Opacification of the optic of an Akeos Adapt® intraocular lens Chong Eun Lee, MD, Sung Dong Chang, MD, PhD Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea The authors have no financial interest

INTRODUCTION The opacifications of intraocular lens, causing the removal or exchange of implanted intraocular lens, have been reported to occur in some hydrophilic acrylic intraocular lens (IOL) We experienced a case of the opacification of hydrophillic intraocular lens (Akreos Adapt ®, Bausch & Lomb) To our knowledge, there was no prior report of an opacification in that IOL

CASE REPORT 55-year-old man 28-year-history of diabetes mellitus (DM) Also receiving peritoneal dialysis for chronic renal failure Two months before, at other eye hostpital pars plana vitrectomy, panretinal photocoagulation (for proliferative diabetic retinopathy) phacoemulsification & implantation of hydrophillic acryl intraocular lens in the capsular bag (Akreos Adapt ®, Bausch & Lomb)

CASE REPORT At the time of the first visit, the patient presented with proliferative diabetic retinopathy in both eyes and clinically significant macular edema Initial best corrected visual acuity (OD) : 0.08 Four months later BCVA (OD) finger count 10 cm Intraocular pressure (OD) 38 mmHg Rubeosis c hyphema in the right eye Dx. : neovascular glaucoma (OD)

CASE REPORT Ahmed valve implantation(OD) through pars plana, at our hospital 5 months following the surgery of glaucoma (10 months following the implantation of IOL) BCVA (OD) 0.08 Microhyphema still present IOL opacification found

CASE REPORT 45 months following the implantation of IOL BCVA (OD) hand motion disappearance of hyphma IOL opacification causing a decreased VA was found (Figure 1) IOL was explanted from the right eye & Hydrophobic acrylic IOL, YA-60BB (HOYA®, Japan), was implanted into the sulcus

Figure 1. Intraoperative photograph of the right eye showing opacification of Akreos Adapt ® IOL. The arrows show the edges of the opacified area of IOL.

CASE REPORT Postoperatively, the patient did not exhibit specific complications and the visual acuity was improved to 0.04 6 months postoperatively, the corrected visual acuity was maintained as 0.06 due to macular edema

DISCUSSION Exchange of IOL d/t the postoperative opacification has been reported Hydroview® (Bausch & Lomb) ACRL-60 (Ophthalmed Inc.) MemoryLens® (Ciba Vision) AquaSense® (Ophthalmic Innovations International) SC60B-OUV (Medical Developmental Research) Centerflex® 570H (Rayner) * Akros Fit® (Bausch & Lomb) : no clinically notable decrease of VA, exchange of IOL was not performed

DISCUSSION Unfortunately histopathological assessments was not performed Deposition of minerals including Ca2+ on the surface of optical part is assumed to be the causative factor 28-year-history of diabetes & inflammatory responses due to hyphema developed during the clinical course of patients affected the opacification of IOLs

CONCLUSION We report our case of the opacification of hydrophillic IOLs (Akreos Adapt®, Bausch & Lomb) which was not reported previously In patients with DM, the substances forming IOLs must be considered for cataract surgery Further histopathological studies are warranted to analyze the causes of opacification of hydrophilic Akreos intraocular lens

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