Pseudophakic asteroiderosis after YAG capsulotomy in a silicone intraocular lens

Session Details

Session Title: Presented Poster Session 08: Cataract Surgery Complications / Management

Session Date/Time: Sunday 14/09/2014 | 09:30-11:00

Paper Time: 10:30

Venue: Pod 2 (Poster Village)

First Author: : P.Rainsbury UK

Co Author(s): :    J. Lochhead              

Abstract Details

Purpose:

This case report describes a potential late complication of silicone lens implantation in the presence of asteroid hyalosis.

Setting:

St Mary's hospital, Newport.

Methods:

An 86 year old male presented to the Ophthalmic service with reduced vision in his left eye. He had poor vision in his right eye due to a failed Decemet stripping endothelial keratoplasty (DSEK), which was originally performed for Fuchs’ endothelial dystrophy. In his left eye he also suffered from Fuchs’ endothelial dystrophy in the presence of advanced glaucoma. He had undergone bilateral uncomplicated cataract surgery 20 years previously. He had also subsequently had YAG capsulotomy in the left eye two years prior to presentation. On assessment he had no perception of light in the right eye, and 6/18 vision in his left eye. Examination revealed a failed DSEK graft in the right eye, and rubeosis of the iris. In the left eye there were corneal gutata, and marked deposits of asteroid hyalosis on the back of the intraocular lens which had migrated through the YAG capsulotomy. In this poster we present the findings in this patient and review the outcome. A literature search was also performed to present a summary of the other 23 cases of this condition that have been previously reported.

Results:

The management of this patient was challenging, whilst IOL exchange combined with vitrectomy was an option, this carried a high risk of corneal decompensation. There was also the risk of post-operative IOP rise further complicating his advanced glaucoma. YAG laser of the lens deposits was attempted unsuccessfully, so it was decided to proceed with an anterior vitrectomy and posterior IOL polish via a pars plana approach.

Conclusions:

Asteroid hyalosis is a common condition, and previous reports of asteroid deposits on silicone intraocular lenses have been treated with IOL exchange. All of these occurred after YAG capsulotomy at varying time intervals. We feel that it is important for cataract surgeons to be aware of this potential late complication. We would suggest avoiding silicone lenses in asteroid hyalosis, and deferring YAG capsulotomy until symptoms are more advanced. YAG capsulotomy can rapidly accelerate this problem in the presence of a silicone IOL. Debulking vitrectomy and posterior intraocular lens polishing may be an alternative treatment to lens exchange in selected cases.