Calcification of an intra-ocular lens (IOL) is an infrequent but clinically significant event. We report a case of late calcification of hydrophilic acrylic intra-ocular lens (HA-IOLs) after Descemet's stripping endothelial keratoplasty (DSEK), where the patient underwent an IOL exchange.

A 64 year old man was referred to our cornea clinic with blurred vision. He had undergone Phacoemulsification and IOL implantation with simultaneous DSEK operation two years ago for Fuchs endothelial dystrophy and cataract. His best corrected visual acuity was 6/60 = 1/10 snellen and IOP was normal. Clinical examination showed significant opacification of the hydrophilic IOL. The central corneal thickness was 636 microns and endothelial cell count was 1535 cell/mm. An IOL exchange was performed with minimally invasive technique. Extra measures were taken to protect the DSEK graft. The opacified hydrophilic IOL was successfully explanted and a hydrophobic IOL was implanted in the bag.

Postoperative visual acuity was 6/9 = 8/10 four weeks after surgery. The central corneal thickness was 650 microns and endothelial cell count was 1450 cell/mm.

The new IOL was implanted in the bag and the quality of the graft was fully preserved during this complex procedure. Opacification of hydrophilic acrylic intraocular lenses is an emerging complication following Descemet's stripping endothelial keratoplasty. IOl exchange is necessary and technically demanding. We report a successful and uneventful IOL exchange using an atraumatic technique.