Comparison of the incidence of opacification of Hydroview hydrogel intraocular lenses with the ophthalmic viscosurgical device used during surgery.

PURPOSE: To determine the effect of intraoperative ophthalmic viscosurgical devices (OVDs) on late opacification of the Hydroview hydrogel intraocular lens (IOL) (Bausch & Lomb Surgical). SETTING: Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. METHODS: A retrospective study of 949 cases of Hydroview IOL implantations from February 1998 to September 2000 was conducted. Of the 949 implantations, 462 were performed by 1 surgeon (J.H.S.) using Viscoat (sodium chondroitin sulfate 4.0%-sodium hyaluronate 3.0%) and 487 were performed by a second surgeon (W.A.N.) using Biolon (sodium hyaluronate 1.0%). Surgical techniques were identical with the exception of surgeon OVD preference. The number of IOLs opacifying and requiring explantation was determined in each group. RESULTS: Seventy-one Hydroview IOLs had surface calcification deposits that presented a mean of 39 months postoperatively. Twenty-two IOLs opacified sufficiently to warrant a recommendation of IOL explantation; 20 IOLs were explanted, and 2 surgeries were cancelled due to death or disability. In all cases of opacification, Viscoat had been used intraoperatively. This represented a 15.4% incidence of opacification in the Viscoat group, with 31.0% cases severe enough to warrant a recommendation of explantation. CONCLUSION: The results suggest that the intraoperative use of Viscoat has a facilitating role in the development of late calcification and opacification of the Hydroview IOL.

Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery.

PURPOSE: To report clinical and laboratory findings of 8 cases of toxic anterior segment syndrome (TASS) related to an oily substance in the anterior chamber of patients following cataract surgery with intraocular lens (IOL) implantation. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Eight patients had uneventful phacoemulsification by the same surgeon via clear corneal incisions with implantation of the same 3-piece silicone IOL design. Postoperative medications included antibiotic/steroid ointment and pilocarpine gel; each eye was firmly patched at the end of the procedure. On the first postoperative day, some patients presented with diffuse corneal edema, increased intraocular pressure, and an oily film-like material within the anterior chamber coating the corneal endothelium. The others presented with an oily bubble floating inside the anterior chamber, which was later seen coating the IOL. Additional surgical procedures required included penetrating keratoplasty, IOL explantation, and trabeculectomy. Two corneal buttons were analyzed histopathologically. Two explanted IOLs had gross and light microscopic analyses (as well as surface analyses of 1 of them), and 4 other explanted IOLs had gas chromatography-mass spectrometry. RESULTS: Pathological examination of the corneas showed variable thinning of the epithelium with edema. The stroma was diffusely thickened and the endothelial cell layer was absent. Evaluation of the explanted IOLs confirmed the presence of an oily substance coating large areas of their anterior and posterior optic surfaces. Gas chromatography-mass spectrometry of the lens extracts identified a mixed chain hydrocarbon compound that was also found in the gas chromatography-mass spectrometry analyses of the ointment used postoperatively. CONCLUSIONS: The results indicate that the ointment gained access to the eye, causing the postoperative complications described. These cases highlight the importance of appropriate wound construction and integrity, as well as the risks of tight eye patching following placement of ointment.