- Email: [email protected]
Surgical removal of dystrophic calcification on a silicone intraocular lens in association with asteroid hyalosis
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CASE REPORT
Surgical removal of dystrophic calcification on a silicone intraocular lens in association with asteroid hyalosis Sean M. Platt, MD, Raymond Iezzi, MD, Michael A. Mahr, MD, Jay C. Erie, MD
We present a case of successful removal of late calcium deposition on the posterior surface of a silicone intraocular lens (IOL) optic in association with asteroid hyalosis using a surgical technique that included pars plana vitrectomy, a lighted pick, and a modified silicone-tipped cannula. The lighted pick provided the most efficient and complete removal of calcium deposits. Postoperatively, the dystrophic calcification was removed and the IOL optic was clear at 6 months follow-up. The patient’s symptoms resolved and uncorrected distance visual
D
ystrophic calcification of the posterior surface of a silicone intraocular lens (IOL) in the presence of asteroid hyalosis is an uncommon but welldescribed late complication after cataract surgery.1–3 Clinically, fleck-like deposits accumulate on the posterior surface of the silicone IOL a mean of 8 years after implantation, resulting in blurred vision and increased glare.4–6 Treatment for IOL opacification has relied mainly on IOL exchange or explantation.5,7 Attempts to avoid an IOL exchange and to remove calcifications from the silicone optic surface by using a neodymium:YAG (Nd:YAG) laser4,6 or by pars plana vitrectomy (PPV)8–10 have had mixed results because deposit removal and clearing of the IOL optic are often incomplete. We describe a surgical approach that permits nearcomplete removal of calcification from the posterior surface of a silicone IOL in the setting of asteroid hyalosis without the need for IOL explantation. CASE REPORT In August 2008, a 75-year-old man had phacoemulsification in both eyes with implantation of a 3-piece LI61 silicone IOL (Bausch & Lomb, Inc.) in the capsular bag. The postoperative course was unremarkable, with an uncorrected distance visual acuity (UDVA) of 20/20 in each eye. In September 2016, the patient returned with decreased UDVA to 20/60 in the right eye.
acuity returned to 20/20. This method can be considered in patients with dystrophic calcification of a silicone IOL in association with asteroid hyalosis and might avoid the need for IOL exchange and its associated complications and uncertain refractive outcomes. J Cataract Refract Surg 2017; 43:1608–1610 Q 2017 ASCRS and ESCRS Online Video
Examination of the right eye showed opacification of the posterior capsule in association with mild vitreous asteroid hyalosis. In the left eye, the posterior capsule was clear with no detectable asteroid bodies in the vitreous. An Nd:YAG posterior capsulotomy in the right eye was performed for presumed posterior capsule opacification. After the Nd:YAG capsulotomy, although the partially opacified posterior capsule was opened, confluent fleck-like opacities remained on the posterior surface of the silicone IOL in a whirling pattern (Figure 1). The corrected distance visual acuity remained 20/60, and the patient was referred for treatment of IOL opacification. At referral, dystrophic calcification of the silicone IOL in the right eye in association with asteroid hyalosis was diagnosed. Because the posterior capsule was open and the patient had excellent UDVA before IOL opacification, it was decided to surgically remove the calcific deposits and avoid an IOL exchange. A subtotal PPV was performed to gain safe access to the posterior surface of the IOL. Then, 3 techniques were used to remove calcific deposits from the central and paracentral posterior optic surfaces (Video 1, available at: http://jcrsjournal.org). First, a vitrector was introduced through a 23-gauge cannula. With the cutter’s lumen directed anteriorly, the cutting surface was used to mechanically scrape the calcium deposits while aspiration was used to remove dislodged particles in a 1-step fashion. The convexity of the posterior central optic provided adequate vitrector surface contact, clearing a small area of the central optic of calcium. The reduced convexity of the paracentral and peripheral optic, however, prevented good vitrector surface contact and limited clearing of deposits in these areas. Next, a silicone-tipped cannula was beveled at 30 degrees using a super-sharp blade, increasing the
Submitted: July 26, 2017 | Final revision submitted: September 17, 2017 | Accepted: September 19, 2017 From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. Drs. Iezzi and Erie contributed equally to this work. Supported by the Mayo Foundation for Medical Education and Research, Rochester, Minnesota, and Research to Prevent Blindness Inc., New York, New York, USA. The funding organizations had no role in the design or conduct of this research. Corresponding author: Jay C. Erie, MD, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. E-mail: [email protected]. Q 2017 ASCRS and ESCRS Published by Elsevier Inc.
