Pseudoexfoliation and Opacification of Intraocular Lenses
Identifieur interne : 001B98 ( Ncbi/Merge ); précédent : 001B97; suivant : 001B99Pseudoexfoliation and Opacification of Intraocular Lenses
Auteurs : Maria Milia [Royaume-Uni] ; Aris Konstantopoulos [Royaume-Uni] ; Panagiotis Stavrakas [Royaume-Uni] ; Abbas Toufeeq [Royaume-Uni]Source :
- Case Reports in Ophthalmology [ 1663-2699 ] ; 2011.
Abstract
To report two cases of spoke-like intraocular lens (IOL) opacification that resembles pseudoexfoliation of the crystalline lens.
Case series presentation.
Patient 1 developed a circle of spoke-like opacification on the anterior IOL surface 7 years after phacoemulsification. Patient 2 had paracentral anterior surface IOL opacification 18 months after cataract extraction and clinical pseudoexfoliation in the fellow eye.
Spoke-like anterior IOL opacification should raise the suspicion of pseudoexfoliation syndrome.
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DOI: 10.1159/000331203
PubMed: 21941508
PubMed Central: 3177812
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Pseudoexfoliation and Opacification of Intraocular Lenses</title><author><name sortKey="Milia, Maria" sort="Milia, Maria" uniqKey="Milia M" first="Maria" last="Milia">Maria Milia</name><affiliation wicri:level="3"><nlm:aff id="aff1">Western Eye Hospital, London</nlm:aff><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>Western Eye Hospital</wicri:orgArea></affiliation></author><author><name sortKey="Konstantopoulos, Aris" sort="Konstantopoulos, Aris" uniqKey="Konstantopoulos A" first="Aris" last="Konstantopoulos">Aris Konstantopoulos</name><affiliation wicri:level="1"><nlm:aff id="aff2">Eye Unit, Stoke Mandeville Hospital, Aylesbury, Southampton, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Eye Unit, Stoke Mandeville Hospital, Aylesbury, Southampton</wicri:regionArea><wicri:noRegion>Southampton</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3">Southampton Eye Unit, Southampton General Hospital, Southampton, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Southampton Eye Unit, Southampton General Hospital, Southampton</wicri:regionArea><wicri:noRegion>Southampton</wicri:noRegion></affiliation></author><author><name sortKey="Stavrakas, Panagiotis" sort="Stavrakas, Panagiotis" uniqKey="Stavrakas P" first="Panagiotis" last="Stavrakas">Panagiotis Stavrakas</name><affiliation wicri:level="1"><nlm:aff id="aff4">Attikon University Hospital, Athens, Greece, High Wycombe, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Attikon University Hospital, Athens, Greece, High Wycombe</wicri:regionArea><wicri:noRegion>High Wycombe</wicri:noRegion></affiliation></author><author><name sortKey="Toufeeq, Abbas" sort="Toufeeq, Abbas" uniqKey="Toufeeq A" first="Abbas" last="Toufeeq">Abbas Toufeeq</name><affiliation wicri:level="1"><nlm:aff id="aff5">Eye Department, Wycombe Hospital, High Wycombe, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Eye Department, Wycombe Hospital, High Wycombe</wicri:regionArea><wicri:noRegion>High Wycombe</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21941508</idno><idno type="pmc">3177812</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177812</idno><idno type="RBID">PMC:3177812</idno><idno type="doi">10.1159/000331203</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000C71</idno><idno type="wicri:Area/Pmc/Curation">000C71</idno><idno type="wicri:Area/Pmc/Checkpoint">001A24</idno><idno type="wicri:Area/Ncbi/Merge">001B98</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Pseudoexfoliation and Opacification of Intraocular Lenses</title><author><name sortKey="Milia, Maria" sort="Milia, Maria" uniqKey="Milia M" first="Maria" last="Milia">Maria Milia</name><affiliation wicri:level="3"><nlm:aff id="aff1">Western Eye Hospital, London</nlm:aff><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>Western