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Pseudophakia with pseudo-pseudoexfoliation

Bahadur, Gavin G. MD; Masket, Samuel MD

Journal of Cataract & Refractive Surgery: October 2007 - Volume 33 - Issue 10 - p 1827-1828
doi: 10.1016/j.jcrs.2007.06.032
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Pseudoexfoliation is a well-described condition associated with characteristic findings including deposition of fibrogranular material on ocular structures, weakened zonules, increased trabecular meshwork pigmentation, and glaucoma.1 We present the case of a patient without pseudoexfoliation who had cataract and intraocular lens (IOL) implantation surgery and later developed opacities on the optic of the IOL that appear similar to those observed on the surface of the natural crystalline lens in pseudoexfoliation.


A 77-year-old woman presented with symptomatic cataracts. She had a history of primary open-angle glaucoma, for which she was taking latanoprost (Xalatan) at bedtime in both eyes. The medical history included hypertension, and the patient was on conjugated estrogen hormone replacement therapy (Premarin). She had no history of metabolic disorders.

On examination, the best corrected visual acuity (BCVA) was 20/40+2 in the right eye and 20/50−1 in the left eye. Slitlamp examination revealed posterior subcapsular and nuclear sclerotic cataracts in both eyes. The rest of the slitlamp and fundus examinations were normal. There was no evidence of pseudoexfoliation or asteroid hyalosis in either eye.

Uneventful phacoemulsification with posterior chamber IOL implantation was performed in the left eye on November 15, 2001, and in the right eye on December 6, 2001. A plate-haptic Collamer IOL (CC4204BF, Staar Surgical) with an overall length of 10.8 mm was implanted in both eyes. On December 17, 2002, uneventful neodymium:YAG laser capsulotomy was performed in the left eye because of symptomatic posterior capsule opacification.

On June 6, 2005, the patient had a routine dilated eye examination. She noted no new visual symptoms. The refraction was plano −0.25 × 90, with a BCVA of 20/20−2, in both eyes. The near visual acuity was J1 with a +2.00 add in both eyes. On slitlamp examination, a concentric ring of fine, spoke-like opacities resembling the appearance of deposits seen in pseudoexfoliation were observed on the anterior surface of the IOL optic in the right eye (Figure 1). The IOL was optically clear in the left eye and the posterior capsule, open. Given the patient's excellent level of visual acuity and lack of symptomatic dysphotopsia, she was advised to follow-up annually for routine eye examinations.

Figure 1
Figure 1:
Slitlamp photograph showing concentric ring of fine, spoke-like opacities on the IOL optic in the right eye.


There are several case reports of IOL deposits/opacities following cataract surgery. These opacifications arise from a variety of etiologies, including immunologic reactions, calcifications related to asteroid hyalosis, and polymer degradation.2–5 The opacities in our case were not symptomatic; however, their precise etiology is unclear and warrants further investigation.


1. Dvorak-Theobald G. Pseudoexfoliation of the lens capsule: relation to true exfoliation of the lens capsule as reported in the literature, and role in the production of glaucoma capsulocuticulare. Trans Am Ophthalmol Soc 1953; 51:385–404. Available at: Accessed July 11, 2007
2. Müllner-Eidenböck A, Amon M, Schauersberger J, et al. Cellular reaction on the anterior surface of 4 types of intraocular lenses. J Cataract Refract Surg. 2001;27:734-740.
3. Werner L, Kollarits CR, Mamalis N, Olson RJ. Surface calcification of a 3-piece silicone intraocular lens in a patient with asteroid hyalosis; a clinicopathologic case report. Ophthalmology. 2005;112:447-452.
4. Turner A, House P. Proliferation of lens epithelial cells on the Acrysof intraocular lens: clinical and histological features of a case. Clin Exp Ophthalmol. 2001;29:426-428.
5. Manuchehri K, Mohamed S, Cheung D, et al. Brown deposits in the optic of foldable intraocular lenses in patients with uveitis. Eye. 2004;18:54-58.
© 2007 by Lippincott Williams & Wilkins, Inc.