0886-3350/$ - see frontmatter https://doi.org/10.1016/j.jcrs.2017.09.026
CASE REPORT: DYSTROPHIC CALCIFICATION OF SILICONE IOLS
Figure 1. Slitlamp photograph showing diffuse calcific deposits on the posterior optic surface of a silicone IOL in association with asteroid hyalosis. The UDVA was 20/60.
surface area of the cannula opening and converting the endaspiration cannula to a side-aspiration cannula. The beveled soft-tipped edge against the IOL enhanced suction and facilitated removal of paracentral calcium particles. Without the bevel modification, the silicone-tipped cannula tended to “snow plow” deposits, pushing them but not removing them. Finally, the most efficient method to remove calcium from the entire posterior optic surface was using a lighted pick. The pick was turned so the tip was parallel to the IOL surface, and the broad, smooth pick edge efficiently dislodged particles with minimal pressure on the IOL. The lighted pick provided oblique illumination of the IOL posterior surface and enhanced visualization of the calcium deposits. The lighted pick removed nearly all remaining dystrophic calcification from the IOL without damaging the silicone optic (Figure 2), and the optic remained clear for more than 6 months after surgery.
DISCUSSION Opacification of the posterior surface of a silicone IOL in association with asteroid hyalosis is caused by the deposition of apatite crystals (calcium and phosphate) on the surface of the IOL. It is hypothesized that these IOL deposits are produced by the same process that causes asteroid hyalosis because more than 85% of patients with dystrophic calcification have clinically detectable ipsilateral asteroid bodies that are composed of the same apatite crystals.3,5 The treatment for dystrophic calcification has relied mainly on IOL explantation or exchange, which have associated complications.7 Complications after an IOL exchange occur in 17% to 30% of cases in the early postoperative period and in 11% to 22% of cases in the late postoperative period.11 Approximately 33% of IOL exchanges require an anterior vitrectomy, and this increases to 48% with a previous Nd:YAG capsulotomy.12 Anterior vitrectomy is a risk factor for subsequent rhegmatogenous retinal detachment (RRD). For example, an anterior vitrectomy at the time of cataract surgery has a 12% long-term risk for RRD.13 By comparison, PPV for nonemergent or elective procedures is associated with approximately a 2.5% risk for RRD and a 3% to 16% risk for retinal breaks.14,15 Spectacle independence is important in patient satisfaction after cataract surgery.16 This goal is difficult to achieve in secondary IOL insertion because the surgery is
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Figure 2. Slitlamp photograph 6 weeks after removal of calcific deposits by PPV, a lighted pick, and a modified silicone-tipped cannula. Deposits were removed from nearly the entire posterior optic surface, and the visual axis has remained clear for over 6 months. The UDVA was 20/20.
