Clinical Features of Patients with Opacification of Hydrophilic Acrylic Intraocular Lens in Neovascular Glaucoma

Purpose: To report the clinical features of patients with opacification of hydrophilic acrylic intraocular lens (IOL) after cataract surgery in neovascular glaucoma.Methods: This retrospective case series included 11 eyes of 10 patients with IOL opacification and neovascular glaucoma (NVG) between January 2006 and December 2010. We included and analyzed cases with opacification of hydrophilic acrylic IOL. An IOL exchange was performed in three cases, and the explanted IOLs were examined grossly and evaluated by light microscopy. Sagittal sections of the optics of the IOLs were evaluated by Von Kossa staining, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX).Results: All 11 eyes of 10 patients were implanted with hydrophilic acrylic IOLs. In addition, there were no cases of hydrophobic acrylic IOL opacification. Nine patients of the 10 patients had diabetic retinopathy and one patient had central retinal artery occlusion. The mean period of IOL opacification after IOL implantation was 19.45 ± 8.52 months and the mean period of IOL opacification after the occurrence of NVG was 14.37 ± 8.51 months. The deposits of the explanted IOLs were shown to consist of calcium by von Kossa staining. The explanted IOLs showed fine whitish irregular granular deposits on the entire anterior surface of the optics by SEM and the presence of calcium deposition was confirmed by EDX analysis.Conclusions: Care is required when using hydrophilic acrylic IOLs in patients with risk of neovascular glaucoma, such as those with diabetic retinopathy or central retinal artery occlusion.

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Central retinal artery and vein occlusion as a complication of persistent hyaloid artery – a case report

BMC Ophthalmology ◽

10.1186/s12886-020-01702-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mirjana Bjeloš ◽

Ana Križanović ◽

Mladen Bušić ◽

Biljana Kuzmanović Elabjer

Keyword(s):

Case Report ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Venous Stasis ◽

Vein Occlusion ◽

Arterial Inflow ◽

Retinal Artery

Abstract Background In this case report, we present for the first time central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) as a complication of persistent hyaloid artery (PHA). Case presentation In August 2019, a six-year-old male patient manifested right eye (RE) excessive tearing, conjunctival injection and pain. On examination, RE demonstrated light perception and intraocular pressure of 36 mmHg. The diagnoses of neovascular glaucoma, CRVO and CRAO were established as affirmed with fluorescein angiography (FA). PHA was not reported. Extensive work-up and family history were unremarkable. The child was born on term after uncomplicated twin pregnancy. In December 2019, he was referred to our Centre. Transillumination revealed fully dilated, non-reactive RE pupil, clear lens and tubular remnant of HA containing blood cells in its lumen freely rotating in the anterior vitreous. Conclusions PHA results from failure of apoptosis during gestation. It can easily be observed during the red reflex screening at neonatal wards. We hypothesized that PHA twisting led to torsion of the residual primordial common bulb, branching off to HA and CRA with CRAO occurring first. The consequential CRVO presumably advanced by venous stasis due to decrease in arterial inflow. Liquid vitreous appears as early as 4 years of age enabling PHA to whirl more freely. Thus, in case of PHA, we advocate FA to be performed and if connection with retinal artery is proven, parents should be informed on the possible devastating complications and prompt surgical treatment should be considered.

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