Eye Hospital</wicri:orgArea></affiliation></author><author><name sortKey="Konstantopoulos, Aris" sort="Konstantopoulos, Aris" uniqKey="Konstantopoulos A" first="Aris" last="Konstantopoulos">Aris Konstantopoulos</name><affiliation wicri:level="1"><nlm:aff id="aff2">Eye Unit, Stoke Mandeville Hospital, Aylesbury, Southampton, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Eye Unit, Stoke Mandeville Hospital, Aylesbury, Southampton</wicri:regionArea><wicri:noRegion>Southampton</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3">Southampton Eye Unit, Southampton General Hospital, Southampton, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Southampton Eye Unit, Southampton General Hospital, Southampton</wicri:regionArea><wicri:noRegion>Southampton</wicri:noRegion></affiliation></author><author><name sortKey="Stavrakas, Panagiotis" sort="Stavrakas, Panagiotis" uniqKey="Stavrakas P" first="Panagiotis" last="Stavrakas">Panagiotis Stavrakas</name><affiliation wicri:level="1"><nlm:aff id="aff4">Attikon University Hospital, Athens, Greece, High Wycombe, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Attikon University Hospital, Athens, Greece, High Wycombe</wicri:regionArea><wicri:noRegion>High Wycombe</wicri:noRegion></affiliation></author><author><name sortKey="Toufeeq, Abbas" sort="Toufeeq, Abbas" uniqKey="Toufeeq A" first="Abbas" last="Toufeeq">Abbas Toufeeq</name><affiliation wicri:level="1"><nlm:aff id="aff5">Eye Department, Wycombe Hospital, High Wycombe, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Eye Department, Wycombe Hospital, High Wycombe</wicri:regionArea><wicri:noRegion>High Wycombe</wicri:noRegion></affiliation></author></analytic><series><title level="j">Case Reports in Ophthalmology</title><idno type="eISSN">1663-2699</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>To report two cases of spoke-like intraocular lens (IOL) opacification that resembles pseudoexfoliation of the crystalline lens.</p></sec><sec><title>Methods</title><p>Case series presentation.</p></sec><sec><title>Results</title><p>Patient 1 developed a circle of spoke-like opacification on the anterior IOL surface 7 years after phacoemulsification. Patient 2 had paracentral anterior surface IOL opacification 18 months after cataract extraction and clinical pseudoexfoliation in the fellow eye.</p></sec><sec><title>Conclusion</title><p>Spoke-like anterior IOL opacification should raise the suspicion of pseudoexfoliation syndrome.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Neuhann, Im" uniqKey="Neuhann I">IM Neuhann</name></author><author><name sortKey="Werner, L" uniqKey="Werner L">L Werner</name></author><author><name sortKey="Izak, Am" uniqKey="Izak A">AM Izak</name></author><author><name sortKey="Pandey, Sk" uniqKey="Pandey S">SK Pandey</name></author><author><name sortKey="Kleinmann, G" uniqKey="Kleinmann G">G Kleinmann</name></author><author><name sortKey="Mamalis, N" uniqKey="Mamalis N">N Mamalis</name></author><author><name sortKey="Neuhann, Tf" uniqKey="Neuhann T">TF Neuhann</name></author><author><name sortKey="Apple, Dj" uniqKey="Apple D">DJ Apple</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gartaganis, Sp" uniqKey="Gartaganis S">SP Gartaganis</name></author><author><name sortKey="Kanellopoulou, Dg" uniqKey="Kanellopoulou D">DG Kanellopoulou</name></author><author><name sortKey="Mela, Ek" uniqKey="Mela E">EK Mela</name></author><author><name sortKey="Panteli, Vs" uniqKey="Panteli V">VS Panteli</name></author><author><name sortKey="Koutsoukos, Pg" uniqKey="Koutsoukos P">PG Koutsoukos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bahadur, Gg" uniqKey="Bahadur G">GG Bahadur</name></author><author><name sortKey="Masket, S" uniqKey="Masket S">S Masket</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ritch, R" uniqKey="Ritch R">R Ritch</name></author><author><name