Late opacification of a silicone intraocular lens caused by ophthalmic ointment

J Cataract Refract Surg. 2006 Feb;32(2):341-6. doi: 10.1016/j.jcrs.2005.07.018.

Abstract

A 55-year-old man had uneventful phacoemulsification with implantation of a 3-piece silicone intraocular lens (IOL). Postoperative medications included antibiotic-steroid drops and ointments. Eight months postoperatively, the patient started having recurrent episodes of anterior chamber inflammatory reaction. Suspicion that lens instability was causing the reactions led to a lens repositioning procedure 11 months after the initial surgical implantation and again at 13 months. Eighteen months postoperatively, the IOL had a "greasy" film. Despite antiinflammatory and antibiotic treatment, the clinical outcome did not improve. Twenty-seven months after implantation, the lens was exchanged with a hydrophilic acrylic IOL. The course after the exchange was uneventful. The explanted lens was examined by gross and microscopic evaluations, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and gas chromatography-mass spectrometry (GC-MS) using electronic ionization. Gross and microscopic evaluations confirmed the presence of a thin, oily film covering the IOL optic surface. Surface analyses at the level of the oily substance showed unspecific peaks of sodium, chloride, and potassium. The GC-MS analysis showed the presence of compounds characteristic of hydrocarbons, including docosane, tricosane, and tetracosane, which are commonly found in the vehicle of ophthalmic ointments. The GC-MS analysis of 1 ointment used postoperatively found matching peaks, suggesting deposition of those compounds on the IOL.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Device Removal
  • Dexamethasone / chemistry
  • Electron Probe Microanalysis
  • Gas Chromatography-Mass Spectrometry
  • Humans
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Male
  • Microscopy, Electron, Scanning
  • Middle Aged
  • Ointment Bases / adverse effects*
  • Ointment Bases / chemistry
  • Ointments / chemistry
  • Phacoemulsification
  • Postoperative Complications*
  • Prosthesis Failure*
  • Reoperation
  • Silicone Elastomers*
  • Tobramycin / chemistry

Substances

  • Ointment Bases
  • Ointments
  • Silicone Elastomers
  • Dexamethasone
  • Tobramycin