Explantation of a light-adjustable intraocular lens: case report with laboratorial analyses

Introduction: A case in which a light-adjustable lens (LAL) underwent explantation and extensive laboratory analyses is reported. Patient and Clinical Findings: A 61-year-old man underwent uneventful cataract surgery with in-the-bag implantation of a first-generation LAL in the right eye. Examination on the second postoperative day revealed limbus-to-limbus corneal edema, moderate anterior chamber cells, and a mid-dilated, minimally responsive pupil, suggesting toxic anterior segment syndrome (TASS). Diagnosis, Intervention, and Outcomes: Endothelial keratoplasty was performed 2 months after LAL implantation. The patient reported noncompliance with required UV-protective eyewear, and an attempted light adjustment confirmed macromer reserve depletion, likely secondary to ambient UV contamination. Gross and microscopic examinations of the explanted LAL showed a decentered round elevation on the optic. The light transmittance (%T) curve was normal, with 95.9%T on average in the visible spectrum. Optical coherence tomography revealed irregular curvatures of the anterior and posterior optic surfaces. Wavefront analysis displayed aberrations and large power variations, which corresponded to decreased focus and contrast through the optic. Conclusions: To the authors' knowledge, this is the first reported case of LAL implantation complicated by TASS, leading to a prolonged clinical course and nonadherence to proprietary UV-protective spectacles. Extensive laboratory analyses of the explanted LAL demonstrated findings that can be expected with uncontrolled polymerization of the LAL.