Case report suggests surface calcification possible with hydrophilic acrylic IOLs

This report describes two cases in which patients implanted with the C-flex 570C hydrophilic acrylic IOL (Rayner Intraocular Lenses Ltd.) developed focal opacification about six months after combined vitrectomy and cataract surgery. Both patients subsequently underwent bilateral lens exchange. Similar anterior surface IOL opacification patterns were later identified via slit-lamp examination in two additional combined surgery patients. They had not undergone explantation because their visual disturbances were minimal.

No previous cases of opacification have been reported in patients with this IOL, which was introduced in 2003. However, one case has been reported in a pediatric patient with a Centerflex 570H IOL, which has the same composition and was introduced in 1999.

The two patients whose IOLs were explanted reported blurry vision approximately six months after combined surgery. Scanning electron microscopy of the explanted IOLs confirmed the presence of cracks and granules. Energy-dispersive X-ray spectroscopy demonstrated calcium deposition. Slit-lamp examination revealed well-demarcated uniform focal granular protrusions.

Because IOL opacification developed in all four eyes that had combined surgery but not in eyes that underwent cataract surgery alone, the authors suggest that combined surgery may increase inflammation and calcium concentration in the anterior chamber, possibly through breakdown of the blood-aqueous barrier. In addition, because the opacification and fine cracks on the IOL surface were limited to the papillary area at the center of the optic, there may have been a relationship between IOL opacification and long-lasting postoperative inflammation or inflammatory membrane formation in the anterior chamber.