When intraocular lenses (IOLs) are implanted during cataract surgery, a small number of patients may develop a dense, vision-obscuring calcification that requires a return to the surgeon. The calcification can even require explantation in rare cases, and that will certainly lead to some dissatisfied patients.1

Researchers now have an idea of two of the primary drivers of calcification. According to a recently published retrospective review of medical records from 15 surgeons from the Royal Victorian Eye and East Hospital in Melbourne, Australia, and six surgeons in private practice in the Australian states of Victoria, New South Wales and Queensland, the top offenders are IOLs that use hydrophilic acrylic materials and the use of intraocular gas.2

The researchers found, of the 15 cases of IOL calcification identified, eight were in hydrophilic acrylic IOLs and seven were in hydrophilic acrylic IOLs with hydrophobic surface properties.2 Another five cases occurred following intraocular injection of gas during endothelial keratoplasties, and another two were seen following pars plana vitrectomy where gas was used.2 Six cases were following trabeculectomy surgery, and two cases were after insertion of a ‘piggyback’ sulcus IOL.2 In each case, researchers say the calcification had the same characteristic pattern: centrally placed in the pupillary zone, mainly affecting the anterior lens surface.2

Researchers suggest that patients likely to struggle with these factors can be identified beforehand by taking a careful history—particularly of the patients’ ocular comorbidities.

1. Rezaei-Kanavi M,  Javadi M, Mirbabaei-Ghafghazi F. Intraocular lens calcification; a clinicopathologic report. J Ophthalmic Vis Res. 2009;4(2):122-4.

2. Darcy K, Apel A, Donaldson M, et al. Calcification of hydrophilic acrylic intraocular lenses following secondary surgical procedures in the anterior and posterior segments. Br J Ophthalmol. February 23, 2019. [Epub ahead of print].