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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 59  |  Issue : 2  |  Page : 175-177

Opacification of intraocular lens: A rare misdiagnosed postoperative façade


Department of Squint, Neuro-Ophthalmology and Pediatric Ophthalmology, Regional Institute of Ophthalmology, Government Ophthalmic Hospital, Chennai, Tamil Nadu, India

Date of Submission03-Nov-2020
Date of Acceptance15-Dec-2020
Date of Web Publication24-Jun-2021

Correspondence Address:
Dr. Niranjan Karthik Senthil Kumar
Department of Ophthalmology, Regional Institute of Ophthalmology, Government Ophthalmic Hospital, Egmore, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_164_20

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  Abstract 


Intraocular lens (IOL) opacification can be one of the rare differential diagnoses for delayed decrease in postoperative vision in patients undergoing cataract surgery. A 73-year-old female presented with the complaints of diminished vision in her operated eye 4 years after a surgery for her cataract. After meticulous evaluation, the patient was diagnosed with opacification of IOL, and appropriate IOL exchange was done. The patient regained vision to 6/12. Hence, it is crucial to keep this cause of postoperative decrease in vision and manage accordingly to restore useful vision.

Keywords: Delayed vision drop, hydrophobic intraocular lens, intraocular lens exchange, intraocular lens opacification, posterior capsular opacification


How to cite this article:
Kumar NK, Raman M, Anuradha A, Sheela S. Opacification of intraocular lens: A rare misdiagnosed postoperative façade. TNOA J Ophthalmic Sci Res 2021;59:175-7

How to cite this URL:
Kumar NK, Raman M, Anuradha A, Sheela S. Opacification of intraocular lens: A rare misdiagnosed postoperative façade. TNOA J Ophthalmic Sci Res [serial online] 2021 [cited 2021 Jul 27];59:175-7. Available from: https://www.tnoajosr.com/text.asp?2021/59/2/175/319275




  Introduction Top


Intraocular lens (IOL) opacification is a rare complication, occurring usually in the late postoperative period, which is reported in various types of IOLs. The exact causes and the underlying mechanisms are still under investigation.[1],[2] It has also been proposed that supposed disturbance of the blood–aqueous barrier may be a part of the process.[3] This condition of pearly white IOL opacification can be easily mistaken with white cataract or posterior capsular opacification (secondary cataract), hence the term, “tertiary cataract.[4]” Clouding of lens has been reported to be much greater among patients with diabetes. In this case report, we present a case of hydrophobic IOL opacification mimicking a posterior capsular opacification.


  Case Report Top


A 73-year-old female presented to the Outpatient Department of RIOGOH, Chennai, with the complaints of diminished vision in her right eye for 3 months. Diminution of vision was insidious in onset which was progressively worsening over 3 months. She had a history of right-eye cataract surgery done 4 years back elsewhere using foldable hydrophobic single-piece IOL. She was a known case of Type II diabetes mellitus and coronary artery disease on oral medications. On examination, vision in her right eye was 1/60 and the anterior segment was unremarkable except for an opacity noted at the plane of the posterior lens capsule [Figure 1]. She had undergone two attempts of neodymium-doped yttrium aluminum garnet (Nd: YAG) capsulotomy, but there was little improvement in vision. Because the patient had undergone two attempts of Nd: YAG capsulotomy but with minimal success, opacification of IOL was suspected. Hence, she was planned for right-eye IOL exchange. Intraoperatively, the IOL was noticed to be opaque and tightly adhered to the underlying capsular bag with dense fibrosis [Figure 2]. Hence, the opacified IOL was removed with the bag in toto. Triamcinolone aided-anterior vitrectomy was carried out and an iris claw lens was inserted [Figure 3]. Postoperatively, vision improved to 6/12, and the patient was comfortable.
Figure 1: Anterior segment examination

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Figure 2: Intraocular lens in situ adhered to the capsular bag

