Two Cases of Late Opacification of the Hydroview Hydrogel Intraocular Lens

In a notice dated 1 June 2000, Scottish Healthcare Supplies advised interested parties of opacification of Acryflex SC60B-OUV and SC600-2 and Orion IFP3D6 intraocular lenses (IOLs), both hydrophilic acrylic types. There are reports of 27 cases from 7 hospitals in the United Kingdom, and 9 IOLs had to be explanted. There is a similar report from France, where 10 cases have been reported. Bausch & Lomb Surgical, makers of the Hydroview IOL, recently announced that because of 76 cases of IOL calcification, out of a total of 417 000 sold worldwide, the United States launch of the Hydroview was to be postponed (Ocular Surgery News International Edition, April 2000). I recently observed 2 cases of late opacification of Hydroview IOLs. In the first case, the patient was referred by her optometrist, complaining of visual blur, while the second was asymptomatic and was examined for other reasons. Case 1 An 80-year-old woman in good health had routine cataract surgery, with a clear corneal incision, uneventful phacoemulsification, and in-the-bag Hydroview IOL insertion; she recovered good postoperative acuity. The viscoelastic material used was Biocorneal; the irrigating fluid, Aqsia. She was referred by her optometrist 19 months later, complaining of visual blur. Examination showed visual acuity of 6/12 with subjective blurring. Slitlamp biomicroscopy showed that the IOL was markedly and diffusely hazy. After the IOL was replaced with a poly(methyl methacrylate) IOL, the patient recovered good acuity. Figure 1 shows the explanted IOL, with a clear IOL for comparison. The IOL was submitted to Bausch & Lomb Surgical (U.K.); at the time of this report, I had not received a response.Figure 1.: (Murray) The explanted (left) and a clear (right) Hydroview IOL.Case 2 An 82-year-old woman, in good health, had the same uneventful procedure as the first case, using the same materials. There was a short period of postoperative iritis, which cleared on topical steroid therapy. Twenty-one months after surgery, still with good visual acuity and no untoward symptoms, the patient attended as a subject for a clinical examination run by the local Royal College, and during routine examination, it was noted that her left IOL was mildly and diffusely hazy. Because she was asymptomatic, no action apart from future follow-up has been taken. There have been reports of IOL opacification affecting silicone,1,2 acrylic,3 and hydrogel4 IOLs. According to a letter sent by Bausch & Lomb Surgical to all its IOL users dated 17 February 20000, “an aggressive worldwide investigation involving scientists and clinicians” is currently underway. I would like to recommend that all users of foldable IOLs should keep the possibility of late opacification in mind and consider a routine 2 year follow-up to detect asymptomatic cases. Robert I. Murray FRCS aMelrose, Scotland, UK