sortKey="Schlotzer Schrehardt, U" uniqKey="Schlotzer Schrehardt U">U Schlötzer-Schrehardt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tetsumoto, K" uniqKey="Tetsumoto K">K Tetsumoto</name></author><author><name sortKey="Schlotzer Schrehardt, U" uniqKey="Schlotzer Schrehardt U">U Schlötzer-Schrehardt</name></author><author><name sortKey="Kuchle, M" uniqKey="Kuchle M">M Küchle</name></author><author><name sortKey="Dorfler, S" uniqKey="Dorfler S">S Dörfler</name></author><author><name sortKey="Naumann, Go" uniqKey="Naumann G">GO Naumann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Richter Mueksch, S" uniqKey="Richter Mueksch S">S Richter-Mueksch</name></author><author><name sortKey="Kahraman, G" uniqKey="Kahraman G">G Kahraman</name></author><author><name sortKey="Amon, M" uniqKey="Amon M">M Amon</name></author><author><name sortKey="Schild Burggasser, G" uniqKey="Schild Burggasser G">G Schild-Burggasser</name></author><author><name sortKey="Schauersberger, J" uniqKey="Schauersberger J">J Schauersberger</name></author><author><name sortKey="Abela Formanek, C" uniqKey="Abela Formanek C">C Abela-Formanek</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Ophthalmol</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Ophthalmol</journal-id><journal-id journal-id-type="publisher-id">COP</journal-id><journal-title-group><journal-title>Case Reports in Ophthalmology</journal-title></journal-title-group><issn pub-type="epub">1663-2699</issn><publisher><publisher-name>S. Karger AG</publisher-name><publisher-loc>Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21941508</article-id><article-id pub-id-type="pmc">3177812</article-id><article-id pub-id-type="doi">10.1159/000331203</article-id><article-id pub-id-type="publisher-id">cop0002-0287</article-id><article-categories><subj-group subj-group-type="heading"><subject>Published: August 2011</subject></subj-group></article-categories><title-group><article-title>Pseudoexfoliation and Opacification of Intraocular Lenses</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Milia</surname><given-names>Maria</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Konstantopoulos</surname><given-names>Aris</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Stavrakas</surname><given-names>Panagiotis</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Toufeeq</surname><given-names>Abbas</given-names></name><xref ref-type="aff" rid="aff5"><sup>e</sup></xref></contrib></contrib-group><aff id="aff1"><sup>a</sup>Western Eye Hospital, London</aff><aff id="aff2"><sup>b</sup>Eye Unit, Stoke Mandeville Hospital, Aylesbury, Southampton, UK</aff><aff id="aff3"><sup>c</sup>Southampton Eye Unit, Southampton General Hospital, Southampton, UK</aff><aff id="aff4"><sup>d</sup>Attikon University Hospital, Athens, Greece, High Wycombe, UK</aff><aff id="aff5"><sup>e</sup>Eye Department, Wycombe Hospital, High Wycombe, UK</aff><author-notes><corresp id="cor1">*Dr. Maria Milia, Mimosas 29, GR-14578 Ekali, Athens (Greece), Tel. +30 694 805 0655, E-Mail <email>mariamilia@hotmail.com</email></corresp></author-notes><pub-date pub-type="collection"><season>May-Aug</season><year>2011</year></pub-date><pub-date pub-type="epub"><day>20</day><month>8</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>8</month><year>2011</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>2</volume><issue>2</issue><fpage>287</fpage><lpage>290</lpage><permissions><copyright-statement>Copyright © 2011 by S. Karger AG, Basel</copyright-statement><copyright-year>2011</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/">http://creativecommons.org/licenses/by-nc-nd/3.0/</ext-link>). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on <ext-link ext-link-type="uri" xlink:href="http://www.karger.com">http://www.karger.com</ext-link> and the terms of this license are included in any shared versions.