Unilateral deposit of exfoliative material on the surface of intraocular lens after phacoemulsification

We report a case of a 78-year old man who consults for blurred vision 5 years after bilateral cataract surgery with pliable intraocular lens (IOL) implanted in the capsular bag. The best corrected visual acuity was 20/20 in the right eye and 20/25 in the left eye. Slit lamp examination found unilateral left sided pseudo-exfoliative deposits on the surface of the IOL (A,B) with a slight opacification of the posterior capsule (B). Intraocular pressure was normal. The examination of the angle found Sampaolesi line with open angle in both eyes. The excavation of the optic nerve head was normal. Pseudo-exfoliation syndrome (PEX) is common. The origin of the exfoliative material is not yet clearly defined. The exfoliative material can have a target pattern on the surface of the lens with a two rings of deposits separated by a clear area. In cases with material on the surface of the IOL, we can find the opposite pattern with presence of the exfoliative deposits in the intermediate zone, like in our case. The presence of this material on the surface of the IOL after cataract surgery suggests that the anterior capsular lens wouldn´t be necessary for its production. Follow-up is necessary due to the risk of pseudo-exfoliative glaucoma.