Posterior Surface Opacification of a Silicone Intraocular Lens in a Patient with Asteroid Hyalosis

Purpose: In the present study, a case of posterior surface opacification of a silicone intraocular lens (IOL) in a patient with asteroid hyalosis (AH) is reported. Case summary: A 76-year-old male was referred to our clinic with IOL opacification in his left eye. The patient had uneventful cataract surgery 7 years prior with the same silicone IOL implanted in both eyes. Three years after surgery, posterior capsular opacity was observed in his left eye and neodymium:YAG (Nd:YAG) laser capulotomy was performed. After posterior capsulotomy, opacification of the IOL's posterior surface was observed on slit lamp examination. IOL exchange was performed and the explanted IOL was analyzed using a light microscope and a scanning electron microscope with energy dispersive X-ray spectroscopy for elemental analysis of the deposits. The calcification was on the posterior surface of the IOL and composed mainly of calcium and phosphorus, the main components of AH. The right eye showed clear IOL with intact posterior lens capsule. Conclusions: Surgeons performing cataract surgery should consider the possibility of surface calcification of silicone IOLs in eyes with AH before IOL selection for implantation.