Mai-Jun - Sociedade Brasileira de Oftalmologia

Microscopic analysis of opacification in Ioflex ® hydrophilic acrylic intraocular lenses151Figure 2: Explanted Ioflex® IOL of case 1. A: Gross photographshowing IOL opacification on the optic and haptics; B: Lightphotomicrograph. Dense deposits can be observed mostly on theanterior surface of the optic component, highlighting the markscaused by forceps during the folding process. Pits, correspondingto Nd:YAG laser application, can also be seen in the center of theoptic component; C and D: Light photomicrographs showingconfluent deposits arranged in a convoluted, “cerebriform” pattern.E: Light photomicrograph, small granular deposits are observed inareas outside of the confluent deposits; F: Light photomicrograph;multiple, small, granular deposits are seen within the haptics ofthe lens, close to the surface; B: unstained, original magnificationX20; C: unstained, original magnification X40; D: unstained, originalmagnification X100; E, unstained, original magnification X10;F, unstained, original magnification X100Figure 3: Explanted Ioflex® IOL of case 2; A: Gross photographshowing that the haptics of the IOL were cut and the IOL wasdivided in two parts to facilitate explantation; B, C and D: Lightphotomicrographs; Dense deposits can be observed mostly on theanterior surface of the optic component, highlighting the markscaused by forceps during the folding process; Confluent depositsare arranged in a convoluted, “cerebriform” pattern Postoperativeoutcome evolved; E: Light hotomicrograph showing confluentdeposits that form a cerebriform pattern on the haptics’ anteriorsurface; B: unstained, original magnification X20: C:unstained;original magnification X40; D: unstained, original magnificationX40; E: unstained, original magnification X40.tocoagulation. Her uncorrected vision after the laser was20/60. Two months later a mild fibroglial proliferation wasobserved superiorly to the optic nerve and there werehard exudates temporally to the macula. Superior retinalphotocoagulation and focal laser were done in OR.Twenty-two months after surgery, her uncorrectedvisual acuity in the right eye was 20/30. She had no macularedema or macular exudates. However, thirty monthspostoperatively she presented with an uncorrected visionon the right eye of 20/150. On biomicroscopy IOLand subcapsular opacification was noted. The patient wassubmitted to a Nd:YAG laser posterior capsulotomy, buther uncorrected visual acuity did not improve and onemonth later had decreased to 20/400.The IOL was explanted seven months later. Adense fibrous tissue was connecting the lens haptics tothe bag. The haptics were cut, the optic was removedsuccessfully and the haptics were left in the eye. A posteriorvitrectomy was done. A hydrophobic acrylic Type7B (Alcon, Inc.) IOL was implanted in the ciliary sulcus.Two months after IOL exchange, the uncorrectedand corrected visual acuity in the right eye was 20/60.During fundus exam, macular edema was noted.Case 4A 79-year-old female had an uneventfulphacoemulsification with implantation of a MediphacosIoflex ® IOL in the capsular bag of the left eye (LotH0731101) on december 2007. The patient had a medicalhistory of hypertension and diabetes, and an ocularhistory of glaucoma (cup-to-disc ratio of 0.9 OU), controlledwith timolol maleate 0.5% and travoprost 0.004%.She presented 33 months later with a decrease inBCVA from 20/30 on the thirtieth postoperative day evaluationto counting fingers at 4 meters. Biomicroscopy revealedIOL opacification. The eye had no signs of inflam-Rev Bras Oftalmol. 2012; 71 (3): 149-54