ANTERIOR SUBCAPSULAR VACUOLAR CHANGE OF THE CRYSTALLINE LENS IN A PATIENT AFTER PHAKIC INTRAOCULAR LENS IMPLANTATION

To describe a case report of anterior subcapsular vacuolar changes of crystalline lens in a high myopic patient after phakic intraocular lens implantation under Viscoat cover. To study the effects of OVD used on the crystalline lens.

Drishti Eye Institute, Dehradun

A 37-year-old female with a CDVA of 6/6 in both eyes with refractions of -5.00/-0.50 @30° and -5.00/ -0.50 @120° in the right and left eyes, respectively. Slit lamp and fundus examinations were normal. ACDs were measured at 2.73 and 2.70 in the right and left eye, respectively. The calculated ICL model was 12.1mm, ICM5-7.00 and 12.1mm, ICM5-6.00. Patient underwent ICL implantation under Viscoat cover in the right eye. However, during the final step of OVD removal, vacuolar changes were generated in the anterior subcapsular space of the crystalline lens. On POD1, UDVA was 6/6 in the right eye with slit lamp showing bleb-like lesions in the anterior subcapsular space, confirmed on ASOCT (Heidelberg Engineering). Vaulting was measured to be 572µm by ASOCT, and IOP was 17 mmHg in the right eye. ICL implantation in the left eye was uneventful and done under BSS irrigation.

The anterior subcapsular vacuolar changes noted in the right eye started to disappear spontaneously at 1 week after surgery and UDVA was maintained at 6/6. No further progression of cataract in the cortex or nucleus of lens has been observed.

Crystalline lens opacification after ICL implantation may have a multifactorial etiology . The use of Viscoat which is a cohesive OVD can be considered as a cause of anterior subcapsular changes because of different physical and chemical properties. The vacuolar changes improved without any visual deterioration. This is one of the rare cases of transient vacuolar changes in the anterior subcapsular space of the crystalline lens and to be considered as a possible complication. To avoid this complication, irrigation should be done carefully and low viscous OVD should be used.