</license-p></license></permissions><abstract><sec><title>Purpose</title><p>To report two cases of spoke-like intraocular lens (IOL) opacification that resembles pseudoexfoliation of the crystalline lens.</p></sec><sec><title>Methods</title><p>Case series presentation.</p></sec><sec><title>Results</title><p>Patient 1 developed a circle of spoke-like opacification on the anterior IOL surface 7 years after phacoemulsification. Patient 2 had paracentral anterior surface IOL opacification 18 months after cataract extraction and clinical pseudoexfoliation in the fellow eye.</p></sec><sec><title>Conclusion</title><p>Spoke-like anterior IOL opacification should raise the suspicion of pseudoexfoliation syndrome.</p></sec></abstract><kwd-group><title>Key words</title><kwd>Pseudoexfoliation</kwd><kwd>Opacification</kwd><kwd>Intraocular lens</kwd><kwd>Spoke-like pattern</kwd></kwd-group><counts><fig-count count="2"></fig-count><ref-count count="6"></ref-count><page-count count="4"></page-count></counts></article-meta></front><body><sec id="sec1_1"><title>Introduction</title><p>Intraocular lens (IOL) opacification is a rare but well-recognised complication following cataract surgery. Various types have been described and these are primarily caused by surface and intralenticular deposition of material [<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B2">2</xref>]. A rarer spoke-like opacification pattern on the anterior IOL surface has been described by Bahadur and Masket [<xref ref-type="bibr" rid="B3">3</xref>] as ‘pseudo-pseudoexfoliation’. Here, we describe two cases with a spoke-like opacification pattern, one with clinical pseudoexfoliation, the other with early exfoliation material on the IOL.</p></sec><sec id="sec1_2"><title>Case Reports</title><sec id="sec2_1"><title>Case 1</title><p>A 70-year-old female patient presented to our hospital 3 years following an uneventful left phacoemulsification. She was asymptomatic, with a Snellen best-corrected visual acuity (BCVA) of 6/9. Slit-lamp examination showed a thin semitransparent membrane on the anterior surface of the IOL. Intraocular pressure (IOP) was normal. She had had in-the-bag implantation of a plate-haptic hydrophilic IOL. Defocused application of YAG laser to the surface membrane and posterior capsulotomy were performed. Four years later, the patient remained asymptomatic, but slit-lamp examination showed that a circular spoke-like opacification, extending radially from the pupillary zone to the margins of the capsulorhexis (<underline><bold>fig.</bold></underline><xref ref-type="fig" rid="F1"><underline><bold>1</bold></underline></xref>), had developed on the surface of the IOL.</p></sec><sec id="sec2_2"><title>Case 2</title><p>A 76-year-old woman underwent uneventful right phacoemulsification with in-the-bag implantation of a plate-haptic hydrophilic lens, resulting in a BCVA of 6/9. The patient was reviewed 18 months later for cataract in the left eye, and ocular examination showed the presence of pseudoexfoliation in this eye. The IOP was normal in both eyes. It was noted that the IOL in the right eye showed paracentral surface opacification with a spoke-like pattern similar to Case 1 (<underline><bold>fig.</bold></underline><xref ref-type="fig" rid="F2"><underline><bold>2</bold></underline></xref>). The patient's IOP was monitored and she underwent YAG laser posterior capsulotomy in the right eye 8 months later. She is currently asymptomatic with a BCVA of 6/9.</p></sec></sec><sec sec-type="results" id="sec1_3"><title>Results</title><p>We present two cases of spoke-like IOL opacification that resembles pseudoexfoliation of the crystalline lens. One patient had clinical pseudoexfoliation in the fellow eye, and the other had early exfoliation material on the affected IOL.