Cases reported "Calcinosis"

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1/6. Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens.

    OBJECTIVE: To report clinical, pathological and histochemical features of 5 Hydroview intraocular lenses (IOLs) explanted from five patients who had visual disturbances caused by postoperative deposits on the lens surfaces. DESIGN: Noncomparative small case series with clinicopathologic and histochemical correlations. PARTICIPANTS: Five hydrophilic IOLs explanted from five different patients. All patients presented with decreased visual acuity and glare circa 12 months after uneventful phacoemulsification and IOL implantation, associated with a red-brown granularity on the optical surfaces of the IOLs. methods: The lenses were explanted, fixed in buffered formaldehyde and examined by gross and light microscopy. MAIN OUTCOME MEASURES: Staining of the IOLs with 1% alizarin red and with the von Kossa method (both stains for calcium). Two additional IOLs were also stained and included as controls. RESULTS: The optical surfaces of all five IOLs were covered by a layer of irregular granular deposits, composed of multiple fine, translucent spherical-ovoid granules. The deposits stained positive for calcium in all cases. No deposit or positive staining was observed on the IOLs haptics. Staining of the control IOLs was also negative. CONCLUSION: This is the first histopathological report of calcified deposits on the surfaces of this hydrogel IOL model. Further studies on other similar cases with this lens should be done to determine the incidence and possible mechanisms of this phenomenon.
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keywords = phacoemulsification
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2/6. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: bilateral case report and clinicopathologic correlation.

    OBJECTIVE: To report clinicopathologic and ultrastructural features of two opacified single-piece hydrophilic acrylic intraocular lenses (IOLs) explanted from a diabetic patient. DESIGN: Interventional case report with clinicopathologic correlation. SETTING: A 64-year-old white female underwent phacoemulsification and implantation of a single-piece hydrophilic acrylic lens (SC60B-OUV; Medical Developmental research, Inc., Clear water, FL) in October 1998 in the left eye and in July 1999 in the right eye. The best-corrected visual acuity after surgery was 20/60 in the left eye and 20/50 in the right eye. The patient had a marked decrease in visual acuity in June 2000 as a result of a milky, white opalescence of both lenses. Intraocular lens explantation and exchange was performed in both eyes and the explanted IOLs were submitted to our center for detailed pathologic, histochemical, and ultrastructural evaluation. They were stained with alizarin red and the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. MAIN OUTCOME MEASURES: documentation of calcium deposits confirmed by histochemical stains and surface analyses. RESULTS: Opacification of the IOL was found to be the cause of decreased visual acuity. The opacification involved both the IOL optic and the haptics in the left eye and was confined to the IOL optic in the right eye. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic and haptics. CONCLUSIONS: There are two features that distinguish this case from those reported earlier. This is the first clinicopathologic report of lens opacification that has involved completely the lens optic and the haptics. Second, these two explanted IOLs document the first bilateral case. This process of intraoptic and haptic opacification represents dystrophic calcification of unknown cause. Diabetic patients appear to be more severely and more often affected by lens opacification. Long-term follow-up of diabetic patients implanted with this IOL design should be maintained by surgeons and manufacturers.
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keywords = phacoemulsification
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3/6. Opacification of a silicone intraocular lens caused by calcium deposits on the optic.

    We describe opacification of a plate-haptic silicone intraocular lens (IOL) caused by calcification in a diabetic patient with asteroid hyalosis. The IOL was explanted 48 months after uneventful phacoemulsification because opacification of the posterior surface was causing significant visual disturbance. light and scanning electron microscopy and x-ray spectrometry of the explanted IOL showed the opacification consisted mainly of calcium and phosphate, presumably hydroxyapatite, in the form of precipitations on the posterior surface of the optic.
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keywords = phacoemulsification
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4/6. Calcified cataractous lens.

    We report a calcified cataractous lens in a 24-year-old man who had retinal degeneration in the right eye since childhood. The visual acuity had dropped to light perception. Clear corneal phacoemulsification was performed, and the shell of a 5.4 mm x 4.0 mm x 2.0 mm calcified substance was removed with a forceps using the can-opener technique. The specimen was analyzed using radiological study, histopathological examination, chemical element analysis, and transmission electron microscopy. Four years postoperatively, the patient's visual acuity was 20/200.
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keywords = phacoemulsification
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5/6. Evaluation of calcification of a hydrogel intraocular lens by optical coherence tomography.

    We describe 2 cases of calcification of hydrogel intraocular lenses (IOLs) evaluated by optical coherence tomography. Dense or slight surface opacities of hydrogel IOLs were detected initially by slitlamp biomicroscopy in a 55-year-old woman and a 77-year-old woman. The opacities resulted in complaints of hazy vision after uneventful phacoemulsification and IOL implantation. Optical coherence tomography was used to further assess the opacities and showed calcification by high reflectivity on the anterior and posterior IOL surfaces in the first patient and on the anterior surface in the second patient. No abnormal reflectivity was seen on the surface of a hydrophobic acrylic IOL in the second patient's fellow eye. Optical coherence tomography may be useful to detect calcification of a hydrogel IOL.
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ranking = 1
keywords = phacoemulsification
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6/6. Acute band keratopathy following intracameral Viscoat.

    Band keratopathy developed rapidly in two patients following uneventful phacoemulsification and intraocular lens implantation using BSS Plus (balanced salt solution enriched with glutathione, bicarbonate, and glucose) infusion and Viscoat (chondroitin sulfate-sodium hyaluronate), which was left in the anterior chamber at the conclusion of the procedure. Histopathologic evaluation of corneal tissue obtained from one patient at the time of edetic acid chelation revealed histochemical findings consistent with anterior stromal calcification. To investigate a possible relationship between Viscoat and the rapid onset of band keratopathy, Viscoat formulated with varying concentrations of phosphate buffer was injected intracamerally into 42 rabbit eyes. Within 48 hours, clinically obvious corneal opacification developed in nine (47%) of 19 eyes injected with the commercial preparation of Viscoat. Also, similar opacification developed in ten (77%) of 13 eyes that received Viscoat formulated with twice the phosphate concentration of the commercial preparation. Band keratopathy did not develop any of ten eyes that received Viscoat with one fourth the commercial phosphate concentration. In selected opacified corneas, the presence of phosphorus in the subepithelial and posterior corneal stroma was confirmed by histochemical stains and energy-dispersive x-ray analysis.
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keywords = phacoemulsification
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