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ARTIGO ORIGINAL 149Microscopic analysis of opacification inIoflex ® hydrophilic acrylic intraocular lensesAnálise microscópica da opacificação delentes intraoculares acrílicas hidrofílicas Ioflex ®Bruna Vieira Ventura 1 , Marcelo Ventura 1,2 , Wagner Lira 1 , Camila Vieira Ventura 1 , Marcony RodriguesSanthiago 3 , Liliana Werner 4ABSTRACTFive cases of intraocular lens (IOL) opacification in patients implanted with the Mediphacos Ioflex® IOL aredescribed. Clinical data in each case was obtained from the patient’s medical record. The five explanted IOLsunderwent gross and light microscopic analysis. Selected lenses were processed for further evaluation and multiplesagittal cuts were stained with the alizarin red and von Kossa methods. Light microscope analysis confirmed thepresence of deposits on and within the lens, which stained positive for calcium. The reason why calcification hasoccurred in these cases remains unclear, but surgeons should be aware of this potential late postoperative complication.Keywords: Lenses, intraocular; Lens implantation, intraocular; Reoperation; Device removal; Microscopy;Case reportsRESUMOCinco casos de opacificação de lente intraocular (LIO) em pacientes implantados com a LIO Ioflex® da Mediphacossão descritos. Os dados clínicos dos pacientes foram obtidos a partir dos prontuários médicos. As cinco LIOsexplantadas foram enviadas para análise macroscópica e sob microscopia óptica. Algumas lentes foram processadaspara análise adicional e múltiplos cortes sagitais foram corados pelos métodos de vermelho de alizarina e vonKossa. A análise sob microscopia óptica confirmou a presença de depósitos na superfície e no corpo da lente, quecoraram positivamente para cálcio. A razão pela qual a calcificação ocorreu nestes casos permanece obscura.Entretanto, cirurgiões devem estar atentos para esta potencial complicação tardia.Descritores: Lentes intraoculares; Implante de lenteintraocular; Reoperação; Remoção de dispositivo;Microscopia; Relatos de casos1Fundação Altino Ventura – FAV – Recife (PE), Brazil;2Hospital de Olhos de Pernambuco – HOPE – Recife (PE), Brazil;3Department of Refractive Surgery, Cole Eye Institute, Cleveland Clinic, Cleveland (OH), USA;4Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City (UT), USA.No author has a financial or proprietary interest in any material or method mentioned.Financial support: none.Recebido para publicação em 29/08/2011 - Aceito para publicação em 18/04/2012Rev Bras Oftalmol. 2012; 71 (3): 149-54
150Ventura BV, Ventura M, Lira W, Ventura CV, Santhiago MR, Werner LINTRODUCTIONPostoperative optic opacification is the leadingcause of explantation of hydrophilic acrylicintraocular lens (IOL) (1) . The Mediphacos Ioflex ®(Belo Horizonte, Minas Gerais, Brazil) IOL is a foldablehydrophilic acrylic single-piece IOL with an optic diameterof 5.7 mm and an overall diameter of 12.5 mm. Thematerial used for the lens manufacture is a copolymer ofpoly-hydroxyethylmethacrylate with 25% water content.It was first introduced in the market in 2001. No case ofIOL opacification has been reported in patients with thislens in articles published in scientific journals indexed inPubMed and SciELO (keywords searched: Ioflex, lensopacification, lens calcification). Although few hydrophilicacrylic IOL designs are approved by the Food and DrugAdministration (FDA) to be used in the United States (2) ,they are largely commercialized in other countries.The purpose of this study was to report the microscopicanalysis of five cases of Mediphacos Ioflex ® IOLopacification. All IOLs were explanted due to significantvisual impairment.This study was approved by the Altino VenturaFoundation Ethics Committee and conducted at the AltinoVentura Foundation.Case reportsCase 1A 72-year-old female had an uneventfulphacoemulsification with implantation of MediphacosIoflex ® IOLs in the right eye (Lot G0718092) on august2007 and in the left eye (Lot H0731101) on november2007. The patient had a medical history of hypertension.She presented 29 months after the surgery on the righteye with a decrease in best-corrected visual acuity (BCVA)in OD from 20/25 on the fifteenth postoperative day evaluationto 20/100. Examination revealed haziness of the IOL(Figure 1). The anterior chamber was quiet, with no signsof inflammation. Her fundus exam was normal.Neodymium:yag (Nd:YAG) laser treatment was ineffectivein removing the opacification