complicated, incisions are often large, and the effective lens position of the secondary IOL can be variable. Only 54% of IOL exchanges achieve a refractive result within G0.50 diopter of the spheroequivalent refractive target.11 Because the calcium deposits coat the silicone IOL posterior surface2 and do not involve the subsurface, the deposits should be amenable to direct surgical removal without the need for IOL explantation. This is in contrast to calcification of certain hydrophilic IOLs in which the calcium deposits cannot be surgically removed because they are incorporated into the subsurface and the surface of the IOL optic.17 Previous attempts to remove calcium deposits from the posterior surface of a silicone IOL using the Nd:YAG laser or PPV have been described with mixed results.8–10 Neodymium:YAG laser displacement of calcium apatite crystals from the IOL optic is often incomplete, and visual improvement is temporary because the displaced deposits will reaccumulate on the silicone optic. In addition, opening the posterior capsule with an Nd:YAG laser might promote acceleration of dystrophic calcification as a result of direct contact between the vitreous and the posterior IOL surface.4 Mehta et al.9 described a case in which central calcific deposits on a silicone optic were removed by using 23-gauge PPV. Others reported partial or incomplete removal of deposits when using PPV alone8,10 as well as “smearing” the deposits on the IOL optic when using a standard silicone-tipped cannula.10 In all case reports, continued IOL opacification was halted during the follow-up, which ranged from 6 to 16 months. The authors hypothesize that in addition to removing the calcium particles, PPV also removes the matrix depot on which the calcium apatite crystals form. We describe a surgical technique that uses PPV, a lighted pick, and a modified silicone-tipped cannula to nearly completely remove dystrophic calcium deposits from the posterior surface of a silicone IOL in the setting of asteroid hyalosis. The result was clearing of the original IOL optic without the complications and uncertain refractive outcomes reported in IOL exchanges. We found the lighted pick to be the most efficient technique to remove calcified Volume 43 Issue 12 December 2017
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CASE REPORT: DYSTROPHIC CALCIFICATION OF SILICONE IOLS
IOL deposits. The lighted pick provides excellent illumination and visualization of the opacified posterior IOL surface. The broad smooth tip facilitates complete and efficient removal of calcium from the central and paracentral optic without damage to the optic. Our follow-up is limited to 6 months. Longer follow-up and additional cases will be necessary to confirm the long-term benefits of this surgical technique in the treatment of dystrophic opacification of silicone IOLs in association with asteroid hyalosis. REFERENCES 1. Wackernagel W, Ettinger K, Weitgasser U, Bakir BG, Schmut O, Goessler W, Faschinger C. Opacification of a silicone intraocular lens caused by calcium deposits on the optic. J Cataract Refract Surg 2004; 30:517–520 2. Foot L, Werner L, Gills JP, Shoemaker DW, Phillips PS, Mamalis N, Olson RJ, Apple DJ. Surface calcification of silicone plate intraocular lenses in patients with asteroid hyalosis. Am J Ophthalmol 2004; 137:979–987 3. Stringham J, Werner L, Monson B, Theodosis R, Mamalis N. Calcification of different designs of silicone intraocular lenses in eyes with asteroid hyalosis. Ophthalmology 2010; 117:1486–1492 4. Werner L, Kollarits CR, Mamalis N, Olson RJ. Surface calcification of a 3piece silicone intraocular lens in a patient with asteroid hyalosis; a clinicopathologic case report. Ophthalmology 2005; 112:447–452 5. Espandar L, Mukherjee N, Werner L, Mamalis N, Kim T. Diagnosis and management of opacified silicone intraocular lenses in patients with asteroid hyalosis. J Cataract Refract Surg 2015; 41:222–225 6. Werner L. Causes of intraocular lens opacification or discoloration. J Cataract Refract Surg 2007; 33:713–726 7. Mamalis N, Brubaker J, Davis D, Espandar L, Werner L. Complications of foldable intraocular lenses requiring explantation or secondary intervention d2007 survey update. J Cataract Refract Surg 2008; 34:1584–1591 8. Ullman DI, Gupta S. Pars plana vitrectomy for dystrophic calcification of a silicone lens in association with asteroid hyalosis. J Cataract Refract Surg 2014; 40:1228–1231 9. Mehta N, Goldberg RA, Shah CP. Treatment of dystrophic calcification on a silicone intraocular lens with pars plana vitrectomy. Clin Ophthalmol 2014; 8:1291–1293. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles /PMC4099192/pdf/opth-8-1291.pdf. Accessed October 7, 2017
