A 65-year-old diabetic male presented to our lens clinic with intraocular lens (IOL) glistenings in his left eye which had been operated 15 years back. On examination, he had a best corrected vision of 20/30 and multiple refractile, glittering inclusions within the polymethylmethacrylate (PMMA) IOL body (Fig. 1) as seen on Spectralis Anterior segment Optical Coherence tomography (Heidelberg Engineering GmbH) (Fig. 2a) and Oculus Pentacam HR Scheimpflug imaging (Fig. 2b).
Fig. 1.
Multiple refractile, glittering inclusions within the IOL body.
Fig. 2a.
Anterior segment optical coherence tomography demonstrating refractile, glittering inclusions within the optic.
Fig. 2b.
Scheimpflug imaging showing intraocular lens glistenings.
Comment
Glistenings are fluid-filled microvacuoles in the IOL optic formed when the IOL is in an aqueous environment. They are seen when water permeates the microchannels of the IOL and subsequently forms minute accumulations of water inside the microvoids in the lens material.1, 2 Differences in the refractive index between the water droplets and the IOL material make the glistenings visible.3 They are commonly seen with hydrophobic acrylic IOL’s and rarely with PMMA IOL’s due to the phenomenon of surface light scattering.4
Factors influencing glistening formation include composition of the IOL material, thickness of the IOL, technique of manufacturing/packaging and associated ocular conditions like glaucoma or those leading to breakdown of the blood-aqueous barrier (diabetes and uveitis), as well as concurrent use of ocular medications.4 Glistenings are usually very small and stable in most of the IOL materials, except the hydrophobic lenses in which they tend to increase a bit over time.
Although the impact of glistenings on postoperative visual outcome and their evolution during the late postoperative period remain controversial, IOL explantation has rarely been reported since the visual acuity usually remains unaffected5 as was seen in our patient.
To conclude, even though this finding is not clinically significant in the vast majority of patients, there is still need to dig further to find the exact ideology of this finding and try to come up with ways to eliminate it completely. These artefacts have no adverse effect on the patients’ visual acuity and are primarily a cosmetic phenomenon, and not an optical incident.
Conflict of interest
The authors declared that there is no conflict of interest.
Footnotes
Peer review under responsibility of Saudi Ophthalmological Society, King Saud University.
References
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