Case reports of IOL opacification after DSEK

The authors describe three cases of IOL opacification in patients who underwent DSEK, occurring at 7, 8 and 18 months postoperatively. Opacifications after DSEK or penetrating keratoplasty have not been reported previously.

Opacification affected visual acuity in all three cases and in one case led to IOL explantation after an attempt to surgically remove the opacification with the aid of a YAG laser failed.

They write that the cause of the opacification in these patients was not clear. In the case in which the IOL was removed, they did not perform ultrastructural examination of the IOL or its opacification. Nevertheless, it cannot be ruled out that the observed IOL alterations are some form of foreign material deposits, organic or inorganic, on the lenses.

The authors note that the question of why IOL alterations occurred in these DSEK patients and none have yet been reported in penetrating keratoplasty patients remains to be answered. It is unclear whether there are any factors inherent to the procedure itself or to the postoperative treatment that might have influenced the formation of opacification. One of the factors that differentiates endothelial keratoplasty from penetrating keratoplasty is that an air bubble is left in the anterior chamber after the former. Yet there are no reports in the literature of any IOL opacities or changes related to donor detachment and rebubbling procedures.