Pseudoexfoliation on the posterior capsule.

Sir,

I read with interest an article on pseudoexfoliation (PXF) on the intraocular lens (IOL) and congratulate the authors for stressing importance of follow-up examination after cataract surgery for pseudoexfoliative material.[1]

I want to share a rare case of deposition of pseudoexfoliative material on the posterior capsule and the anterior surface of IOL 7 years after phacoemulsification with implantation of hydrophilic IOL in the bag.

A 75-year-old man came to the outpatient department for routine check up. The patient underwent uneventful cataract surgery by phacoemulsification technique with implantation of hydrophilic IOL in his both eyes 7 years ago. The IOL was placed in the capsular bag. Previous records did not mention about PXF material before and during cataract surgery. The best-corrected visual acuity of both eyes was 20/20. Right eye had grayish-white flaky material deposited on the posterior capsule in a random manner [Fig. 1]. The central part of the posterior capsule was free of PXF material. Few strands of PXF material were noted on the anterior lens surface and the pupillary margin. Left eye was normal with no evidence of PXF material. Intraocular pressure was 12 mm of Hg in both eyes. Gonioscopy showed open angle with no evidence of PXF material in the angles. Fundus examination was normal in both eyes.

Figure 1

Pseudoexfoliative material on the posterior capsule of the lens

Contrary to the published report, the exfoliative material was not arranged in a radial manner in our case, suggesting deposition on the posterior capsule. The PXF material produced by one of the ocular structures reaches others due to aqueous current flow. The deposits in our case were more on the posterior capsule than the anterior lens surface. This could be due to nonadhesive nature of the hydrophilic lens to the posterior lens capsule leading to aqueous current flow behind the IOL carrying PXF material on the posterior capsule. Sulcus implanted IOLs have more chances of deposition of PXF material than in the bag-implanted IOLs. Our patient had in the bag implantation of IOL.

Primary open angle glaucoma is common in patients with PXF. PXF material appearing years after cataract surgery may cause glaucoma. Therefore, it is important to suspect and diagnose this condition.