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Liquefied after cataract
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Received: ,
Accepted: ,
How to cite this article: Rao A. Liquefied after cataract. J Ophthalmic Res Pract. 2026;4:52-3. doi: 10.25259/JORP_1_2026
Abstract
We describe the clinical features, and management of liquefied after-cataract mimicking intraocular lens (IOL) opacification in a pseudophakic patient. A 68-year-old woman presented with gradual vision loss eight years after cataract surgery with no intraoperative vitreoretinal interventions. Slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT; ANTERION, Heidelberg Engineering, Germany) was done for arriving at a correct diagnosis. Slit-lamp examination revealed a clear anterior IOL front surface, with a posterior milky fluid level, thicker superiorly and centrally, while AS-OCT demonstrated a concavo -convex fluid layer posterior to the IOL, without any evidence of IOL opacification, confirming liquefied after-cataract. Following Neodymium-doped Yttrium Aluminum Garnet capsulotomy, the fluid resolved and best-corrected visual acuity improved. The presence of a posterior fluid level with a clear anterior IOL surface on indirect illumination, and on AS-OCT, helps differentiate liquefied after-cataract from IOL opacification, thereby avoiding IOL exchange.
Keywords
Anterior segment optical coherence tomography
Fluid level
Intraocular lens opacification
Liquefied after cataract
Nd: YAG
INTRODUCTION
Liquified after-cataract (LAC), also referred as capsular bag fluid syndrome, is a rare late complication of cataract surgery. Retained lens epithelial cells degenerate over time, causing accumulation of a turbid milky fluid within a sealed compartment, namely the capsular bag. In contrast, posterior capsule opacification (PCO), involves cellular proliferation of the lens epithelial cells and has a different pathomechanism from LAC. These two conditions can be readily confused with IOL opacification that caused by changes within the IOL material. Differentiating these two conditions is critical, because management differs substantially. Specific clinical clues, like the presence of a gravitational fluid level, a distinctly clear anterior IOL surface, which may be confirmed by anterior segment optical coherence tomography (ASOCT), may help in the correct diagnosis. Misdiagnosis of LAC as PCO may lead to capsulotomy in the wrong optical plane or could drive unnecessary invasive surgery. This case describes a 68-year-old woman with gradual vision loss years after cataract surgery that was appropriately diagnosed and managed.
CASE REPORT
A 68-year-old woman presented with gradual vision loss in her right eye, after cataract surgery 8 years ago (Intraocular lens (IOL) model unavailable). There was no evidence of prior vitreoretinal intervention, trauma, or immediate postoperative decline/intervention in that eye. Slit-lamp evaluation showed a multifocal IOL, with a clear front surface on indirect illumination, a milky-fluid level posteriorly [Figure 1], thicker superiorly and centrally, with white deposits inferiorly. The presence of a fluid level with a clear front surface suggested liquefied after-cataract, as opposed to IOL opacification.[1] Dilated fundus examination revealed a hazy media with no evident retinal lesions with normal optic nerve in both eyes. Anterior segment optical coherence tomography (ASOCT) (ANTERION, Heidelberg Engineering, Germany) confirmed a concavo-convex fluid layer with no IOL opacification. Three days after Neodymium-doped Yttrium Aluminium Garnet capsulotomy inferiorly, her vision improved to 6/12, with no retinal or fundus abnormality seen on fundus examination. A clear fluid level, indirect illumination showing a clear IOL front surface, and ASOCT help differentiate this from IOL opacification.[2-4]
CONCLUSION
A concavo-convex fluid level on ASOCT can help differentiate LAC form IOL opacification or other causes. Simple non-invasive Nd:Yag capsulotomy inferiorly helps restore vision avoiding invasive measures or surgeries.
Author contributions:
AR: Solely responsible for conceptualization, manuscript writing, review, editing, and approval of the final version.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for their images and other clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Liquefied after cataract and its surgical treatment. Indian J Ophthalmol. 2014;62:580-4.
- [CrossRef] [PubMed] [Google Scholar]
- Late postoperative capsular block syndrome versus liquefied after-cataract. J Cataract Refract Surg. 2008;34:1799-802.
- [CrossRef] [PubMed] [Google Scholar]
- Late postoperative capsular block syndrome: Entrapment of liquefied after-cataract by capsular bend. J Cataract Refract Surg. 2005;31:630-2.
- [CrossRef] [PubMed] [Google Scholar]
- Liquefied aftercataract: A complication of continuous curvilinear capsulorhexis and intraocular lens implantation in the lens capsule. Am J Ophthalmol. 1998;126:612-3.
- [Google Scholar]