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 Table of Contents  
Year : 2023  |  Volume : 3  |  Issue : 2  |  Page : 558-559

Intraocular lens opacification - “The Hidden Pearl”

1 Uveitis and Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Uvea and Cataract Services, Sankara Nethralaya, Kolkata, West Bengal, India
3 Department of Nanobiotechnology, Vision Research Foundation, Chennai, Tamil Nadu, India

Date of Submission05-Feb-2023
Date of Acceptance20-Feb-2023
Date of Web Publication28-Apr-2023

Correspondence Address:
Mamta Agarwal
Uveitis and Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai - 600 006 Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJO.IJO_357_23

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Keywords: Intraocular lens opacification, intraocular lens, mature cataract, scanning electron microscopy

How to cite this article:
Agarwal M, Patnaik G, Narayanan J. Intraocular lens opacification - “The Hidden Pearl”. Indian J Ophthalmol Case Rep 2023;3:558-9

How to cite this URL:
Agarwal M, Patnaik G, Narayanan J. Intraocular lens opacification - “The Hidden Pearl”. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 5];3:558-9. Available from: https://www.ijoreports.in/text.asp?2023/3/2/558/375047

A 64-year-old woman presented with decreased vision in the left eye (best-corrected visual acuity [BCVA]–20/40) for the last 6 months, with a history of cataract surgery 4 years ago. Slit-lamp examination showed a white pupillary reflex simulating a mature cataract [Figure 1]a and an opacified “pearly white” intraocular lens (IOL-Acriva-BBUD613) [Figure 1]b and [Figure 1]c, which was then exchanged with acrylic hydrophobic IOL, improving vision to 20/20. Scanning electron microscopy of IOL showed numerous fine, granular crystalline deposits and inflammatory cellular deposits on both optic and haptics (350×) [Figure 1]d, [Figure 1]e, [Figure 1]f, possibly due to the supersaturation of aqueous humor with calcium phosphates.[1],[2]
Figure 1: Slit-lamp image shows (a) white pupillary reflex, (b and c) an opacified “pearly white” intraocular lens (Acriva-BBUD613), and explanted IOL (inset). Scanning electron microscopy (d-f) shows numerous crystalline and cellular deposits on the optic and haptics of IOL (SEM× 350)

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  Discussion Top

Late postoperative IOL opacification is a rare complication, mechanism of which is still unclear and related to the supersaturation of aqueous humor with calcium phosphates.[1] The nature of IOL material, inadequate cortex cleaning from the capsular bag and blood aqueous barrier breakdown have been reported to be the possible factors for IOL opacification.[1],[2]

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 initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment for funding the equipment

Department of Biotechnology, Govt. of India (sanction no. BT/PR26926/NNT/28/1500/2017).

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Fernández J, Sánchez-García A, Rodríguez-Vallejo M, Piñero DP. Systematic review of potential causes of intraocular lens opacification. Clin Exp Ophthalmol 2020;48:89-97.  Back to cited text no. 1
Gartaganis SP, Kanellopoulou DG, Mela EK, Panteli VS, Koutsoukos PG. Opacification of hydrophilic acrylic intraocular lens attributable to calcification: Investigation on mechanism. Am J Ophthalmol 2008;146:395-403.  Back to cited text no. 2


  [Figure 1]


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