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34 September 2014 EW CATARACT by M. Aabid Farukhi, MD, Nick Mamalis, MD, and Liliana Werner, MD, PhD Gross examination demonstrat- ed signifi cant white discoloration of the optic component. However, as the lens was drying, the degree of optic discoloration progressively decreased. Under light microscopy, the lens appeared fully transparent 10 to 15 minutes after removal from the solution. Upon reimmersion in balanced salt solution, the cloudiness reappeared throughout the optic over a period of 15 minutes (Figure 2). The lens was further analyzed for the presence of chemicals that could potentially increase the absorption of water in the silicone lens, which is a hydrophobic mate- rial. The lens was sent to the Center of Human Toxicology (University of Utah), where it was extracted with acetonitrile and the extracts ana- lyzed by gas chromatography and mass spectroscopy (GC/MS) using electronic ionization. The compounds identifi ed by GC/MS analysis in the explanted, cloudy lens but not the control lens included phenol, 2,4-bis (1,1-di- methylethyl); (Z)-diisooctyl adipate; tributoxyethyl phosphate. Exog- enous molecules were also found in the analyses of the other lenses explanted in Brazil. Comments There have been reports on discol- oration and central haze of silicone lenses in the early 1990s, occurring from weeks to months after IOL implantation. 3–6 In general this com- plication was considered clinically insignifi cant; IOL explantation has rarely been performed. These reports have suggested that the brown haze was due to light scatter from water vapor that may diffuse into the sili- cone when immersed in an aqueous medium. This may be caused by some anomaly of the curing process during the manufacture of those lenses or by incomplete extraction of large polymers. Ultraviolet blocking agents did not seem to be an issue with lens discoloration since the phenomenon was also observed with silicone IOL models not containing these agents. Additional fi ltration steps in the manufacturing process of silicone lenses seemed to solve the problem. Medical Optics, Santa Ana, Calif.; model SI-40NB) in the left eye on June 17, 2003. During the fi rst week, the BCVA in the left eye improved to 20/25. A week later, phacoemulsifi ca- tion was performed in the right eye with implantation of the same IOL model. The IOL remained transpar- ent during the implantation, and no intraoperative complications occurred. This was the fourth of 12 procedures performed that day with implantation of the same IOL design. Tobramycin and dexameth- asone ointment was applied at the conclusion of the procedure and the eye was occluded. On the fi rst postoperative day, approximately 20 hours after the surgery, a homogeneous, milky gray opacifi cation of the IOL optic was apparent. BCVA of the affect- ed eye was 20/30 (Figure 1). There was no anterior chamber reaction noted on slit lamp examination. Contrast sensitivity of the affected eye was 20/200 compared to 20/20 in the unaffected eye. The IOL was removed 78 days later. BCVA after explantation of the lens in the affected eye was 20/20. Interestingly, other similar cases with the same type of lens occurred approximately the same time in other locations in Brazil. Lab analysis and results The lens was sent to our laboratory immersed in balanced salt solution. Gross examination, light microsco- py, and photography of the explant- ed lens were performed in both the hydrated and dry state. tion, surgeons and IOL manufactur- ers should be aware of the potential causes of early postoperative optic opacifi cation of silicone lenses. Case report A 65-year-old woman with a history of diabetes and systemic hyperten- sion presented with bilateral nuclear cataracts and a best corrected visual acuity (BCVA) of 20/50 in each eye (case of Dr. Christiana Hilgert, Campo Grande, Brazil). She had routine phacoemulsifi cation and silicone IOL implantation (Advanced T his case represents a unique complication involving a silicone intraocular lens (IOL) after cataract ex- traction. 1,2 Although a rare occurrence in general, postoperative opacifi cation of silicone IOLs has been previously documented. 3–6 This current scenario involves an early onset of lens opacifi cation and required explantation to correct the problem, compared to earlier report- ed cases that involved later onset of opacifi cation. Given the interesting issues surrounding this complica- A case of early postoperative opacifi cation of a silicone intraocular lens M. Aabid Farukhi, MD Nick Mamalis, MD Liliana Werner, MD, PhD Cataract/IOL complications: Moran CPC reports Free web seminar on "Ocular Surface Lumps and Bumps" Featuring Edward J. Holland, MD, Stephen C. Kaufman, MD, PhD, Clara Chan, MD, and Edwin Chen, MD S ponsored by the ASCRS Young Eye Surgeons Clinical Committee, this web seminar will address how the comprehensive ophthalmologist can best manage ocular surface irregularities, "lumps and bumps" such as pterygia, anterior basement membrane degeneration, Salzmann's nodules, and limbal stem cell defi ciency. Procedures such as super- fi cial keratectomy, PTK, and amniotic membrane grafting prior to cataract or refractive surgery will be discussed. The free web seminar will take place on September 24 at 9 p.m. EST. The seminar will be hosted by Clara Chan, MD, and will feature Edward J. Holland, MD, Stephen C. Kaufman, MD, PhD, and Edwin Chen, MD. 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