Anterior subcapsular cataract caused by forceful irrigation during implantation of a posterior chamber phakic intraocular lens with a central hole

Abstract

To report the rare entity of anterior subcapsular cataract after implantation of a posterior chamber phakic intraocular lens (pIOL) with a central hole. Department of Ophthalmology, Goethe-University, Frankfurt, Germany. Retrospective case series. Medical reports were reviewed of patients with vision loss caused by anterior subcapsular cataract after implantation of the V4c Visian Implantable Collamer Lens with a central hole. Patients were identified during regular follow-up visits between January and September 2015. Possible causative factors, such as microbial contamination of surgical instruments, type of ophthalmic viscosurgical device (OVD) and irrigation substance, intracameral application of mydriatics and antibiotics, duration of surgeries, and surgical technique were analyzed. Eleven eyes of 8 patients showed white opacification behind the anterior capsule of the crystalline lens 1day postoperatively. Opacification led to a significant loss of corrected distance visual acuity in all eyes. In 9 eyes, the pIOL was explanted and in 8 eyes, phacoemulsification with IOL implantation was performed. All other analyzed possible causative factors were excluded; thus, the opacification was attributed to the surgical technique of OVD removal by irrigation with a cannula in the presence of a central hole in the pIOL. After the surgical technique was adapted, no further cases of anterior subcapsular cataract occurred. Anterior subcapsular cataract was induced during implantation of a pIOL with a central hole by cannula irrigation with enforced stream onto the capsule through that hole. This entity can be avoided by a change in surgical technique.