Spectroscopic study of explanted opacified hydrophilic acrylic intraocular lenses

To report a detailed spectroscopic analysis of explanted hydrophilic acrylic intraocular lenses (IOLs) that were removed because of postoperative opacification of the lens optic.

Thirteen Hydroview H60M (Bausch & Lomb Surgical) IOLs were explanted from 13 different patients on average 56 months after phacoemulsification and IOL implantation. All patients had decreased visual acuity because of a fine granularity of the optical surface of the IOLs. The surface was investigated by gross, microscopic, histochemical and scanning electron microscopic analysis, and the elemental composition of the opacified IOLs was determined by X-ray fluorescence spectroscopy (XRF). The spectrograms were compared to three different originally packed and never-implanted hydrophilic acrylic IOLs.

Light and scanning electron microscopy of the optical surface of explanted IOLs revealed multiple fine granular deposits varying in size and shape that were positive for alizarin red. XRF confirmed that the explanted IOLs contained not only the previously reported calcium and phosphorous (calcium apatite), chlorine, silicone, sodium, aluminum and magnesium but also iron, sulfur, potassium as well as lesser amounts of iodine, zinc, strontium and yttrium.

This is the first spectroscopic analysis determining the content of more than 10 elements of explanted and originally packed never-implanted hydrophilic acrylic IOLs. The possible origin of the different elements obtained from the spectrograms and their implications are discussed.