Noninflammatory White Punctate Posterior Capsular Deposits After Uneventful Phacoemulsification With Preserved Objective Optical Quality: A Rare Presentation

To describe a rare noninflammatory postoperative presentation of posterior capsular white punctate deposits after uneventful phacoemulsification with preserved visual acuity and objectively confirmed optical quality, and to report the incidental finding of bilateral angioid streaks.

Ophthalmology Department, Centre Hospitalier Sud-Francilien, Paris, France

Postoperative white punctate deposits at the posterior capsule or at the posterior capsular-intraocular lens (IOL) interface are rarely reported and may be mistaken for inflammatory or infectious entities, early posterior capsule opacification, or IOL material-related changes.

A 76-year-old woman underwent phacoemulsification for senile cataract and in-the-bag implantation of a hydrophilic acrylic IOL with a hydrophobic surface (ZEISS ASPHINA 509 MP). On postoperative day 7, numerous homogeneously distributed white punctate opacities were reported behind the IOL optic. Best-corrected visual acuity reached 20/20. Anterior segment OCT demonstrated hyperreflective deposits along the posterior IOL surface/capsular interface. Double-pass optical quality testing showed excellent media clarity (Objective Scatter Index 0.5 in the right eye and 0.8 in the left eye). Fundus examination and angiography revealed bilateral angioid streaks without choroidal neovascularization, with no associated systemic disease identified.

White punctate posterior capsular deposits may represent a benign, noninflammatory postoperative interface phenomenon with no functional impact. Objective optical quality metrics and multimodal imaging can support conservative management and help avoid unnecessary treatment.