Postoperative discoloration of a multifocal hydrophobic acrylic lens: case report with laboratory analyses

Introduction: A case of discoloration of a multifocal hydrophobic acrylic intraocular lens (IOL), which was explanted and exchanged as well as underwent laboratory analysis, is reported. Patient and Clinical Findings: The patient presented with a corrected distance visual acuity of 20/50 and glare in the right eye 8 years after implantation. Slitlamp examination revealed a nasally decentered IOL with a whitish-brownish haze throughout. Diagnosis, Intervention, and Outcomes: The discolored IOL (ZMB00) was explanted and exchanged for a 3-piece IOL (sulcus fixation). Grossly, the explanted IOL showed a whitish discoloration of the optic only after hydration, corresponding to a yellowish-brownish discoloration observed under light microscopy. Back light scattering revealed bulk scatter throughout the optic. Light transmittance (%T) showed a slight progressive decrease starting at 500 nm when compared with %T in the directions for use (DFUs). Although modulation transfer function analysis demonstrated similar values to the control lens, the contrast of U.S. Air Force targets appeared slightly decreased. Conclusions: To the authors' knowledge, this is the first reported case of a discolored ZMB00 IOL that underwent explantation and laboratory assessment. Although current analyses did not reveal the etiology of the discoloration, surgeons should be aware of this possible occurrence with this lens design and carefully assess signs and symptoms before explantation.