Optical Density and Polarized Light Microscopy to confirm calcification of Intra-ocular Lens.

Introduction: Intra-ocular lens (IOL) calcification is a rare yet serious complication, presenting as clouding within the optics of IOL and necessitating IOL exchange.

Patient and clinical findings: In this case, a 77-year-old male experienced gradual vision loss in his left eye (LE) over four years post-cataract surgery a decade before. His best corrected visual acuity (BCVA) was 3/60 in the LE, with the anterior segment displaying a clear cornea but an opacified IOL within the capsular bag. Ultrasound biomicroscopy (UBM) revealed hyperechoic reflections from the IOL in the LE. ImageJ software used on UBM images indicated a significant difference in optical density (OD) compared to the right eye (RE).

Results: The patient was diagnosed with IOL calcification in LE, and underwent anterior vitrectomy and IOL exchange with sulcus-placed IOL with optic capture in the capsular bag, resulting in an improved visual acuity of 6/18. Microscopic examination of explanted IOL revealed whitish calcium carbonate crystal deposits on the IOL, which were visible under polarized light.

Conclusions and significance: The innovative use of polarized light and ImageJ software can be used in resource-constraint settings to confirm the diagnosis in such cases. Based on ImageJ on the UBM image, OD can pick up even subtle changes in the optical clarity of the IOL optic preoperatively.