Xie J, Liu T, Huang Y S, Wu X M, Dai Y H
Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, China.
Zhonghua Yan Ke Za Zhi. 2021 Jul 11;57(7):512-518. doi: 10.3760/cma.j.cn112142-20200924-00614.
To analyze the cause of late postoperative opacification of hydrophilic acrylic intraocular lenses (IOLs) and the effect of IOL replacement surgery. This retrospective case series study comprised 15 eyes of 15 patients who were diagnosed as late postoperative opacification of hydrophilic acrylic IOLs from January 2019 to June 2020 at Qingdao Eye Hospital of Shandong First Medical University. The clinical data of patients were reviewed, and two IOLs were examined by scanning electron microscopy and energy dispersive X-ray spectroscopy. The intraoperative and postoperative complications of IOL replacement surgery were evaluated, and best corrected visual acuity was compared before and after surgery. Preoperative and postoperative data were compared using the paired test. The interval between the first IOL implantation and the detection of IOL opacification in 15 patients was (27.3±5.9) months. All the 15 patients had unilateral IOL opacification, and 9 patients had hypertension. Glycosylated hemoglobin A1c was significantly higher than the normal value in 4 of the 10 patients who underwent cataract surgery at our hospital. Confocal microscopy disclosed coralliform deposits on the superficial IOL optic. Scanning electron microscopy and energy dispersive X-ray spectroscopy showed the presence of calcium and phosphorus crystals in the opacification region of IOLs. Visual acuity in all 13 eyes receiving IOL exchange was significantly improved from 1.03±0.64 (logarithm of the minimum angle of resolution) to 0.39±0.21 (<0.05). Posterior capsule rupture (4 eyes), new IOL implanted in the ciliary sulcus (3 eyes) and zonule breaking (1 eye) occurred during IOL replacement. IOL opacification is related with the IOL material and calcium ion concentration on the IOL surface. IOL replacement surgery can improve visual acuity safely and effectively. .
分析亲水性丙烯酸人工晶状体（IOL）术后晚期混浊的原因及IOL置换手术的效果。本回顾性病例系列研究纳入了2019年1月至2020年6月在山东第一医科大学附属青岛眼科医院被诊断为亲水性丙烯酸IOL术后晚期混浊的15例患者的15只眼。回顾患者的临床资料，对两枚IOL进行扫描电子显微镜和能量色散X射线光谱分析。评估IOL置换手术的术中及术后并发症，并比较手术前后的最佳矫正视力。术前和术后数据采用配对检验进行比较。15例患者首次IOL植入至IOL混浊检测的间隔时间为（27.3±5.9）个月。15例患者均为单眼IOL混浊，9例患者患有高血压。在我院接受白内障手术的10例患者中，4例糖化血红蛋白A1c显著高于正常值。共聚焦显微镜检查显示IOL光学表面有珊瑚状沉积物。扫描电子显微镜和能量色散X射线光谱分析显示IOL混浊区域存在钙和磷晶体。所有接受IOL置换的13只眼的视力从1.03±0.64（最小分辨角对数）显著提高至0.39±0.21（<0.05）。IOL置换术中发生后囊破裂4眼、新IOL植入睫状沟3眼和悬韧带断裂1眼。IOL混浊与IOL材料及IOL表面钙离子浓度有关。IOL置换手术能安全有效地提高视力。
