Risk of Intraocular Lens Opacification After Endothelial Keratoplasty for Different Intraocular Lens Models: A Retrospective Single-Center Cohort Study

Abstract

Purpose: The aims of this study were to calculate the specific risk of opacification for different intraocular lens (IOL) models and to determine whether differences exist, even between lenses made of similar acrylic materials. Methods: This is a retrospective cohort study of all patients who underwent endothelial keratoplasty (EK), either after or in conjunction with cataract surgery, from June 2009 to October 2020 at Fundación Jiménez Díaz Hospital. Results: Three hundred seventy-two eyes of 308 patients with a median follow-up of 856 days [interquartile range (IQR): 384–1570] were included, of which 128 IOLs were hydrophobic, 120 hydrophilic, and 124 unknown. 12.9% of IOLs opacified after a median of 466 days (IQR: 255–743). Visual acuity (VA) was significantly lower in the opacified IOL group [0.51 (IQR: 0.36–1.13)] compared with the nonopacified group [0.22 (IQR: 0.11–0.65)] (P < 0.001). IOL explantation and exchange was performed in 10 eyes, in which VA improved markedly, from 1.75 (IQR: 0.99–3.00) to 0.60 (IQR: 0.36–0.86) (P = 0.004). IOL material and opacification events were not independent (P < 0.001). Significant differences were found between the Akreos ADAPT AO and MI60P models and the Asphina 409M model (P = 0.022). No significant differences were found in the opacification ratio for hydrophilic IOLs in the clinical diagnosis (P = 0.11), the type of EK (P = 0.25), the rebubbling rate (P = 0.44), or the tamponade used (P = 0.36). Conclusions: Hydrophilic lenses should be avoided in patients at risk of requiring EK. It is important to know the probability of opacification of each IOL model to balance risk and benefits when planning an EK procedure because not all lenses opacify equally. Opacification is an unwanted event with a negative impact on VA, making IOL explantation and exchange the only viable treatment, although one that is not without risks.