Biological Mineralization of Hydrophilic Intraocular Lenses

Biomaterials calcify upon implantation in contact with biological fluids, which are supersaturated with respect to more than one crystalline phase of calcium phosphate. The implantation of intraocular lenses (IOLs) for cataract treatment has been hailed as a major advance. Hydrophilic acrylic IOLs, made of Poly(2-hydroxyethyl methacrylate) (PHEMA), upon contact with aqueous humor, exhibit significant incidence of opacification, due to the formation of calcium phosphate crystals, mainly hydroxyapatite (Ca5(PO4)3OH, HAP) on the surface or in their interior. The aqueous humor is supersaturated with respect to HAP. Clinical findings were duplicated by laboratory experiments through the development of appropriate experimental models which included batch reactors, well stirred operating at constant supersaturation (CCR) and reactors simulating anterior eye chamber (ECSR). In both CCR and ECSR, simulated aqueous humor was used. In ECSR the flow rate was the same as in the eye chamber (2.5 mL per 24 h). HAP formed both on the surface and inside the IOLs tested. Induction times preceding the crystallization of HAP on the surface of the IOLs and crystal growth rates were measured. Surface hydroxyl ionized groups favored the development of locally high supersaturation by surface complexation. In the interior of the IOLs, HAP formed by the diffusion of the calcium and phosphate ions inside the polymeric matrix

Biological Mineralization of Hydrophilic Intraocular Lenses

Biomaterials calcify upon implantation in contact with biological fluids, which are supersaturated with respect to more than one crystalline phase of calcium phosphate. The implantation of intraocular lenses (IOLs) for cataract treatment has been hailed as a major advance. Hydrophilic acrylic IOLs, made of Poly(2-hydroxyethyl methacrylate) (PHEMA), upon contact with aqueous humor, exhibit significant incidence of opacification, due to the formation of calcium phosphate crystals, mainly hydroxyapatite (Ca5(PO4)3OH, HAP) on the surface or in their interior. The aqueous humor is supersaturated with respect to HAP. Clinical findings were duplicated by laboratory experiments through the development of appropriate experimental models which included batch reactors, well stirred operating at constant supersaturation (CCR) and reactors simulating anterior eye chamber (ECSR). In both CCR and ECSR, simulated aqueous humor was used. In ECSR the flow rate was the same as in the eye chamber (2.5 mL per 24 h). HAP formed both on the surface and inside the IOLs tested. Induction times preceding the crystallization of HAP on the surface of the IOLs and crystal growth rates were measured. Surface hydroxyl ionized groups favored the development of locally high supersaturation by surface complexation. In the interior of the IOLs, HAP formed by the diffusion of the calcium and phosphate ions inside the polymeric matrix

Graphene-Derivative Coatings for the Prevention of Opacification Due to Calcification of Hydrophilic Intraocular Lenses

The widespread use of hydrophilic intraocular lenses (IOLs) in eye surgery, fabricated by poly-2-(hydroxyethyl methacrylate) (PHEMA), has highlighted their calcification as a serious problem, implying that their surgical explantation is a rather risky process. The field of biomaterials has been developing rapidly in recent years, with research interest turning to the development of novel materials which involve either copolymers of PHEMA or protective functional coatings. Graphene coatings are particularly attractive because of their respective unique properties. In the present work, we present the results of the investigation of the development of graphene coatings on hydrophilic IOLs and their subsequent performance with respect to calcification opacification. Hydrophilic IOLs with a water content of 18% by weight were coated with graphene oxide (GO) by equilibration with GO suspensions in water. The concentrations of the suspensions ranged from 1 × 10−4 to 20 × 10−4% w/v. The GO suspensions were equilibrated with the IOLs for 5 days at a constant temperature, 37 °C, and rotated in 30 mL tubes end over end. This treatment resulted in the formation of a uniform coating of GO on the IOLs verified by scanning electron microscopy (SEM) and other physicochemical methods. The contact angle of the GO-coated IOLs decreased significantly in comparison with the uncoated IOLs. The GO-coated IOLs exhibited a higher tendency to calcify in supersaturated solutions simulating aqueous humor (SAH). The growth rate of hydroxyapatite (Ca5(PO4)3OH, HAP) on GO-coated IOLs was higher in comparison with the respective untreated IOLs. The conversion of the GO coating via a reduction with phenyl hydrazine resulted in the formation of a reduced-graphene (rGO) surface film, as identified by Raman and XPS spectroscopy. The rGO film was hydrophobic (contact angle 100°) and did not calcify in supersaturated calcium phosphate solutions

Calcification of Hydrophilic Acrylic Intraocular Lenses With a Hydrophobic Surface: Laboratory Analysis of 6 Cases

PURPOSE: To investigate the nature and characteristic features of deposits causing opacification of intraocular lenses (IOLs) based on the examination of clinical findings using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDX) analysis. DESIGN: Retrospective, observational case series. METHODS: This is a multicenter study of 6 hydrophilic acrylic IOLs (Lentis LS-502-1; Oculentis GmbH, Berlin, Germany) with a hydrophobic surface that were explanted from 5 patients because of pacification. Three patients had an uncomplicated phacoemulsification. One patient underwent combined phacoemulsification and pars plana vitrectomy for retinal detachment and later silicone oil endotamponade owing to redetachment. The last patient had a pars plana vitrectomy and silicone oil instillation combined with phacoemulsification for tractive retinal detachment and diabetic retinopathy. The explanted lenses were submitted to our laboratory and were examined by SEM and EDX in order to identify the morphologic features and the composition of the deposits. RESULTS: SEM and EDX analyses confirmed the presence of calcific deposits in the interior of the opacified hydrophilic IOLs, with a pattern showing the formation of lumps on the surface. The lumps were due to subsurface formation of calcium phosphate crystalline deposits. The crystallite clusters seemed to diffuse from the IOL interior to the surface. CONCLUSIONS: We demonstrated the calcification pattern of the hydrophilic IOL (Lentis LS-502-1) with a hydrophobic surface. Although hydrophilic acrylic lenses have a hydrophobic surface, the development of calcification is a possible threat initiating from the hydrophilic subsurface of the IOLs. ((C) 2016 Elsevier Inc. All rights reserved.

Explantation of a sutureless scleral fixated Carlevale intraocular lens due to calcification: a clinical and laboratory report

Abstract Background Hydrophilic intraocular lens opacification is a rare complication due to calcification. With current new surgical techniques, including lamellar endothelial keratoplasty and vitrectomies, this irreversible complication is becoming more common. In this case study, we present clinical and laboratory features of a case of Carlevale hydrophilic acrylic IOL calcification. Case presentation Observational case report of a single incident case. An 83-year-old man was referred to our ophthalmic department complaining of right eye vision blurring for six months. Slit-lamp biomicroscopy revealed IOL opacification. Deposits of calcium phosphate were found both on the IOL’s surface and inside it, according to thorough investigation using optical, scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX) spectrometry. Conclusions To the best of our knowledge, this is the first case to describe the laboratory evidence of Carlevale hydrophilic IOL calcification, suggesting possible explanation mechanisms based on underlying pathology and surgical technique. It reminds us that these findings suggest that physicians should be aware of possible hydrophilic IOL calcification