To the Editor,
Intraocular lens (IOL) opacification also known as tertiary cataract[1] is a rare and serious complication after cataract surgery and it can occur anytime ranging from months to years after the surgery. The exact pathophysiology is not known but clouding mainly occurs due to the deposition of calcium salts on the IOL surface which increases over time. Disturbance of blood-aqueous barrier due to any cause is found to be the culprit in some of the cases.[2]
We report a case of opacification of AcrySof single-piece hydrophobic acrylic IOL (model SA60AT) in a 60-year-old patient with no other comorbid factors.
A 60-year-old female presented to us with the decrease in vision of the left eye for 2 months. She was nondiabetic, nonhypertensive, and had no other comorbidities. She got her left eye operated 6 months back and after 2 months the vision started deteriorating gradually. Best-corrected visual acuity was 20/20 OD and 20/200 OS with prescriptions of –0.75 DC X90 and-0.5DCX80, respectively. On slit-lamp examination anterior chamber was quiet with annular IOL opacification involving the capsulorhexis and optic in the left eye [Figure 1a and b]. The right eye was pseudophakic with centrally placed IOL. Intraocular pressure and fundus examination were normal. She was advised IOL exchange for better vision. Hydrophobic acrylic IOLs have a lower incidence rate of posterior capsule opacification, IOL discoloration, and calcification as compared to hydrophilic and silicone IOLs.[3]
Figure 1.
(a and b) Intraocular lens opacification in the left eye involving capsulorhexis and optic
The cause of IOL opacification is not proven but varied etiologies such as diabetes, ocular pathologies such as uveitis and asteroid hyalosis, manufacturing as well as the method of IOL storage, the surgical technique used, adjuvants, or a combination of these may be the root cause.[4] Neuhann et al.[5] classified IOL opacifications into three types (1) primary calcification, (2) secondary calcification, and (3) false-positive calcification or pseudocalcification. The calcification due to IOL quality which may be fabricated IOL or faulty packaging method falls under primary calcification. The primary type mostly occurs in normal eyes without any associated comorbidities. The opacification occurring as a result of environmental circumstances such as changes in the aqueous humor, preexisting diseases, or breakdown of the blood-aqueous barrier and not due to IOL issues comes under secondary calcification. The false-positive or pseudocalcification term is given to those cases, in which there is an error in diagnosis (protein deposits on IOL or IOL staining other than due to calcium). In cases of primary opacification, IOL exchange is the option, while in secondary type treatment of the underlying cause should be done.[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given her consent for images and other clinical information to be reported in the journal. The guardian understands that her names and initials will not be published and due efforts will be made to conceal the patient's identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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