Study finds 5% incidence of IOL opacification after DSEK

Issue: January 10, 2016

IOL opacification was identified in 5% of eyes that underwent Descemet’s stripping endothelial keratoplasty, according to one study.

Perspective from Marianne O. Price, PhD

Investigators retrospectively analyzed the records of 160 pseudophakic eyes that underwent DSEK between 2003 and 2013. They assessed the interval between DSEK and diagnosis of IOL opacification, Snellen corrected distance visual acuity before and after opacification, IOL specifications and incidence of IOL exchange.

DSEK was indicated for 159 eyes with Fuchs’ endothelial dystrophy and one eye with corneal decompensation after uneventful cataract surgery.

All patients had hydrophilic acrylic IOLs before undergoing DSEK. Only those with attached grafts or those who had undergone extra air insufflation were included in the study.

IOL opacification occurred in eight eyes (5%). Before opacification, mean Snellen corrected distance visual acuity was 0.6; afterward, it was 0.3.

The mean interval between DSEK and patient awareness of IOL opacification was 9.6 months.

Four of eight eyes (50%) underwent IOL exchange because of loss of corrected distance visual acuity related to opacification. Original post-DSEK corrected distance visual acuity was restored in all patients after IOL exchange.

No recurrences of opacification were reported. – by Matt Hasson

Disclosure: The authors report no relevant financial disclosures.

Perspective

Marianne O. Price, PhD

This study found a 5% incidence of IOL opacification in a series of 160 DSEK cases with a hydrophilic acrylic IOL. We have also seen this but at a far lower incidence. Laboratory studies have shown the opacification is associated with calcium deposits within the margins of the anterior capsulorrhexis. The mechanism is not clear but may be related to air injection, breakdown of the blood-aqueous barrier or inflammatory reaction. The findings argue against the use of hydrophilic acrylic IOLs in patients who are having or may need a cornea transplant.

Marianne O. Price, PhD

Executive Director, Cornea Research Foundation of America, Indianapolis

Disclosures: Price reports no relevant financial disclosures.

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Sources/Disclosures

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Source:

Nieuwendaal CP, et al. Cornea. 2015;doi:10.1097/ICO.0000000000000574.