Histopathological studies of eyes enucleated after failure of intraocular acrylic lens operations.

SINCE Ridley (1951) described his operation, there has been considerable interest and speculation about the possible reaction of the human eye to the presence of an acrylic lenticulus. The clinical impression has been that a certain amount of irritation occurs, as evidenced by frequent iridocyclitis and almost invariable pigment disturbance, but a difference of opinion appears to exist as to the seriousness of these features and as to whether they are caused by trauma at operation, by the irritating mechanical effect of the presence of an intra-ocular foreign body, by the plastic material itself, or by the liberation from the plastic material of previously absorbed antiseptics. Despite a wealth of clinical contributions (Arruga, 1951; Charamis, 1952; Anton, 1953; Arruga and Arruga, 1953; Cavara and Ciotola, 1953; Jonkers, 1953; Silvain Lopez, 1953; McLean, 1953; and many other authors), descriptions of histopathological material are scanty. Theobald (1953) described a slide she had seen of one of our specimens and gave her opinion that the inflammatory response was most marked around the site of the lenticulus and was "an answer to the insult of the irritating acrylic lens". This view, however, remains speculative, and many workers in the field of orthopaedic surgery report excellent tolerance of acrylic material by the tissues (Judet and Judet, 1952; Cherry, 1953; Bingold, 1954; Heck and Chandler, 1954). Henrichsen, Jansen, and Krogh-Poulsen (1952) found that acrylic monomer was highly toxic to animal tissues, but that methyl methacrylate (Metex) was tolerated with no inflammatory response. Finlay and Romaine (1954) described two small pieces of iris removed from eyes containing acrylic lenses and reported a non-specific round cell infiltration, slight in degree and accompanied by fibrosis. Nine eyes enucleated following the acrylic lens operation have now been examined in this department. One was received in 1952, two in 1953, three in 1954, and three in 1955. Eight of the specimens originated from sources outside London and the remaining one from the London area. None was received from the Moorfields group of hospitals. It is not possible, therefore, on the basis of these cases, to give a statistical estimate of the failure rate as compared to that in conventional cataract extraction, since the number of satisfactory cases, which is probably considerable, is not known;