention – 2001 survey update. J Cataract Refract Surg. 2002; 28 2193-2201
23 Mamalis N, Davis B, Nilson C. et al . Complications of foldable intraocular lenses requiring explantation or secondary intervention – 2003 survey update. J Cataract Refract Surg. 2004; 30 2209-2218
24 Mattová J, Bohácová E, Murgasová Z. et al . Opacification of hydrophilic MemoryLens U 940A intraocular lenses. Analysis of 2 explanted lenses. J Cataract Refract Surg. 2004; 30 1934-1939
25 Neuhann T H. Intraocular folding of an acrylic lens for explantation through a small incision cataract wound. J Cataract Refract Surg. 1996; 22 1383-1386
26 Neuhann I, Werner L, Izak A. et al . Late postoperative opacification of hydrophilic Acrylic (Hydrogel) Intraocular lens. A clinicopathological analysis of 106 explants. Ophthalmology. 2004; 111 2094-2101
27 Retzlaff J A, Sanders D R, Kraff M C. Development of the SRK/T intraocular lens implant power calculation formula. J Cataract Refract Surg. 1990; 16 333-340
28 Seward H C. Folding intraocular lenses: materials and methods (commentary). Br J Ophthalmol. 1997; 81 340-341
29 Tehrani M, Dick H B, Wolters B. et al . Material properties of various intraocular lenses in an experimental study. Opthalmologica. 2002; 218 57-63
30 Tehrani M, Mamalis N, Wallin T. et al . Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses. Case series and review. J Cataract Refract Surg. 2004; 30 115-122
31 Werner L, Apple D J, Escobar-Gomez M. et al . Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens. Ophthalmology. 2000; 107 2179-2185
32 Werner L, Apple D J, Kaskaloglu M. et al . Dense opacification of the optical component of a hydrophilic acrylic intraocular lens, a clinicopathological analysis of 9 explanted lenses. J Cataract Refract Surg. 2001; 27 1485-1492
33 Werner L, Legeais J M. Les matériaux pour implants intraoculaires. Partie II: Les implants intraoculaires souples en silicone. J Fr Ophtalmol. 1999; 22 492-501

John M. Katsimpris, MD, PhD

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Greece

Phone: ++ 30/261/0 64 34 97 , ++ 30/6 93/6 95 09 50

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Email: jkatsimpris@yahoo.com