Opacification of the optic of an Akeos Adapt

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Opacification of the optic ofan Akeos Adapt
intraocular lens

• Chong Eun Lee, MD, Sung Dong Chang, MD, PhD
• Department of Ophthalmology, School of Medicine,
• Dongsan Medical Center,
• Keimyung University, Daegu, Korea

The authors have no financial interest
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INTRODUCTION

• The opacifications of intraocular lens, causing
  the removal or exchange of implanted intraocular
  lens, have been reported to occur in some
  hydrophilic acrylic intraocular lens (IOL)
• We experienced a case of the opacification of
  hydrophillic intraocular lens (Akreos Adapt ,
  Bausch Lomb)
• To our knowledge, there was no prior report of an
  opacification in that IOL

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CASE REPORT

• 55-year-old man
• 28-year-history of diabetes mellitus (DM)
• Also receiving peritoneal dialysis for chronic
  renal failure
• Two months before, at other eye hostpital
• pars plana vitrectomy, panretinal
  photocoagulation
• (for proliferative diabetic retinopathy)
• phacoemulsification implantation of
  hydrophillic acryl intraocular lens in the
  capsular bag
• (Akreos Adapt , Bausch Lomb)

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CASE REPORT

• At the time of the first visit, the patient
  presented with proliferative diabetic retinopathy
  in both eyes and clinically significant macular
  edema
• Initial best corrected visual acuity (OD) 0.08
• Four months later
• BCVA (OD) finger count 10 cm
• Intraocular pressure (OD) 38 mmHg
• Rubeosis c hyphema in the right eye
• Dx. neovascular glaucoma (OD)

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CASE REPORT

• Ahmed valve implantation(OD) through pars
• plana, at our hospital
• 5 months following the surgery of glaucoma
• (10 months following the implantation of IOL)
• BCVA (OD) 0.08
• Microhyphema still present
• IOL opacification found

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CASE REPORT

• 45 months following the implantation of IOL
• BCVA (OD) hand motion
• disappearance of hyphma
• IOL opacification causing a decreased VA was
  found
• (Figure 1)
• IOL was explanted from the right eye
• Hydrophobic acrylic IOL, YA-60BB (HOYA,
• Japan), was implanted into the sulcus

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Figure 1. Intraoperative photograph of the right
eye showing opacification of Akreos Adapt IOL.
The arrows show the edges of the opacified area
of IOL.
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CASE REPORT

• Postoperatively, the patient did not exhibit
  specific complications and the visual acuity was
  improved to 0.04
• 6 months postoperatively, the corrected visual
  acuity was maintained as 0.06 due to macular edema

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DISCUSSION

• Exchange of IOL d/t the postoperative
• opacification has been reported
• Hydroview (Bausch Lomb)
• ACRL-60 (Ophthalmed Inc.)
• MemoryLens (Ciba Vision)
• AquaSense (Ophthalmic Innovations International)
• SC60B-OUV (Medical Developmental Research)
• Centerflex 570H (Rayner)
• Akros Fit (Bausch Lomb) no clinically
  notable
• decrease of VA, exchange of IOL was not performed

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DISCUSSION

• Unfortunately histopathological assessments
• was not performed
• Deposition of minerals including Ca2 on the
  surface of optical part is assumed to be the
• causative factor
• 28-year-history of diabetes inflammatory
• responses due to hyphema developed during the
  clinical course of patients affected the
• opacification of IOLs

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CONCLUSION

• We report our case of the opacification of
  hydrophillic IOLs (Akreos Adapt, Bausch Lomb)
  which was not reported previously
• In patients with DM, the substances forming
• IOLs must be considered for cataract surgery
• Further histopathological studies are warranted
  to analyze the causes of opacification of
  hydrophilic Akreos intraocular lens

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