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Figure 3: Iris-claw lens implanted

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  Discussion Top


IOL opacification is a complication associated with significant loss of vision. Opacification pattern is peculiar to the material used for lens. Silicone IOLs are associated with brownish discoloration,[5] hydrophobic IOLs are known for diffuse glistening pattern, and hydrophilic IOLs are known for superficial opacification due to calcium deposits.[6],[7] Postoperative opacification of hydrophilic acrylic IOL due to the presence of granular deposits within the optic of the lens has been reported,[8] which are the naturally occurring calcium produced by the patient's body. Removal of IOLs is required in the cases of vision-threatening opacification, which is challenging due to the tight adherence of the IOL to the capsular bag and may require cutting the haptics before removal of the opacified IOL.[9] In our case of hydrophobic IOL, a distinctive pattern of opacification was noted. Gross evaluation of IOL showed total involvement of the optics with complete sparing of the haptic [Figure 4]. Microscopic visualization of IOL revealed deposition of crystals in the region of optics and haptics to be free of any deposits even at the microscopic level, which was a unique distribution pattern [Figure 5] and [Figure 6]. Review of literature revealed no similar cases demonstrating this distinctive pattern of crystalline deposition associated with hydrophobic IOL.
Figure 4: Explanted intraocular lens showing clear haptics

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Figure 5: Deposits in the optic region with adjacent clear area under microscope

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Figure 6: Clear haptics under microscope

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  Conclusion Top


The important lesson that is aimed to be driven home from this case would be to be aware of this rare and close differential to the more common cause of late postoperative decrease in vision – posterior capsular opacification especially when it is unresponsive to multiple sittings of Nd: YAG capsulotomy. More research is required to provide adequate data regarding the ideal material for an IOL to avoid such complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Izak AM, Werner L, Pandey SK, Apple DJ. Calcification of modern foldable hydrogel intraocular lens designs. Eye (Lond) 2003;17:393-406.  Back to cited text no. 1
    
2.
Tandogan T, Khoramnia R, Choi CY, Scheuerle A, Wenzel M, Hugger P, et al. Optical and material analysis of opacified hydrophilic intraocular lenses after explantation: a laboratory study. BMC Ophthalmol 2015;15:170.  Back to cited text no. 2
    
3.
Morgan-Warren PJ, Andreatta W, Patel AK. Opacification of hydrophilic intraocular lenses after Descemet stripping automated endothelial keratoplasty. Clin Ophthalmol 2015;9:277-83.  Back to cited text no. 3
    
4.
Gupta G, Goyal P, Bal A, Jain AK, Malhotra C. Pearly white intraocular lens opacification-”Tertiary cataract”. Indian J Ophthalmol 2020;68:188-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Koch DD, Heit LE. Discoloration of silicone intraocular lenses. Arch Ophthalmol 1992;110:319-20.  Back to cited text no. 5
    
6.
Werner L. Glistenings and surface light scattering in intraocular lenses. J Cataract Refract Surg 2010;36:1398-420.  Back to cited text no. 6
    
7.
Prabhakar G, Reddy J, Khan S. Air bubble-induced intraocular lens opacification in hydrophobic intraocular lens following posttraumatic cataract surgery: A first-ever case report. TNOA J Ophthalmic Sci Res 2017;55:225.  Back to cited text no. 7
  [Full text]  
8.
Goodall KL, Ghosh YK. Total Opacification of Intraocular Lens Implant After Uncomplicated Cataract Surgery: A Case Series. Archives of Ophthalmology. 2004;122:782-4.  Back to cited text no. 8
    
9.
Jarwal PN, Singh R, Vseem K, Choudhary N. Total Opacification of Intraocular Lens Implant After Uncomplicated Cataract Surgery: A Case Report. The Official Scientific Journal of Delhi Ophthalmological Society. 2019;29:64-6.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
Introduction
Case Report
Discussion
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