[Intraocular Lens Opacification Following Posterior Lamellar Keratoplasty].

BACKGROUND

The opacification of an artificial intraocular lens is a rare but serious complication following cataract surgery as an exchange of the intraocular lens can become necessary. At our eye center we observed single cases of IOL opacifications following complicated posterior lamellar keratoplasty (Descemet stripping automated endothelial keratoplasty = DSAEK or Descemet membrane endothelial keratoplasty = DMEK). Therefore, we performed a retrospective analysis of all our digital charts regarding the incidence of this serious complication with respect to posterior lamellar keratoplasty, penetrating keratoplasty or sole cataract extraction.

METHODS

We searched our digital patient database from 2003 to 2015 using the following headings: intraocular lens, artificial lens or IOL and opacification or calcification and selected only those patients who had undergone either DSAEK, DMEK, penetrating keratoplasty or sole cataract surgery (n = 19,565).

RESULTS

In total we found five IOL opacifications out of 153 DSAEK and two out of 450 DMEK cases, respectively. Five of these seven cases had a complicated clinical course with repeated rebubbling or additional intraocular surgery (i.e., repeat DSAEK or DMEK or secondary penetrating keratoplasty). There were no documented IOL opacifications following penetrating keratoplasty or sole cataract extraction. In two cases intraocular lens exchange became necessary. All opacifications showed similar clinical appearance in form of small granular deposits on the surface of the intraocular lens. Almost all implanted lenses were made from hydrophilic acrylate.

DISCUSSION

In total we found seven cases of intraocular lens opacification that have only been observed following DSAEK or DMEK. According to reports from the literature these opacifications are superficial calicifications of the hydrophilic lenses. As five of the seven cases had a complicated clinical course, the repeated air contact of the lens could be one major factor in inducing the calcification. Besides the air contact a breakdown of the blood-aqueous barrier could also play a role in the induction of calcium phosphate crystallisation on the intraocular lens. The risk of this serious complication in mainly hydrophilic intraocular lenses with respect to posterior lamellar keratoplasty should be kept in mind for the selection of the type of intraocular lens in patients with endothelial diseases or in patients undergoing combined cataract extraction and DSAEK/DMEK.