Sir,
We read with interest the UK case series recently reported in Eye detailing four cases of intraocular lens (IOL) opacification following Descemet’s stripping automated endothelial keratoplasty (DSAEK).1 This is a serious complication that causes visual loss and may necessitate IOL exchange that can adversely affect the long-term survival the corneal transplant.
All of the cases in the report involved Rayner (Hove, UK) hydrophilic acrylic IOL’s and all involved rebubbling (repeat injection of intracameral air to achieve graft attachment). This series supports previous observations that such opacification appears to be almost unique to hydrophilic acrylic IOL’s, and furthermore, having air or gas in the anterior chamber appears to be a risk factor.2, 3
However, it is certainly possible for this complication to occur without rebubbling. Although all four cases had rebubbling in this series,1 in our recently published UK series only two of the five cases had rebubbling.4 In our series, all five cases were also hydrophilic acrylic IOL’s, although only one was a Rayner implant highlighting that this problem relates to hydrophilic acrylic material regardless of the manufacturer (other IOL’s that opacified included Zeiss, STABIBAG; Lenstec, LH 3000; Bausch and Lomb, MI60 and Bausch and Lomb, Akreos).4
We agree with the authors that patients requiring cataract surgery who are at risk of corneal endothelial failure (typically those with Fuchs’ endothelial dystrophy) should not have a hydrophilic acrylic IOL inserted regardless of the manufacturer, in order to avoid the risk of IOL opacification. Although rebubbling may be a risk factor, our series demonstrates the complication can occur after DSAEK without rebubbling.
The number of corneal transplants in the UK has increased significantly in the last decade (2206 in 2002 rising to 3455 in 2011).5 The proportion of endothelial transplants has risen markedly (0% in 2002 to 33% in 2011) and this is now almost as common as penetrating keratoplasty (33% vs 38%, respectively).5 In the future, a significant number of patients may develop the serious complication of IOL opacification following DSAEK, and this could be reduced if cataract surgeons avoid hydrophilic acrylic IOL insertion in patients at risk of corneal endothelial failure.
References
De Cock R, Fajgenbaum MAP . Calcification of Rayner hydrophilic acrylic intra-ocular lenses after Descemet’s stripping automated endothelial keratoplasty. Eye 2014; 28: 1383–1384.
Neuhann IM, Neuhann TF, Rohrbach JM . Intraocular lens calcification after keratoplasty. Cornea 2013; 32: e6–e10.
Dhital A, Spalton DJ, Goyal S, Werner L . Calcification in hydrophilic intraocular lenses associated with injection of intraocular gas. Am J Ophthalmol 2012; 153 (6): 1154–1160.
Park JC, Habib NE, Moate RM . Intraocular lens opacification after corneal endothelial keratoplasty: Electron microscopy and x-ray element spectroscopy analysis. J Cataract Refract Surg 2015; 41: 140–145.
UK Transplant Registry. NHS Blood and Transplant authority, 2002 to 2011.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Park, J., Habib, N. & Moate, R. Intraocular lens calcification following endothelial keratoplasty: a message for all cataract surgeons. Eye 29, 984 (2015). https://doi.org/10.1038/eye.2015.49
Published:
Issue Date:
DOI: https://doi.org/10.1038/eye.2015.49