Decreased visual acuity resulting from glistening and sub-surface nano-glistening formation in intraocular lenses: A retrospective analysis of 5 cases

BACKGROUND: To report on five patients with decreased visual acuity due to glistening and severe sub-surface nano-glistening (SSNG) formation within their intraocular lenses (IOLs). DESIGN: Case reports and analysis of extracted IOLs. PARTICIPANTS AND SAMPLES: We report improved visual acuity when IOLs with severe glistening and SSNG were exchanged for clear IOLs in five patients. METHODS: Case reports. MAIN OUTCOME MEASURES: The main outcome measure was visual acuity. The secondary outcome measure was light transmission. Explanted IOLs were subjected to investigation. Pre- and postoperative slit lamp images of the anterior eye and microscopic images of the extracted IOLs were taken and compared. Light transmission of the IOL was measured using a double beam type spectrophotometer. An integrated value of the percentage light transmittance in the visible light spectrum was calculated. RESULTS: We report on five patients whose visual acuity improved when IOLs were exchanged because of severe glistening and SSNG. All of the affected IOLs were MA60BM (Alcon, Forth Wroth Texas, USA) and the original implantation had occurred over a range of 6-15 years prior to the IOL exchange. Light transmission was decreased in all affected lenses compared to a similar control IOL. CONCLUSIONS: Although only a few reports of cases in which glistening and SSNG have progressed to the level of decreased visual function have been published, the likelihood is that this phenomena will increase as the severity and incidence of these inclusions have been shown to increase with time. Appropriate evaluations of visual function in such patients are needed and consideration should be given to IOL exchange in symptomatic patients.