“Tertiary Cataract”- A Rare Enigma Of Intraocular Lens Opacification

To highlight intraocular lens opacification as a late complication of cataract surgery, to assess different risk factors leading to this complication, its impact on vision and the associated management thereafter. 

Outpatient ophthalmology department in a tertiary healthcare hospital.

We report a case series of 4 patients who presented to tertiary care hospital with progressive painless diminution of vision many months after cataract surgery. History regarding events during cataract surgery, type of IOL implanted, ocular pathologies and any ocular events after cataract surgery was assessed. Their subjective refraction was done to assess the most suitable management protocol.

Two out of four eyes had hydrophilic acrylic intraocular lens implanted. One out of the two patients with opacified hydrophilic acrylic IOLs had diabetes mellitus. Only one out of four patients with opacified acrylic IOL had visually significant opacification. Two patients had history of posterior capsular rent during their cataract surgery which prolonges the duration of surgery which can lead to breakdown of blood aqueous barrier. Two patients with visually significant opacification underwent IOL exchange.

There seems to be a wide list of undiscovered risk factors to this late rare complication that needs to be looked out for. Both hydrophilic and hydrophobic IOL materials can fall into the sequelae of opacification. Hence, cases with predisposition to the known risk factors need cautious follow up.