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   Table of Contents      
PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 1  |  Page : 188-189

Pearly white intraocular lens opacification – “Tertiary cataract”


1 Department of Ophthalmology, Advanced Eye Centre, Chandigarh, India
2 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission29-Jun-2019
Date of Acceptance26-Aug-2019
Date of Web Publication19-Dec-2019

Correspondence Address:
Prof. Arun Kumar Jain
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_205_19

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  Abstract 


Keywords: Cataract surgery complication, hydrophilic IOL, IOL opacification, phacoemulsification


How to cite this article:
Gupta G, Goyal P, Bal A, Jain AK, Malhotra C. Pearly white intraocular lens opacification – “Tertiary cataract”. Indian J Ophthalmol 2020;68:188-9

How to cite this URL:
Gupta G, Goyal P, Bal A, Jain AK, Malhotra C. Pearly white intraocular lens opacification – “Tertiary cataract”. Indian J Ophthalmol [serial online] 2020 [cited 2020 Jan 19];68:188-9. Available from: http://www.ijo.in/text.asp?2020/68/1/188/273223



A 60-years-old female presented with chief complaints of left eye diminution of vision since 6 months. Patient underwent both eyes cataract surgery 2 years back elsewhere. On examination, her best corrected visual acuity (BCVA) was 6/6 in right eye and 6/18 in left eye. On torch light examination, there was presence of white pupillary reflex in left eye appearing to be white cataract [Figure 1]a. On careful slit-lamp biomicroscopic examination, both eyes were found to be pseudophakic with presence of white opacification over intraocular lens (IOL) in left eye [Figure 1]b. On dilated examination, whole of the hydrophilic IOL (including optic and both haptics) was opacified in left eye, giving pearly white appearance to the IOL [Figure 2]. Patient underwent IOL exchange with acrylic hydrophobic IOL. Postoperative BCVA was 6/6. Explanted opacified IOL was sent for detailed light microscopy (including special staining) and scanning electron microscopy. Alizarin red [Figure 3]a and von Kossa staining [Figure 3]b was suggestive of presence of calcium deposition over the IOL surface. Scanning electron microscopy of the explanted IOL showed presence of calcium crystals over the surface of IOL [Figure 4].
Figure 1: Anterior segment photographs of left eye, (a) on diffuse illumination, showing white pupillary reflex; (b) On slit examination, showing presence of pearly white opacification over intraocular lens (IOL)

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Figure 2: Anterior segment photograph on dilated examination, showing opacification of whole of the hydrophilic IOL (including optic and both haptics), giving pearly white appearance to the IOL

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Figure 3: Analysis of explanted IOL: (a) Photomicrograph showing numerous granular calcium deposits (Red) beneath the edge of the optical surface (Alizarin Red, ×400), (b) Photomicrograph showing numerous granular calcium deposits (Black) beneath the edge of the optical surface (von Kossa, ×400)

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Figure 4: Scanning electron microscope scan of explanted IOL showing numerous crystalline deposits situated over the optical surface of IOL (SEM, ×3000)

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  Discussion Top


The IOL opacification is a rare complication, usually occurring in the late postoperative period in hydrophilic IOLs. The exact causes and patho-mechanisms are still unknown [1],[2] It has also been proposed that supposed disturbance of the blood-aqueous-barrier caused by underlying conditions may contribute to the process.[3] This condition of pearly white IOL opacification, can be easily mistaken with white cataract or posterior capsular opacification (secondary cataract), that is why the term, “Tertiary cataract.” Therefore, detailed clinical evaluation including careful slit lamp examination and dilated examination is of paramount importance in diagnosis of this condition to prevent intraoperative surprises. These cases if visually significant require IOL exchange procedure for treatment, which is associated with good visual outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Izak AM, Werner L, Pandey SK, Apple DJ. Calcification of modern foldable hydrogel intraocular lens designs. Eye (Lond) 2003;17:393-406.  Back to cited text no. 1
    
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.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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