Intraocular lens opacification after corneal endothelial keratoplasty: Electron microscopy and x-ray element spectroscopy analysis

PurposeTo assess a newly recognized long-term complication of Descemet-stripping automated endothelial keratoplasty (DSAEK).SettingPlymouth Royal Eye Infirmary and Plymouth Electron Microscope Centre, Plymouth, United Kingdom.DesignRetrospective case series.MethodsThis study evaluated cases of intraocular lens (IOL) opacification that developed after uneventful DSAEK. None of the IOLs was previously known to opacify. In 1 case, the opacified IOL was explanted and analyzed using detailed light microscopy, scanning electron microscopic (SEM) analysis, and element x-ray spectroscopy.ResultsIn all 5 cases, the IOL was hydrophilic acrylic and the eye developed IOL anterior surface opacification 4 to 12 months after DSAEK. In 1 eye, the opacification was symptomatic; thus, an IOL exchange was performed. Light microscopy and SEM analysis of the explanted IOL confirmed opacification on the anterior surface and subsurface areas. X-ray element spectroscopy showed the granules were composed of calcium and phosphorous.ConclusionsThese cases indicate that IOL opacification after DSAEK is a late, although newly recognized, complication of endothelial keratoplasty.Financial DisclosureNo author has a financial or proprietary interest in any material or method mentioned.