Unusual Presentation of Extensive Visually Significant Pseudoexfoliative Deposits on an Intraocular Lens Implant in a Pseudophakic Eye: Insights and Implications.

Objective: The aim of this report is to present a rare case of visually significant pseudoexfoliative deposition on an intraocular lens implant in a pseudophakic eye and describe the clinical characteristics, surgical approach, and histopathological characteristics.

Case presentation: We present the case of a 61-year-old male with a history of cataract surgery in the left eye who presented with blurry vision bilaterally. Examination of the left eye revealed a centered posterior-chamber intraocular lens implant (IOL) with extensive, visually significant pseudoexfoliative plaques growing over the entire IOL. The decision was made to perform right eye phacoemulsification and IOL implantation and left eye IOL exchange. The tissue specimens were subsequently processed using the classical histological technique of paraffin embedding. Intraocular surgery improved the visual acuity from 6/30 in the left and 6/60 in the right eye to 6/6 in both eyes at 3 months postoperative. The extracted implant was examined under a microscope and showed amyloid-positive deposits.

Conclusion: This case highlights the importance of comprehensive examination for pseudoexfoliation, even in patients with pseudophakia. Visually significant PEX deposition was first reported and should be managed with caution.