Opacification of piggyback IOLs associated with an amorphous material attached to interlenticular surfaces

To report the pathological and ultrastructural features and interval surgical management of an atypical case of opacification between piggyback intraocular lenses (IOLs).

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, and Nature Coast EyeCare Institute and Surgery Center, Perry, Florida, USA.

Opacification between 2 acrylic piggyback lenses was observed 16 months after implantation, with decreased best corrected visual acuity and a hyperopic shift. Elschnig pearls were observed in the peripheral interface between the lenses, and the central interface was occupied by an amorphous material. The pearls were surgically aspirated, but attempts to remove the central material were unsuccessful. The lenses were explanted and sent to the laboratory. Staining with hematoxylin and eosin (H&E), examination under a light microscope, and scanning electron microscopic analysis were performed.

The surfaces of the anterior IOL were relatively clear. The amorphous material, mostly attached to the center of the anterior surface of the posterior IOL, was homogeneously stained with H&E. No cell nucleus was observed in this region. Scanning electron microscopy showed that the IOL edge presented a smooth, regular surface relatively free of deposits. The most central region was covered by an irregular layer of an amorphous compact material with some cracks, fissures, or both on its surface.

Although the exact composition of the material between the lenses could not be established, hypotheses were advanced to understand the pathological mechanism associated with this condition. This case is different from those in previous reports of opacification composed of cortex and cells between piggyback IOLs.