Polypoidal Choroidal Vasculopathy Complicated by Red Blood Cell-Coated Intraocular Lens: A Case Report

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Oct 21

PMID 39429384

Authors

Aisha Sawazono

Ryoh Funatsu

Hiroto Terasaki

Naohisa Mihara

Taiji Sakamoto

Affiliations

Soon will be listed here.

Abstract

This study aimed to characterize the detailed multi-modal imaging findings of red blood cell (RBC)-coated intraocular lenses (IOLs). A 68-year-old patient with polypoidal choroidal vasculopathy underwent vitrectomy for subretinal and vitreous hemorrhage. Subsequently, RBC-coated IOL was diagnosed. The iris and IOL surface exhibited a reddish discoloration, while the fundus was completely obscured by slit-lamp examination and ultra-widefield scanning laser ophthalmoscopy. However, posterior segment optical coherence tomography (OCT) allowed visualization of retinal structures. Anterior segment OCT revealed no opacity in the optic part of the IOL in either eye, with comparable findings between both eyes. Given the high absorption spectrum of blood in the visible light range and its minimum absorption at approximately 1100 nm, RBC-coated IOLs may minimally affect anterior and posterior segment OCT images. Conversely, they significantly impair slit-lamp examination and direct fundus visualization. The discrepancy in imaging outcomes between fundus image and OCT could be a characteristic feature of RBC-coated IOLs. This may serve as a characteristic of RBC-coated IOLs. In cases of suspected IOL opacification or RBC-coated IOL following vitreous hemorrhage, anterior segment OCT can evaluate the IOL optic clarity. Additionally, comparing image quality between fundus photographs and posterior segment OCT may provide valuable diagnostic information.

References

Fernandez-Buenaga R, Alio J, Munoz-Negrete F, Barraquer Compte R, Alio-Del Barrio J . Causes of IOL explantation in Spain. Eur J Ophthalmol. 2012; 22(5):762-8. DOI: 10.5301/ejo.5000168. View

Werner L . Causes of intraocular lens opacification or discoloration. J Cataract Refract Surg. 2007; 33(4):713-26. DOI: 10.1016/j.jcrs.2007.01.015. View

Lin H, Yang C, Yang C . Visual outcomes of vitrectomy for polypoidal choroidal vasculopathy-related breakthrough vitreous haemorrhage. Eye (Lond). 2014; 28(7):797-806. PMC: 4094807. DOI: 10.1038/eye.2014.124. View

Yildirim T, Auffarth G, Labuz G, Bopp S, Son H, Khoramnia R . Material Analysis and Optical Quality Assessment of Opacified Hydrophilic Acrylic Intraocular Lenses After Pars Plana Vitrectomy. Am J Ophthalmol. 2018; 193:10-19. DOI: 10.1016/j.ajo.2018.06.002. View

Roggan A, Friebel M, Do Rschel K, Hahn A, Mu Ller G . Optical Properties of Circulating Human Blood in the Wavelength Range 400-2500 nm. J Biomed Opt. 2012; 4(1):36-46. DOI: 10.1117/1.429919. View

Choudhry S, Goel N, Mehta A, Mahajan N . Anterior segment optical coherence tomography of intraocular lens opacification. Indian J Ophthalmol. 2018; 66(6):858-860. PMC: 5989518. DOI: 10.4103/ijo.IJO_1172_17. View

Yildirim T, Labuz G, Hammer M, Son H, Schickhardt S, Auffarth G . A Novel Approach for Assessing Visual Impairment Caused by Intraocular Lens Opacification: High-Resolution Optical Coherence Tomography. Am J Ophthalmol. 2021; 226:108-116. DOI: 10.1016/j.ajo.2021.02.001. View

Hou J, Tao Y, Li X, Zhao M . Clinical characteristics of polypoidal choroidal vasculopathy in Chinese patients. Graefes Arch Clin Exp Ophthalmol. 2010; 249(7):975-9. DOI: 10.1007/s00417-010-1575-7. View

Uyama M, Matsubara T, FUKUSHIMA I, Matsunaga H, Iwashita K, Nagai Y . Idiopathic polypoidal choroidal vasculopathy in Japanese patients. Arch Ophthalmol. 1999; 117(8):1035-42. DOI: 10.1001/archopht.117.8.1035. View

10.

Uyama M, Wada M, Nagai Y, Matsubara T, Matsunaga H, Fukushima I . Polypoidal choroidal vasculopathy: natural history. Am J Ophthalmol. 2002; 133(5):639-48. DOI: 10.1016/s0002-9394(02)01404-6. View

11.

Neuhann I, Werner L, Izak A, Pandey S, Kleinmann G, Mamalis N . Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants. Ophthalmology. 2004; 111(11):2094-101. DOI: 10.1016/j.ophtha.2004.06.032. View

12.

Goemaere J, Trigaux C, Denissen L, Dragnea D, Hua M, Tassignon M . Fifteen years of IOL exchange: indications, outcomes, and complications. J Cataract Refract Surg. 2020; 46(12):1596-1603. DOI: 10.1097/j.jcrs.0000000000000349. View

13.

Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T . Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003; 121(10):1392-6. DOI: 10.1001/archopht.121.10.1392. View

14.

Kim H, Murakami Y, Woo S . Clinical features of red blood cell-coated intraocular lens after breakthrough vitreous hemorrhage secondary to neovascular age-related macular degeneration. J Cataract Refract Surg. 2020; 47(7):892-897. DOI: 10.1097/j.jcrs.0000000000000549. View

15.

Labuz G, Knebel D, Auffarth G, Fang H, van den Berg T, Yildirim T . Glistening Formation and Light Scattering in Six Hydrophobic-Acrylic Intraocular Lenses. Am J Ophthalmol. 2018; 196:112-120. DOI: 10.1016/j.ajo.2018.08.032. View

16.

Jones J, Jones Y, Jin G . Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol. 2013; 157(1):154-162.e1. DOI: 10.1016/j.ajo.2013.08.019. View