EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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September 2011 Differential diagnosis 1. Posterior capsule opacification is caused by migration and proliferation of residual lens epithelial cells behind the IOL optic. It can be treated successfully with Nd:YAG laser capsulotomy. 2. Snowflake degeneration is a slowly progressive opacification associated with lenses made of polymethyl methacrylate (PMMA), resulting from long-term exposure to ultraviolet light. The snowflake lesions are typically found within the anterior third of the optic substance. They are generally not observed in the periphery (due to protection from the iris), and do not disappear in the dry state. This type of degeneration has been observed mostly in lenses implanted between the early 1980s and mid 1990s. 3. Glistenings are fluid-filled microvacuoles, most often associated with hydrophobic acrylic lenses. They can typically be found within the entire optic substance of the lens, and unlike the lesions involved in snowflake degeneration, glistenings disappear when the lens is dry. 4. Cell deposits may be observed on the IOL surface after cataract surgery, and usually are composed of giant cells, macrophages, and fibroblast-like cells. They usually degenerate and detach from the IOL surface in the postoperative period. If necessary, they can be "dusted off" the IOL surface by using an Nd:YAG laser. EW References 1. Werner L, et al. Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens. Ophthalmology 2000; 107:2179-2185. 2. Werner L. Calcification of hydrophilic acrylic intraocular lenses. Am J Ophthalmol 2008; 146:341-343. 3. Werner L. Causes of intraocular lens opacification or discoloration. J Cataract Refract Surg 2007; 33:713-726. 4. Haymore J, et al. Misdiagnosis of hydrophilic acrylic intraocular lens optic opacification: report of 8 cases with the MemoryLens. Ophthalmology 2007; 114:1689-1695. 25 Contact information Editors' note: Drs. Stallings, Werner, and Mamalis are affiliated with the John A. Moran Eye Center, University of Utah, Salt Lake City. They have no financial interests related to this article. Stallings: shannon.stallings@hsc.utah.edu Mamalis: nick.mamalis@hsc.utah.edu Werner: liliana.werner@hsc.utah.edu Practice Makes Perfect! W NE mately leading to calcification of the lenses are still unknown, continuous research on this complication is warranted.2 Surgeons must be able to recognize this condition during clinical examination. Not recognizing it can lead to potentially avoidable procedures (e.g., Nd:YAG laser posterior capsulotomy because of a misdiagnosis of posterior capsule opacification, which will make explantation more complicated and jeopardize implantation of a new lens inside of the capsular bag) and increased risk of complications after repeated interventions.4 Explantation/exchange of the opacified/calcified IOL is to date the only possible treatment. EW CATARACT KITARO® Lab Kits. The Revolutionary Training Tools to Master Cataract Surgery Kitaro Lab Kits ofer surgeons the ability to practice various procedures and techniques repeatedly using synthetic but realistic materials without complicated preparation and expensive consumable goods such as those needed for porcine wet labs. THREE NEW KITS NOW AVAILABLE: KITARO Dry/Wet Lab to practice: • Capsulorhexis • Grooving & Splitting the Nucleus • Phacoemulsification • Wound Construction • IOL Insertion KITARO Complex Lab 1 to practice: • Small Pupil Management • Weak/Ruptured Zonules • IOL Transcleral Fixation KITARO Complex Lab 2 to practice: • Conventional Extracapsular Extraction (ECCE) • Posterior Capsule Rupture Management (PCRM) Visit FCI-Ophthalmics.com to watch the KITARO Training Video. Figure 3: Histochemical (alizarin red and von Kossa), scanning electron microscopic, and surface analysis of explanted calcified hydrophilic acrylic lenses (Hydroview). P: phosphate, Ca: calcium Source: Mamalis/Werner laboratory, John A. Moran Eye Center FCI-Ophthalmics.com 800.932.4202 Call us at 800-932-4202 to receive promotional pricing on your first KITARO Lab Kit.