Volume 43 Issue 12 December 2017
10. Rainsbury PG, Lochhead J. Pars plana vitrectomy for posterior surface calcification in a silicone intraocular lens in asteroid hyalosis – a report of mistaken identity. Clin Ophthalmol 2014; 8:2239–2241. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235510/pdf/opth-8-2239 .pdf. Accessed October 7, 2017 11. Brunin G, Sajjad A, Kim EJ, Montes de Oca I, Weikert MP, Wang L, Koch DD, Al-Mohtaseb Z. Secondary intraocular lens implantation: complication rates, visual acuity, and refractive outcomes. J Cataract Refract Surg 2017; 43:369–376 12. Leysen I, Bartholomeeusen E, Coeckelbergh T, Tassignon M-JBR. Surgical outcomes of intraocular lens exchange; five-year study. J Cataract Refract Surg 2009; 35:1013–1018 13. Erie JC, Raecker ME, Baratz KH, Schleck CD, Burke JP, Robertson DM. Risk of retinal detachment after cataract extraction, 1980–2004; a population-based study. Ophthalmology 2006; 113:2026–2032 14. Tan HS, Mura M, de Smet MD. Iatrogenic retinal breaks in 25-gauge macular surgery. Am J Ophthalmol 2009; 148:427–430 15. Tan HS, Mura M, Lesnik Oberstein SY, Bijl HM. Safety of vitrectomy for floaters. Am J Ophthalmol 2011; 151:995–998. Available at: http: //www.ajo.com/article/S0002-9394(11)00039-0/pdf. Accessed October 7, 2017 16. Hawker MJ, Madge SN, Baddeley PA, Perry SR. Refractive expectations of patients having cataract surgery. J Cataract Refract Surg 2005; 31:1970– 1975 17. Werner L, Wilbanks G, Nieuwendaal CP, Dhital A, Waite A, Schmidinger G, Lee WB, Mamalis N. Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas. J Cataract Refract Surg 2015; 41:199–207
Disclosures: Dr. Iezzi is a consultant to Alcon Laboratories, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.
First author: Sean M. Platt, MD Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
CASE REPORT
Surgical removal of dystrophic calcification on a silicone intraocular lens in association with asteroid hyalosis Sean M. Platt, MD, Raymond Iezzi, MD, Michael A. Mahr, MD, Jay C. Erie, MD
We present a case of successful removal of late calcium deposition on the posterior surface of a silicone intraocular lens (IOL) optic in association with asteroid hyalosis using a surgical technique that included pars plana vitrectomy, a lighted pick, and a modified silicone-tipped cannula. The lighted pick provided the most efficient and complete removal of calcium deposits. Postoperatively, the dystrophic calcification was removed and the IOL optic was clear at 6 months follow-up. The patient’s symptoms resolved and uncorrected distance visual
D
ystrophic calcification of the posterior surface of a silicone intraocular lens (IOL) in the presence of asteroid hyalosis is an uncommon but welldescribed late complication after cataract surgery.1–3 Clinically, fleck-like deposits accumulate on the posterior surface of the silicone IOL a mean of 8 years after implantation, resulting in blurred vision and increased glare.4–6 Treatment for IOL opacification has relied mainly on IOL exchange or explantation.5,7 Attempts to avoid an IOL exchange and to remove calcifications from the silicone optic surface by using a neodymium:YAG (Nd:YAG) laser4,6 or by pars plana vitrectomy (PPV)8–10 have had mixed results because deposit removal and clearing of the IOL optic are often incomplete. We describe a surgical approach that permits nearcomplete removal of calcification from the posterior surface of a silicone IOL in the setting of asteroid hyalosis without the need for IOL explantation. CASE REPORT In August 2008, a 75-year-old man had phacoemulsification in both eyes with implantation of a 3-piece LI61 silicone IOL (Bausch & Lomb, Inc.) in the capsular bag. The postoperative course was unremarkable, with an uncorrected distance visual acuity (UDVA) of 20/20 in each eye. In September 2016, the patient returned with decreased UDVA to 20/60 in the right eye.