from the lens. The IOLwas explanted 31 months postoperatively and a hydrophobicacrylic Type 7B (Alcon, Inc.) IOL was implantedin the capsular bag. There were no intraoperative or postoperativecomplications. The patient’s final BCVA on theright eye was 20/30. The BCVA of OS afterphacoemulsification was always 20/20.Case 2An 86-year-old male with vascular hypertension wassubmitted to an uneventful phacoemulsification with implantationof Mediphacos Ioflex® IOLs in the capsular bagof the right eye (Lot C0715102) in august 2007 and of theleft eye (Lot J0729351) in december 2007. On evaluationon the thirtieth postoperative day of the surgery in the lefteye, his BCVA in OD was 20/30 and in OS was 20/25.Figure 1: Slitlamp photograph of case 1 showing IOL opacification.In the center of the optic component there are pits, correspondingto Nd:YAG laser application. The marks caused by forceps duringthe folding process are highlighted by the opacificationThirty-three months later he returned referring aprogressive decrease in the left eye’s visual acuity. He presentedwith a 20/200 BCVA in this eye and 20/30 in OD. Onexamination IOL’s optic and posterior capsule opacificationwas noted. The eye had no inflammatory signs. A posteriorcapsulotomy was done with Nd:YAG laser, without visionimprovement. The IOL was explanted 35 months postoperatively.A dense fibrous tissue was connecting the lenshaptics to the bag. The haptics were cut to facilitate IOL’sremoval, the optic was explanted successfully and thehaptics were left in the eye. An anterior vitrectomy wasdone and a poly(methyl methacrylate) (PMMA) OP-72(Mediphacos, Belo Horizonte, Brazil) IOL was implantedin the sulcus. There were no intraoperative complications.On the first postoperative day, the eye had mild inflammatorysigns and the IOL was centered.Postoperative outcome evolved with secondaryglaucoma treated medically, later requiringtrabeculectomy. One month after this procedure, BCVAin the left eye was 20/400 and the IOP was 10 mm Hg.Case 3In september 2007 a 53-year-old female with severenon-proliferative diabetic and hypertensive retinopathywas submitted to phacoemulsification with uneventfulimplantation of a Mediphacos Ioflex® IOL inthe right eye (Lot H0731101). There were no intraoperativecomplications. At the moment of the surgery, thepatient had hard exudates in the macula and fewmicroaneurysms in the right eye. In the left eye she hadmild nucleosclerosis. Pan-retinal photocoagulation andan intravitreal injection of triamcinolone acetonide weredone in the right eye three and two years prior to cataractsurgery, respectively.One month after phacoemulsification she presentedwith hard exudates in the macula and clinicallysignificant macular edema. She was submitted to grid pho-Rev Bras Oftalmol. 2012; 71 (3): 149-54
Page 1 and 2: vol. 71 - nº 3 - Maio/Junho 2012RB
Page 3 and 4: 144Revista Brasileira de Oftalmolog
Page 5 and 6: 146173 Características e deficiên
Page 7: 148Rezende F, Bisol RAR, Tiago Biso
Page 11 and 12: 152Ventura BV, Ventura M, Lira W, V
Page 13 and 14: 154Ventura BV, Ventura M, Lira W, V
Page 15 and 16: 156Moura EM, Volpini M, Moura GAGIN
Page 17 and 18: 158Moura EM, Volpini M, Moura GAGco
Page 19 and 20: 160ARTIGO ORIGINALEficácia da comb
Page 21 and 22: 162Almodin J, Buhler Junior C, Almo
Page 23 and 24: 164ARTIGO ORIGINALHipermetropia ap
Page 25 and 26: 166Ambrósio Jr R, Silva RS; Lopes
Page 33 and 34: 174Ventura CVOC, Gomes MLS, Ventura
Page 39 and 40: 180ARTIGO ORIGINALPeriocular basal
Page 41 and 42: 182Macedo EMS, Carneiro RC, Carrico
Page 43 and 44: 184RELATO DE CASODiplopia após inj
Page 45 and 46: 186Rassi MMO, Santos LHBTABELA 1Per
Page 47 and 48: 188RELATO DE CASOSíndrome de Down:
Page 49 and 50: 190Lorena SHTachados de blefarite e
Page 51 and 52: 192Passos AF, Borges DFINTRODUÇÃO
Page 53 and 54: 194ARTIGO DE REVISÃOImportance of
Page 55 and 56: 196Veloso CER, Almeida LNF, De Marc
Page 57 and 58: 198Veloso CER, Almeida LNF, De Marc
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200Schellini SA, Sousa RLFINTRODUÇ
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202Schellini SA, Sousa RLFduzidos m
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204Schellini SA, Sousa RLF18. Ferra
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206Instruções aos autoresA Revist
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208RevistaBrasileira deOftalmologia
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