Pathologic Assessment of Complications with Asymmetric or Sulcus Fixation of Square-Edged Hydrophobic Acrylic Intraocular Lenses
Identifieur interne : 002732 ( Main/Exploration ); précédent : 002731; suivant : 002733Pathologic Assessment of Complications with Asymmetric or Sulcus Fixation of Square-Edged Hydrophobic Acrylic Intraocular Lenses
Auteurs : Kevin R. Kirk [États-Unis] ; Liliana Werner [États-Unis] ; Ryan Jaber [États-Unis] ; Susan Strenk [États-Unis] ; Lawrence Strenk [États-Unis] ; Nick Mamalis [États-Unis]Source :
- Ophthalmology : (Rochester, MN) [ 0161-6420 ] ; 2012.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Objective: One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation because of complications, such as uveitis-glaucoma-hyphema syndrome. Similar complications may also be observed with 3-piece lenses that have a square optic edge on the anterior surface. The objective of this study was to provide pathologic evidence of complications related to out-of-the-bag fixation of 1- or 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges. Design: Comparative case series with pathology. Participants: A total of 661 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs. Methods: Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathologic analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses. Main Outcome Measures: Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses. Results: A total of 256 eyes were implanted with hydrophobic acrylic IOLs with anterior and posterior square optic edges; 18 of them exhibiting asymmetric or sulcus IOL fixation (six 1-piece and twelve 3-piece IOLs) underwent complete histopathologic evaluation and were compared with the contralateral eyes with symmetric in-the-bag IOL implantation. Pathologic findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, iris thinning, and iris atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the control contralateral eyes and were particularly evident in relation to the sulcus-fixated haptic in the case of 1-piece lenses. The majority of the eyes with 3-piece lenses showed signs of complicated surgery. Conclusions: This study provides pathologic correlation of complications that were clinically reported in the peer-reviewed literature in relation to sulcus fixation of 1-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidence of complicated surgery; therefore, all pathologic findings in those cases may not be strictly attributed to the out-of-the-bag fixation.
Affiliations:
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<front><div type="abstract" xml:lang="en">Objective: One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation because of complications, such as uveitis-glaucoma-hyphema syndrome. Similar complications may also be observed with 3-piece lenses that have a square optic edge on the anterior surface. The objective of this study was to provide pathologic evidence of complications related to out-of-the-bag fixation of 1- or 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges. Design: Comparative case series with pathology. Participants: A total of 661 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs. Methods: Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathologic analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses. Main Outcome Measures: Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses. Results: A total of 256 eyes were implanted with hydrophobic acrylic IOLs with anterior and posterior square optic edges; 18 of them exhibiting asymmetric or sulcus IOL fixation (six 1-piece and twelve 3-piece IOLs) underwent complete histopathologic evaluation and were compared with the contralateral eyes with symmetric in-the-bag IOL implantation. Pathologic findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, iris thinning, and iris atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the control contralateral eyes and were particularly evident in relation to the sulcus-fixated haptic in the case of 1-piece lenses. The majority of the eyes with 3-piece lenses showed signs of complicated surgery. Conclusions: This study provides pathologic correlation of complications that were clinically reported in the peer-reviewed literature in relation to sulcus fixation of 1-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidence of complicated surgery; therefore, all pathologic findings in those cases may not be strictly attributed to the out-of-the-bag fixation.</div>
</front>
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<name sortKey="Jaber, Ryan" sort="Jaber, Ryan" uniqKey="Jaber R" first="Ryan" last="Jaber">Ryan Jaber</name>
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<name sortKey="Mamalis, Nick" sort="Mamalis, Nick" uniqKey="Mamalis N" first="Nick" last="Mamalis">Nick Mamalis</name>
<name sortKey="Strenk, Lawrence" sort="Strenk, Lawrence" uniqKey="Strenk L" first="Lawrence" last="Strenk">Lawrence Strenk</name>
<name sortKey="Strenk, Susan" sort="Strenk, Susan" uniqKey="Strenk S" first="Susan" last="Strenk">Susan Strenk</name>
<name sortKey="Werner, Liliana" sort="Werner, Liliana" uniqKey="Werner L" first="Liliana" last="Werner">Liliana Werner</name>
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