acuity returned to 20/20. This method can be considered in patients with dystrophic calcification of a silicone IOL in association with asteroid hyalosis and might avoid the need for IOL exchange and its associated complications and uncertain refractive outcomes. J Cataract Refract Surg 2017; 43:1608–1610 Q 2017 ASCRS and ESCRS Online Video
Examination of the right eye showed opacification of the posterior capsule in association with mild vitreous asteroid hyalosis. In the left eye, the posterior capsule was clear with no detectable asteroid bodies in the vitreous. An Nd:YAG posterior capsulotomy in the right eye was performed for presumed posterior capsule opacification. After the Nd:YAG capsulotomy, although the partially opacified posterior capsule was opened, confluent fleck-like opacities remained on the posterior surface of the silicone IOL in a whirling pattern (Figure 1). The corrected distance visual acuity remained 20/60, and the patient was referred for treatment of IOL opacification. At referral, dystrophic calcification of the silicone IOL in the right eye in association with asteroid hyalosis was diagnosed. Because the posterior capsule was open and the patient had excellent UDVA before IOL opacification, it was decided to surgically remove the calcific deposits and avoid an IOL exchange. A subtotal PPV was performed to gain safe access to the posterior surface of the IOL. Then, 3 techniques were used to remove calcific deposits from the central and paracentral posterior optic surfaces (Video 1, available at: http://jcrsjournal.org). First, a vitrector was introduced through a 23-gauge cannula. With the cutter’s lumen directed anteriorly, the cutting surface was used to mechanically scrape the calcium deposits while aspiration was used to remove dislodged particles in a 1-step fashion. The convexity of the posterior central optic provided adequate vitrector surface contact, clearing a small area of the central optic of calcium. The reduced convexity of the paracentral and peripheral optic, however, prevented good vitrector surface contact and limited clearing of deposits in these areas. Next, a silicone-tipped cannula was beveled at 30 degrees using a super-sharp blade, increasing the
Submitted: July 26, 2017 | Final revision submitted: September 17, 2017 | Accepted: September 19, 2017 From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. Drs. Iezzi and Erie contributed equally to this work. Supported by the Mayo Foundation for Medical Education and Research, Rochester, Minnesota, and Research to Prevent Blindness Inc., New York, New York, USA. The funding organizations had no role in the design or conduct of this research. Corresponding author: Jay C. Erie, MD, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. E-mail: [email protected]. Q 2017 ASCRS and ESCRS Published by Elsevier Inc.
0886-3350/$ - see frontmatter https://doi.org/10.1016/j.jcrs.2017.09.026
CASE REPORT: DYSTROPHIC CALCIFICATION OF SILICONE IOLS
Figure 1. Slitlamp photograph showing diffuse calcific deposits on the posterior optic surface of a silicone IOL in association with asteroid hyalosis. The UDVA was 20/60.
surface area of the cannula opening and converting the endaspiration cannula to a side-aspiration cannula. The beveled soft-tipped edge against the IOL enhanced suction and facilitated removal of paracentral calcium particles. Without the bevel modification, the silicone-tipped cannula tended to “snow plow” deposits, pushing them but not removing them. Finally, the most efficient method to remove calcium from the entire posterior optic surface was using a lighted pick. The pick was turned so the tip was parallel to the IOL surface, and the broad, smooth pick edge efficiently dislodged particles with minimal pressure on the IOL. The lighted pick provided oblique illumination of the IOL posterior surface and enhanced visualization of the calcium deposits. The lighted pick removed nearly all remaining dystrophic calcification from the IOL without damaging the silicone optic (Figure 2), and the optic remained clear for more than 6 months after surgery.
