Clinically significant deterioration in the quality of vision as a result of subsurface nanoglistenings in a hydrophobic acrylic intraocular lens

Jacob Rullo, PhD, John C. Lloyd, MD

Glistenings are fluid-filled refractile microvacuoles that form within implanted intraocular lens (IOL)material. 1 The clinical significance of glistenings remains controversial in the field of cataract and refractive surgery. The hydrophobic acrylic Acrysof IOL (Alcon Laboratories, Inc.) has been cited with the greatest number of reported glistening outcomes.2 This IOL has also been implicated in a phenomenon known as whitening or subsurface nanoglistenings.3 Subsurface nanoglistenings appear as surface scattering or dense whitening on the surface of IOLs under slitlampmicroscopy.3 Subsurface nanoglistenings have been resolved under cryofocused scanning electron microscopy as spherical hydration-related aggregates approximately 100 nm in size.4 Conventional intralenticular glistenings, on the other hand, are significantly larger phase-separated water aggregates ranging from 1 mm to 20 mm and located throughout voids within the IOL. Subsurface nanoglistenings have been shown to contribute to significant surface light scattering in vitro, yet no effect on visual acuity has been reported.5 We report the case of a 41-year-old healthy individual with progressive deterioration and disabling vision quality as a result of grade 3C subsurface nanoglistenings.

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