I reviewed 271 abstracts that were cited from the PubMed search terms “lens and capsule and deposit.” I have included some references from my search, as well as hyperlinks for convenience.
The preponderance of cases involved pseudoexfoliation (PEX). Uncommon manifestations of common problems must be considered1. It may be helpful to check the pupillary ruff for atrophy and gonio the angle looking for pigment deposition as seen in pre-clinical PEX.2
There are many rare causes of lens capsular deposits reported. I have listed some below along with suggested investigation:
-foreign substances (silicone oil3): did this patient have a silicone IOL? Consider reviewing the operative report for the IOL to see if they used anything unusual like triamcinolone.
-infectious agents4: remain on the look-out for inflammation into the future.
-Fabry disease5: rare but important to consider…any sign of retinal vascular tortuosity or cornea verticillata?
-familial amyloidosis6: amyloid deposits on anterior capsule are more prevalent than vitreous amyloid…but were there any vitreous opacities or retinal vascular changes?
-rock inhibitor7: (more out on a limb in terms of possibility). They affect the lens epithelial cells.
-Healon8: Any crystalline deposits on IOL surface?
References:
1. Sorkou KN, Manthou ME, Meditskou S, Ziakas N, Tsinopoulos IT. Exfoliation Fibrils within the Basement Membrane of Anterior Lens Capsule: A Transmission Electron Microscopy Study. Curr Eye Res. 2019;44(8):882-886. doi:10.1080/02713683.2019.1608262
https://pubmed.ncbi.nlm.nih.gov/30986086/
2. Suwan Y, Kulnirandorn T, Schlötzer-Schrehardt U, et al. Light and electron microscopic features of preclinical pseudoexfoliation syndrome. PLoS One. 2023;18(3):e0282784. Published 2023 Mar 9. doi:10.1371/journal.pone.0282784
https://pubmed.ncbi.nlm.nih.gov/36893133/
3. Liu W, Huang D, Guo R, Ji J. Pathological Changes of the Anterior Lens Capsule. J Ophthalmol. 2021;2021:9951032. Published 2021 May 4. doi:10.1155/2021/9951032
https://pubmed.ncbi.nlm.nih.gov/34055399/
4. Tandon A, Tay-Kearney ML, Metcalf C, McAllister L. Bacillus circulans endophthalmitis. Clin Exp Ophthalmol. 2001;29(2):92-93.
https://pubmed.ncbi.nlm.nih.gov/11341454/
5. Rothstein K, Gálvez JM, Gutiérrez ÁM, Rico L, Criollo E, De-la-Torre A. Ocular findings in Fabry disease in Colombian patients. Manifestaciones oculares de la enfermedad de Fabry en pacientes colombianos. Biomedica. 2019;39(3):434-439. Published 2019 Sep 1. doi:10.7705/biomedica.3841
https://pubmed.ncbi.nlm.nih.gov/31584758/
6. Beirão JM, Malheiro J, Lemos C, Beirão I, Costa P, Torres P. Ophthalmological manifestations in hereditary transthyretin (ATTR V30M) carriers: a review of 513 cases. Amyloid. 2015;22(2):117-122. doi:10.3109/13506129.2015.1015678
https://pubmed.ncbi.nlm.nih.gov/26096568/
7. Imaizumi T, Kurosaka D, Tanaka U, Sakai D, Fukuda K, Sanbe A. Topical administration of a ROCK inhibitor prevents anterior subcapsular cataract induced by UV-B irradiation. Exp Eye Res. 2019;181:145-149. doi:10.1016/j.exer.2019.01.016
https://pubmed.ncbi.nlm.nih.gov/30690025/
8. Jensen MK, Crandall AS, Mamalis N, Olson RJ. Crystallization on intraocular lens surfaces associated with the use of Healon GV. Arch Ophthalmol. 1994;112(8):1037-1042. doi:10.1001/archopht.1994.01090200043019