Cataract development associated with collagen copolymer posterior chamber phakic intraocular lenses: Clinicopathological correlation

PURPOSE: To assess the histopathology of anterior subcapsular cataract associated with a collagen copolymer posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens) using light microscopy after pIOL explantation and cataract surgery. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Laboratory investigation. METHODS: Pathology specimens related to explanted pIOLs were reviewed and preoperative and postoperative patient data collected. The anterior lens capsules and explanted pIOLs were examined. RESULTS: Four eyes (3 patients) had pIOL explantation for low vault and anterior subcapsular cataract. The explanted pIOLs were the shorter length models (3, 12.1 mm; 1, 12.6 mm). Anterior segment optical coherence tomography (AS-OCT) confirmed the low pIOL vault before explantation in 2 eyes. Histopathology of the anterior subcapsular cataract showed fibrous metaplasia with a variable number of lens epithelial cell (LEC) layers attached to the inner surface of the anterior capsulorhexis specimens. Light microscopy of the explanted pIOLs showed no pigment on 1 lens, mild pigment deposition on 1 haptic, and pigment deposition throughout the anterior surface of 2 pIOLs. CONCLUSIONS: Anterior subcapsular cataract associated with the pIOLs was caused by low vaulting (confirmed on AS-OCT) and consequent fibrous metaplasia of the anterior LECs. Surgeons should consider the possibility of anterior subcapsular cataract associated with shorter platforms when selecting a pIOL length for appropriate vault.