Transient intraoperative opacification of a Carlevale intraocular lens

Various pathologic processes may lead to clinically significant opacification or discoloration of the optic component of intraocular lenses (IOLs) manufactured from different biomaterials and in different designs. Factors such as the patient's associated conditions, the manufacturing process, the method of IOL storage, the surgical technique and adjuvants, or a combination of these may be involved. The complication may be observed intraoperatively or postoperatively from a few hours after implantation to many years after surgery, depending on the processes involved. Based on a review of the literature as well as our own laboratory analyses, the following types of processes were identified: formation of deposits/precipitates on the IOL surface or within the IOL substance; opacification by excess influx of water in hydrophobic materials; direct discoloration by capsular dyes or medications; coating by substances such as ophthalmic ointment and silicone oil; and a slow, progressive degradation of the IOL biomaterial.

A 83-year-old woman underwent phacoemulsification in the left eye, complicated by posterior capsular rupture and dislocation of nuclear fragments in the vitreous cavity. She was left aphakic and referred to the Clinica Oculistica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. After 2 days, she underwent pars plana vitrectomy, with removal of the nuclear fragments, and secondary intraocular lens (IOL) implantation. The lens used was a sutureless scleral fixation Carlevale lens (I71 FIL SSF Carlevale lens™. Soleko IOL Division), which was delivered to the operating theatre on the morning of the operation. During the implantation, it appeared opaque, without any deposit on its surfaces. The lens was not removed. On the next day, the lens was transparent, and it remained clear at the following control visits. An in vitro experimental test demonstrated that 25% hydrophilic polymers are vulnerable to thermal shock, developing an opacification which resolves after temperature stabilization of the lens.