Reversible opacification of hydrophobic acrylic intraocular lens- two cases report

An 86-year-old Korean man was taking medication for hypertension (losartan potassium [Cozaar, MSD, Kenilworth] and lercanidipine hydrochloride [Zanidip, LG, Seoul]), diabetes mellitus (gliclazide [Diamicron, Servier, Neuilly sur Seine]), chronic obstructive pulmonary disease combined with asthma (budesonide [Pulmican, Kuhnil, Seoul], doxofylline [Asima, Bukwang, Seoul], erdosteine [Erdos, Daewoong, Seoul], and salbutamol sulfate [Ventolin, GSK, Brentford]), and benign prostatic hyperplasia (tamsulosin hydrochloride [Harnal-D, Astellas, Tokyo]). Primary open-angle glaucoma of both eyes was controlled with Cosopt (MSD, Kenilworth) and Xalatan (Pfizer, New York), keeping the intraocular pressure (IOP) between 13 and 15 mmHg. The patient had no history of uveitis. He had sequential phacoemulsification and hydrophobic acrylic IOL (Tecnis ZCB00) implantation in both eyes with 1 week between procedures. Surgery was performed uneventfully through a clear corneal incision, and a dispersive ophthalmic viscosurgical device (4% sodium chondroitin sulfate, 3% sodium hyaluronate [Viscoat, Alcon, Fort Worth]) was used. Preoperatively, the corrected distance visual acuity (CDVA) was 20/80 in each eye. One day after surgery, the CDVA had improved to 20/40 in the right eye and 20/50 in the left eye. Postoperative medication included 1.0%-prednisolone eyedrops (Pred-Forte, Allergan, Waco) and 0.5%-levofloxacin eyedrops (Cravit, Santen, Osaka), with one drop each, four times daily for 4 weeks. To eliminate the risk of pseudophakic cystoid macular edema, we discontinued both cosopt and xalatan for 4 weeks after the surgery. After 4 weeks, the anti-glaucoma medications that were used preoperatively were restarted. Seven weeks postoperatively, the patient was still using the remnants of the Cravit and Pred-Forte, and he complained of decreased visual acuity in the left eye; CDVA was 0.05 in the left eye. Significant opacification covered the anterior surface of the IOL without a chamber reaction. No evidence of inflammation was observed upon fundus examination. The angle was wide open upon gonioscopic examination, but IOP increased to 31 mmHg in the left eye. Cravit and Pred-Forte were discontinued, and Alphagan (Allergan, Waco) was added to the left eye. Five weeks later, IOL opacification had decreased, and the patient had improved visual acuity (20/100) and IOP (17 mmHg). Another 4 weeks later, the IOL opacification had almost disappeared from the left eye (Fig. 1). However, further follow-up examination was not possible because the patient died of aspiration pneumonia.

A 72-year-old Korean woman was taking medication for angina (aspirin [Bayer, Leverkusen] and nitroglycerin, if needed). She had no history of uveitis and was diagnosed with a senile cataract. She underwent phacoemulsification and hydrophobic acrylic IOL (Tecnis ZCB00) implantation in the left eye. Surgery was performed uneventfully through a clear corneal incision, and a dispersive ophthalmic viscosurgical device (Viscoat) was used. Preoperatively, the CDVA was 20/25 but with blurred vision in the left eye. Postoperative medication included 0.1% fluorometholone (Flumetholone, Santen, Osaka) and 0.5%-moxifloxacin eyedrops (Vigamox, Alcon, Fort Worth), with one drop each, four times daily. Two weeks after surgery, the patient complained of discomfort in the left eye, but CDVA was still 20/25. Significant IOL opacification covered the entire anterior surface of the IOL except for the central area, with very mild anterior chamber reaction. The 0.1% Flumetholone was changed to 1.0% Pred-Forte, with one drop four times a day. Two weeks later, IOL opacification had decreased with the resolution of the anterior chamber reaction. Another two weeks later, both IOL opacification and ocular discomfort had completely disappeared, and the CDVA was 20/20 (Fig. 2).