Two years after vitreoretinal surgery with air-fluid exchange for a macular hole, a patient who received a hydrophilic acrylic intraocular lens at the time of combined phaco-vitrectomy notices progressive whitening of the lens optic. Slit-lamp examination confirms central opacification of the optic with a clear haptic. What is the mechanism?

• A Nd:YAG laser pits on the posterior optic surface
• B Growth of glistening microvacuoles in the hydrophobic acrylic material
• C Calcium phosphate deposition within the hydrophilic acrylic polymer ✓
• D Silicone oil emulsification absorbed into the haptics

Explanation

Hydrophilic acrylic lenses are prone to late calcific opacification, and exposure to intraocular gas or air tamponade during vitreoretinal surgery is a recognised risk factor, as is systemic metabolic derangement. The deposits are calcium phosphates within the polymer and require IOL explantation since they resist Nd:YAG treatment. Glistening affects hydrophobic acrylic lenses, laser pits follow capsulotomy, and oil emulsifies rather than opacifying optics.

Reference: AAO Basic and Clinical Science Course, Section 11: Lens and Cataract, 2023-2024 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.