Intraocular lens opacification after corneal endothelial keratoplasty: Electron microscopy and x-ray element spectroscopy analysis

Abstract

PURPOSE: To assess a newly recognized long-term complication of Descemet-stripping automated endothelial keratoplasty (DSAEK). SETTING: Plymouth Royal Eye Infirmary and Plymouth Electron Microscope Centre, Plymouth, United Kingdom. DESIGN: Retrospective case series. METHODS: This study evaluated cases of intraocular lens (IOL) opacification that developed after uneventful DSAEK. None of the IOLs was previously known to opacify. In 1 case, the opacified IOL was explanted and analyzed using detailed light microscopy, scanning electron microscopic (SEM) analysis, and element x-ray spectroscopy. RESULTS: In all 5 cases, the IOL was hydrophilic acrylic and the eye developed IOL anterior surface opacification 4 to 12 months after DSAEK. In 1 eye, the opacification was symptomatic; thus, an IOL exchange was performed. Light microscopy and SEM analysis of the explanted IOL confirmed opacification on the anterior surface and subsurface areas. X-ray element spectroscopy showed the granules were composed of calcium and phosphorous. CONCLUSIONS: These cases indicate that IOL opacification after DSAEK is a late, although newly recognized, complication of endothelial keratoplasty. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.