</p></sec><sec sec-type="discussion" id="sec1_4"><title>Discussion</title><p>Pseudoexfoliation involves the production of exfoliation fibres by pre-equatorial lens epithelial, non-pigmented ciliary epithelial and corneal endothelial cells, which are distributed by the aqueous humour to the central anterior lens capsule, zonules, anterior hyaloid surface and artificial lenses [<xref ref-type="bibr" rid="B4">4</xref>]. It is often forgotten that a precursor material is initially deposited on the lens surface, producing a homogeneous ground-glass or matte appearance [<xref ref-type="bibr" rid="B5">5</xref>]. The early membrane that was present on the IOL surface in Case 1 may represent early exfoliation material. The classical appearance is then created by a thickening of this material and rubbing of the iris during pupillary movement on the surface of the lens.</p><p>Central IOL opacification may be related to local supersaturation with octacalcium phosphate, a process facilitated by surface hydroxyl groups of the polyacrylic materials [<xref ref-type="bibr" rid="B6">6</xref>]. The patterns of deposition in our two cases suggest that exfoliation material may deposit on the anterior IOL surface by a process similar to that in phakic pseudoexfoliation. Both patients had acrylic one-piece plate-haptic IOLs, with no posterior angulation of the optic. The lack of posterior angulation may facilitate the rubbing of the iris against the material deposited on the IOL surface, resulting in the spoke-like pattern. Interestingly, the case by Bahadur and Masket [<xref ref-type="bibr" rid="B3">3</xref>] also involved the use of a plate-haptic Collamer IOL. In general, hydrophilic acrylic IOLs have proven to have high uveal biocompatibility, inducing less inflammatory response than hydrophobic and silicone lenses [<xref ref-type="bibr" rid="B6">6</xref>]. The anterior surface of the artificial IOL is less curved and more posterior than that of the crystalline lens. As a result, the point of contact between the iris and the IOL is less peripheral than is the case with the crystalline lens. This may produce a spoke-like pattern that extends more centrally than on the surface of the crystalline lens.</p></sec><sec sec-type="conclusion" id="sec1_5"><title>Conclusion</title><p>In conclusion, the presence of a spoke-like pattern on the anterior IOL surface, especially on IOLs of plate-haptic design, should raise the suspicion of pseudoexfoliation. The presence of glaucoma in the case by Bahadur and Masket [<xref ref-type="bibr" rid="B3">3</xref>] highlights this issue. 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position="float"><label><underline><bold>Fig. 1</bold></underline></label><caption><p>Image demonstrating the spoke-like pattern on the anterior IOL surface.</p></caption><graphic xlink:href="cop0002-0287-f01"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label><underline><bold>Fig. 2</bold></underline></label><caption><p>Paracentral IOL surface opacification with a spoke-like pattern.</p></caption><graphic xlink:href="cop0002-0287-f02"></graphic></fig></floats-group></pmc><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Milia, Maria" sort="Milia, Maria" uniqKey="Milia M" first="Maria" last="Milia">Maria Milia</name></region><name sortKey="Konstantopoulos, Aris" sort="Konstantopoulos, Aris" uniqKey="Konstantopoulos A" first="Aris" last="Konstantopoulos">Aris Konstantopoulos</name><name sortKey="Konstantopoulos, Aris" sort="Konstantopoulos, Aris" uniqKey="Konstantopoulos A" first="Aris" last="Konstantopoulos">Aris Konstantopoulos</name><name sortKey="Stavrakas, Panagiotis" sort="Stavrakas, Panagiotis" uniqKey="Stavrakas P" first="Panagiotis" last="Stavrakas">Panagiotis Stavrakas</name><name sortKey="Toufeeq, Abbas" sort="Toufeeq, Abbas" uniqKey="Toufeeq A" first="Abbas" last="Toufeeq">Abbas Toufeeq</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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