DISCUSSION Opacification of the posterior surface of a silicone IOL in association with asteroid hyalosis is caused by the deposition of apatite crystals (calcium and phosphate) on the surface of the IOL. It is hypothesized that these IOL deposits are produced by the same process that causes asteroid hyalosis because more than 85% of patients with dystrophic calcification have clinically detectable ipsilateral asteroid bodies that are composed of the same apatite crystals.3,5 The treatment for dystrophic calcification has relied mainly on IOL explantation or exchange, which have associated complications.7 Complications after an IOL exchange occur in 17% to 30% of cases in the early postoperative period and in 11% to 22% of cases in the late postoperative period.11 Approximately 33% of IOL exchanges require an anterior vitrectomy, and this increases to 48% with a previous Nd:YAG capsulotomy.12 Anterior vitrectomy is a risk factor for subsequent rhegmatogenous retinal detachment (RRD). For example, an anterior vitrectomy at the time of cataract surgery has a 12% long-term risk for RRD.13 By comparison, PPV for nonemergent or elective procedures is associated with approximately a 2.5% risk for RRD and a 3% to 16% risk for retinal breaks.14,15 Spectacle independence is important in patient satisfaction after cataract surgery.16 This goal is difficult to achieve in secondary IOL insertion because the surgery is
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Figure 2. Slitlamp photograph 6 weeks after removal of calcific deposits by PPV, a lighted pick, and a modified silicone-tipped cannula. Deposits were removed from nearly the entire posterior optic surface, and the visual axis has remained clear for over 6 months. The UDVA was 20/20.
complicated, incisions are often large, and the effective lens position of the secondary IOL can be variable. Only 54% of IOL exchanges achieve a refractive result within G0.50 diopter of the spheroequivalent refractive target.11 Because the calcium deposits coat the silicone IOL posterior surface2 and do not involve the subsurface, the deposits should be amenable to direct surgical removal without the need for IOL explantation. This is in contrast to calcification of certain hydrophilic IOLs in which the calcium deposits cannot be surgically removed because they are incorporated into the subsurface and the surface of the IOL optic.17 Previous attempts to remove calcium deposits from the posterior surface of a silicone IOL using the Nd:YAG laser or PPV have been described with mixed results.8–10 Neodymium:YAG laser displacement of calcium apatite crystals from the IOL optic is often incomplete, and visual improvement is temporary because the displaced deposits will reaccumulate on the silicone optic. In addition, opening the posterior capsule with an Nd:YAG laser might promote acceleration of dystrophic calcification as a result of direct contact between the vitreous and the posterior IOL surface.4 Mehta et al.9 described a case in which central calcific deposits on a silicone optic were removed by using 23-gauge PPV. Others reported partial or incomplete removal of deposits when using PPV alone8,10 as well as “smearing” the deposits on the IOL optic when using a standard silicone-tipped cannula.10 In all case reports, continued IOL opacification was halted during the follow-up, which ranged from 6 to 16 months. The authors hypothesize that in addition to removing the calcium particles, PPV also removes the matrix depot on which the calcium apatite crystals form. We describe a surgical technique that uses PPV, a lighted pick, and a modified silicone-tipped cannula to nearly completely remove dystrophic calcium deposits from the posterior surface of a silicone IOL in the setting of asteroid hyalosis. The result was clearing of the original IOL optic without the complications and uncertain refractive outcomes reported in IOL exchanges. We found the lighted pick to be the most efficient technique to remove calcified Volume 43 Issue 12 December 2017
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CASE REPORT: DYSTROPHIC CALCIFICATION OF SILICONE IOLS
