Sir,
We read the brief communication titled “Pseudoexfoliation on pseudophakos” with interest.[1] Authors have reported three cases of pseudoexfoliation (PXF) on polymethylmethacrylate (PMMA) intraocular lenses (IOLs), all implanted in the sulcus. They have supported the hypothesis given by Park and Kee that IOL placed in sulcus stimulates the production of PXF by the ciliary body.[2]
Contrary to these findings, we have a similar case of PXF on the anterior and posterior surface of PMMA IOL which was well placed in capsular bag [Fig. 1]. PXF was dense, involving visual axis, and was distributed as pattern striations originating from periphery on anterior surface and as multiple granular spots on the posterior surface of IOL [Fig. 2]. The patient was 68-year-old, cattle breeder by occupation, spending most of the time outdoors, and was operated for nuclear cataract as small incision cataract surgery with PMMA IOL implantation in capsular bag 6 years back in our center, and PXF was not observed in either eye at that time.
Figure 1.
Linear striations of pseudoexfoliation material on anterior surface of intraocular lens implanted in the bag
Figure 2.
Granular deposit of pseudoexfoliation on posterior surface of polymethylmethacrylate lens
This PXF material may be produced by equatorial lens capsule and deposited on IOLs in the bag.[3] Duration of outdoor activity exposing the individual for ultraviolet and infrared rays as well as IOL surface irregularities[4] may aggravate the deposition of PXF in such cases. In largest published series till date, da Rocha-Bastos et al. had reported seven such cases out of which six patients had in the bag implantation.[5]
Pathophysiology and clinical significance of this finding remain unknown, but careful follow-up of suspected PXF syndrome is essential even in pseudophakos since PXF material deposits even over IOLs and lead to glaucoma.
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Conflicts of interest
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References
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