Sir,

Pseudoexfoliation sydrome is the most common identifiable form of secondary open-angle glaucoma worldwide. It is characterized by white powdery deposits at the pupillary margin of the iris and throughout the inner surface of the anterior chamber.1 We present a case of an 86-year-old gentleman, who presented with pseudoexfoliative material deposited on an intraocular lens implant, a phenomenon widely accepted as rare.2

Case report

An 86-year-old gentleman presented for review of a right-sided cataract. He had a left eye phacoemulsification and insertion of posterior intraocular, Akreous Adapt Bausch and Lomb lens (Bausch and Lomb, Kingston upon Thames, UK), in 2004. His post-operative course had been complicated by persistent iritis and cystoid macular oedema, which settled leaving him with a best-corrected visual acuity of 6/9 in that eye, at which point he was discharged. On re-referral for cataract in the right eye, a new finding of bilateral pseudoexfoliation was noted, with pseudoexfoliative plaques growing over the left intraocular implant (Figure 1). His best-corrected visual acuity was 6/12 in the left eye, with his intraocular pressure measuring 24 mm Hg in the left eye and 38 mm Hg in the right. The use of Bimatoprost (Allergan, Marlow, UK) daily in both eyes adequately controlled the intraocular pressures, which were measured at 20 and 16 mm Hg in the right and left eyes respectively, approximately seven weeks after commencing treatment.

Figure 1
figure 1

Colour photograph showing pseudoexfoliative deposits on intraocular lens implant.

Full size image

Comment

Pseudoexfoliative deposits are known to be found on natural lenses; however, here we present a case of pseudoexfoliation deposits on an intraocular lens implant. It has been suggested that such cases are only infrequently noted as the distance between the posterior iris epithelium, and an intraocular lens is too large to allow deposition of pseudoexfoliation material resulting in these cells passing into the posterior chamber.3 This case is of interest to raise awareness of vigilant examination for pseudoexfoliation, even in pseudophakic patients, where plaques on the lens implant may be the only sign for diagnosis of secondary glaucoma.