IOL deposits. The lighted pick provides excellent illumination and visualization of the opacified posterior IOL surface. The broad smooth tip facilitates complete and efficient removal of calcium from the central and paracentral optic without damage to the optic. Our follow-up is limited to 6 months. Longer follow-up and additional cases will be necessary to confirm the long-term benefits of this surgical technique in the treatment of dystrophic opacification of silicone IOLs in association with asteroid hyalosis. REFERENCES 1. Wackernagel W, Ettinger K, Weitgasser U, Bakir BG, Schmut O, Goessler W, Faschinger C. Opacification of a silicone intraocular lens caused by calcium deposits on the optic. J Cataract Refract Surg 2004; 30:517–520 2. Foot L, Werner L, Gills JP, Shoemaker DW, Phillips PS, Mamalis N, Olson RJ, Apple DJ. Surface calcification of silicone plate intraocular lenses in patients with asteroid hyalosis. Am J Ophthalmol 2004; 137:979–987 3. Stringham J, Werner L, Monson B, Theodosis R, Mamalis N. Calcification of different designs of silicone intraocular lenses in eyes with asteroid hyalosis. Ophthalmology 2010; 117:1486–1492 4. Werner L, Kollarits CR, Mamalis N, Olson RJ. Surface calcification of a 3piece silicone intraocular lens in a patient with asteroid hyalosis; a clinicopathologic case report. Ophthalmology 2005; 112:447–452 5. Espandar L, Mukherjee N, Werner L, Mamalis N, Kim T. Diagnosis and management of opacified silicone intraocular lenses in patients with asteroid hyalosis. J Cataract Refract Surg 2015; 41:222–225 6. Werner L. Causes of intraocular lens opacification or discoloration. J Cataract Refract Surg 2007; 33:713–726 7. Mamalis N, Brubaker J, Davis D, Espandar L, Werner L. Complications of foldable intraocular lenses requiring explantation or secondary intervention d2007 survey update. J Cataract Refract Surg 2008; 34:1584–1591 8. Ullman DI, Gupta S. Pars plana vitrectomy for dystrophic calcification of a silicone lens in association with asteroid hyalosis. J Cataract Refract Surg 2014; 40:1228–1231 9. Mehta N, Goldberg RA, Shah CP. Treatment of dystrophic calcification on a silicone intraocular lens with pars plana vitrectomy. Clin Ophthalmol 2014; 8:1291–1293. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles /PMC4099192/pdf/opth-8-1291.pdf. Accessed October 7, 2017
Volume 43 Issue 12 December 2017
10. Rainsbury PG, Lochhead J. Pars plana vitrectomy for posterior surface calcification in a silicone intraocular lens in asteroid hyalosis – a report of mistaken identity. Clin Ophthalmol 2014; 8:2239–2241. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235510/pdf/opth-8-2239 .pdf. Accessed October 7, 2017 11. Brunin G, Sajjad A, Kim EJ, Montes de Oca I, Weikert MP, Wang L, Koch DD, Al-Mohtaseb Z. Secondary intraocular lens implantation: complication rates, visual acuity, and refractive outcomes. J Cataract Refract Surg 2017; 43:369–376 12. Leysen I, Bartholomeeusen E, Coeckelbergh T, Tassignon M-JBR. Surgical outcomes of intraocular lens exchange; five-year study. J Cataract Refract Surg 2009; 35:1013–1018 13. Erie JC, Raecker ME, Baratz KH, Schleck CD, Burke JP, Robertson DM. Risk of retinal detachment after cataract extraction, 1980–2004; a population-based study. Ophthalmology 2006; 113:2026–2032 14. Tan HS, Mura M, de Smet MD. Iatrogenic retinal breaks in 25-gauge macular surgery. Am J Ophthalmol 2009; 148:427–430 15. Tan HS, Mura M, Lesnik Oberstein SY, Bijl HM. Safety of vitrectomy for floaters. Am J Ophthalmol 2011; 151:995–998. Available at: http: //www.ajo.com/article/S0002-9394(11)00039-0/pdf. Accessed October 7, 2017 16. Hawker MJ, Madge SN, Baddeley PA, Perry SR. Refractive expectations of patients having cataract surgery. J Cataract Refract Surg 2005; 31:1970– 1975 17. Werner L, Wilbanks G, Nieuwendaal CP, Dhital A, Waite A, Schmidinger G, Lee WB, Mamalis N. Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas. J Cataract Refract Surg 2015; 41:199–207
Disclosures: Dr. Iezzi is a consultant to Alcon Laboratories, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.
First author: Sean M. Platt, MD Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA