Air Bubble-Induced Intraocular Lens Opacification In Hydrophobic Intraocular Lens Following Post Traumatic Cataract Surgery

Intraocular lens opacification is a serious but rare problem that may necessitate exchange of the lens.  Type of opacificationis typical to the material intraocular lens (IOL) is made of. Inthis report, we describe a distinct kind of opacification in a hydrophobic IOL due to intracameral air injection following posttraumatic cataract surgery.

Case report at a tertiary eye center.

A 19‑year‑old male presented with complaints of diminution of vision in the right eye (RE) both for distance and near. He had undergone cataract surgery in the RE elsewhere 6 years ago for traumatic cataract following firecracker injury.His best-corrected visual acuity in RE was 6/60 and in the left eye (LE) was 6/6.On slit-lamp biomicroscopic examination in the RE, he had peripheral anterior synechiae at 11’o clock position with 
pupillary peaking and intraocular lens (IOL) glistening involving only the eccentric pupillary area as confirmed following a dilated examination.The rest of the anterior and posterior segment findings werewithin normal limits. LE anterior and posterior segment examination was unremarkable.As the rest of the IOL, which was protected by the iris, was noted to be clear, the opacification at pupillary area suggests it to be secondary to air bubble contact.He underwent IOL exchange in the RE. A three-piece polymethylmethacrylate IOL was placed in sulcus. Optic capture was done to prevent iris rubbing and pigment dispersion. Inferonasal sphincterotomy was done to shift pupil centrally. IOL was noted to be hydrophobic. Explanted IOL maintained its flexibility even after drying up, suggestiveof hydrophobic material. Explanted IOL was confirmed as hydrophobic material by an IOL manufacturer.

Intraocular lens opacification is rare but can be associated with significant loss of vision. Opacification pattern is peculiar to the material used for lens. IOL opacifications of similar pattern were reported in hydrophilic lenses following air Injection in anterior chamber for DSEK/DMEK and air injection associated with surgery posttrauma. None of these cases were associated with hydrophobic IOL. With this case report, we want to highlight the fact that one should be careful before using intracameral air injection in eyes with both types of IOLs.