Delhi Journal of Ophthalmology

IOL Opacification Simulating White Cataract

Ankit Ahir, Isha Agarwalla, Mohit Garg, Ganesh Kuri, Bhavya Gokani
Department of Ophthalmology, Sri Sankaradeva Netralaya, Beltola, Guwahati. India.

Corresponding Author:

Isha Agarwalla 
Sri Sankaradeva Netralaya, Beltola, Guwahati, Assam, India
Email: ishaagarwalla@gmail.com 

Received: 20-AUG-2020

Accepted: 11-SEP-2020

Published Online: 12-MAR-2021

DOI:http://dx.doi.org/10.7869/djo.645

Abstract
A 79-year-old male patient presented complaining of decreased visual performance in his right eye(OD) over a 2 month period. On examination, visual acuity was CFCF with a white reflex in pupillary area. On diffuse biomicroscopic examination thin layer of whitish opacification was seen on anterior surface of lens, simulating the presence of total cataract.

Keywords :IOL Opai Fixation White Cataract, Calcium Deposite, Iol Extraction

Case Details
A 79-year-old male patient presented complaining of decreased visual performance in his right eye(OD) over a 2 month period. On examination, visual acuity was CFCF with a white reflex in pupillary area. On diffuse biomicroscopic examination thin layer of whitish opacification was seen on anterior surface of lens, simulating the presence of total cataract (Figure 1A). Slit beam revealed presence of IOL beneath and a uniform thickness of opacification on the surface (Figure 1B).
AS-OCT revealed a uniformly thickened opacification over the IOL surface that did not extend beyond the equator (Figure 2). Posterior segment was unremarkable. 
Diagnosis of opacified IOL was confirmed and IOL explant and replacement was done for the patient with a silicon IOL. 


Figure 1: (A) On diffuse biomicroscopic examination thin layer of whitish opacification was seen on anterior surface of lens, simulating the presence of total cataract.
Figure 1: (B) Slit beam revealed presence of IOL beneath and a uniform thickness of opacification on the surface.


Figure 2: AS-OCT revealed a uniformly thickened opacification over the IOL surface that did not extend beyond the equator.

Comments 
IOL opacification, although a very rare complication, occurrence depends upon the IOL material, underlying eye conditions such as uveitis, diabetic retinopathy or trauma.1,2 Exact etiopathogenesis is unkonown, however conditions that lead to breakdown of blood-aqueous barrier leads to opacification and calcium deposits have been found most commonly.3 IOL opacification has been found following procedures of endothelium, where there is contact of air bubble with IOL surface.4 These cases lead to a surprise in diagnosis, thus a correct sequale of proper history and examination is to be followed. In most cases, explant of IOL is required.

References
  1. Izak AM, Werner L, Pandey SK, Apple DJ. Calcification of modern foldable hydrogel intraocular lens designs. Eye (Lond) 2003;17:393-406.
  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. 
  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.
  4. Fellman MA, Werner L, Liu ET, Stallings S, Floyd AM, van der Meulen IJ, et al. Calcification of a hydrophilic acrylic intraocular lens after Descemet-stripping endothelial keratoplasty: Case report and laboratory analyses. J Cataract Refract Surg. 2013;39:799–803.

CITE THIS ARTICLE

Ahir A, Agarwalla I, Garg M, Kuri G, Gokani BIOL Opacification Simulating White Cataract.DJO 2021;31:110-111

CITE THIS URL

Ahir A, Agarwalla I, Garg M, Kuri G, Gokani BIOL Opacification Simulating White Cataract.DJO [serial online] 2021[cited 2021 Jul 28];31:110-111. Available from: https://www.djo.org.in/articles/31/3/IOL-Opacification-Simulating-White-Cataract.html