Presumed nonadaptation to a multifocal intraocular lens masking visual loss from a pituitary tumor

To report a case of delayed diagnosis of a pituitary tumor impacting vision. The patient had undergone bilateral cataract surgery with multifocal lenses, and even an intraocular lens (IOL) exchange for persistent visual dissatisfaction, which was ultimately due to the tumor and not the visually significant cataracts or the intra-ocular lens.

Single case report and narrative review.

An 81-year-old male patient presented with visually significant nuclear sclerotic cataracts that were consistent with his chief complaint of decreased visual acuity and colors not being vivid. About one month after uneventful sequential cataract phacoemulsification with multifocal IOL insertion, he complained of bilateral visual dissatisfaction, primarily with color and contrast issues. This was attributed to his non-adaption to the bilateral multifocal intra-ocular lenses. A unilateral IOL exchange of the multifocal lens to a monofocal lens occurred without complication. Still, the persistence of visual dissatisfaction after a unilateral IOL exchange prompted consultation with neuro-ophthalmology where he was diagnosed with a pituitary macroadenoma.

Prior to performing an IOL exchange in patients with persistent visual dissatisfaction after multifocal lens placement, other causes of visual dissatisfaction should be thoroughly investigated.