Sir,

Opacification of intraocular lenses (IOLs) is a complication of cataract surgery that may result in IOL explantation.1, 2 We describe a patient with uveitis who developed early postoperative IOL opacification, which subsequently resolved spontaneously.

Case Report

A 50-year-old Chinese female with quiescent idiopathic intermediate uveitis underwent left uneventful 1. 8 mm clear cornea phacoemulsification with in-the-bag implantation of a hydrophilic acrylic IOL (Akreos MI60, Bausch and Lomb, Rochester, NY, USA) in 2007. Posterior synechiae and pupillary membrane were absent. She received prophylactic intracameral dexamethasone 0.4 mg/0.1 ml at the end of surgery.

During postsurgery visits at 1 day and 1 week, there was 1+ anterior chamber (AC) cells, no flare, and the IOL was clear. Her unaided visual acuity (UAVA) was 6/9.

A haze was seen on the anterior surface of the IOL, within the capsulorhexis opening but distinct from the plane of the anterior capsule margin, at 1 month postsurgery (Figures 1a and b). There was 1+ AC and anterior vitreous cells. She was asymptomatic with 6/9 UAVA.

Figure 1
figure 1

Slit lamp photograph of the left eye (a) showing a haze on the surface of the hydrophilic acrylic intraocular lens at 1 month postsurgery; (b) The rest of the intraocular lens and the posterior capsule are clear; (c) at 2 months postsurgery, showing partial resolution of the deposit; (d) The deposit had cleared entirely by 6 months and the intraocular lens remained clear at 3 years after surgery.

Full size image

The central optic haze cleared by 2 months (Figure 1c). At six months, the IOL had completely cleared (Figure 1d) and has since remained clear despite further uveitis recurrences, resulting in 6/7.5 UAVA.

Comment

The IOL opacification seen in our patient differs in its appearance and clinical course from other causes including calcification,2 whitening, glistening,3 and lens epithelial cell (LEC) outgrowth.4

Calcium phosphates deposits, described in older hydrophilic IOLs, usually appear more than 1 year postoperatively.2 LEC outgrowth onto the anterior IOL surface starts early postoperatively.4 It is thought that hydrophilic IOLs with higher water content may promote LEC migration.5 Calcifications and LEC outgrowth are persistent and frequently impact vision significantly. In our patient, the opacification minimally affected her vision and cleared spontaneously.

Inflammatory deposition from blood-aqueous barrier disruption6 is another possible explanation for the haze, especially in a uveitic eye.

Although the cause of IOL haze in our patient remains uncertain, this case suggests that cataract surgeons may consider conservative management in patients with uveitis implanted with hydrophilic IOLs who develop an early haze that minimally affects vision as it may clear spontaneously.