Intraoperative explantation of two single-piece hydrophobic acrylic intraocular lenses due to surface deposits

Purpose: To report clinical, pathological, and laboratory analyses of two cases of single-piece hydrophobic acrylic intraocular lenses (IOLs), which presented with significant surface deposits during implantation. Methods: The lenses were implanted with the manufacturer's recommended injector (loaded with Viscoat® and Healon GV®, respectively). Immediately after injection into the anterior chamber, areas on the lenses' surfaces were covered by deposits, which could not be entirely removed by irrigation/aspiration. The lenses were explanted and replaced with lenses of the same design. They underwent gross analyses, light microscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy for analysis of the elemental composition of the deposits. Liquid chromatography/mass spectroscopy was also performed to identify the presence of proteins. Results: The deposits on the first lens had a granular appearance, forming a homogeneous layer mostly on the posterior lens surface. Larger crystal-like deposits were present mostly on the anterior surface of the second lens. Elemental analyses of the deposits in both cases revealed the presence of peaks of sodium, chloride, phosphate, and potassium, in addition to the peaks of carbon and oxygen (normal constituents of the lens material). Only protein components normally found in the anterior chamber during surgery, such as haemoglobin and albumin, were identified. Conclusions: The results obtained suggest that the deposits in both cases may have resulted from crystallization of the ophthalmic viscosurgical device normally used during the loading of the IOLs into the cartridges.