Rosette-pattern intraocular lens calcification in a patient with hyperphosphatemia secondary to peritoneal dialysis...

Intraocular lens calcification is a rare but significant late complication that primarily affects hydrophilic acrylic intraocular lenses. Systemic metabolic disorders, particularly diabetes mellitus and end-stage renal disease, are recognized risk factors because they promote breakdown of the blood-aqueous barrier and alter calcium-phosphate metabolism, creating a favorable environment for intraocular calcification.

A 58-year-old woman with a more than 20-year history of diabetes mellitus and end-stage renal disease receiving dialysis presented with progressive visual decline in her left eye. Slit-lamp examination demonstrated marked opacification of a hydrophilic acrylic intraocular lens. The opacified lens was explanted and replaced with a retropupillary iris-claw intraocular lens. Scanning electron microscopy revealed dense rosette-like crystalline deposits on both intraocular lens surfaces with calcification thickness of 7.55-16.7 μm. Energy dispersive spectrometry demonstrated calcium and phosphorus (69.69% and 30.31%), consistent with hydroxyapatite. The patient's systemic evaluation demonstrated hyperphosphatemia and elevated parathyroid hormone levels. Following surgery, best-corrected visual acuity improved from 6/30 to 6/12.

This case highlights the critical role of systemic metabolic derangements in promoting secondary calcification of hydrophilic acrylic intraocular lens. Careful selection of intraocular lens materials, favoring hydrophobic acrylic or polymethyl methacrylate lenses, is recommended in high-risk patients to prevent this complication.