ABSTRACT

Postoperative opacification of the foldable hydrophilic acrylic lens designs is a major concern among surgeons, and manufacturers. The majority of cases are reported from Asia, Australia, Canada, Europe, Latin America, and South Africa. However, mostly in North America we have noted cases of “snowflake” opacification of the rigid PMMA lenses, a new syndrome of biodegradation of PMMA biomaterial. Our analysis of all 28 cases showed that dense snowflake lesions were clustered in the central part of the lens optic with the peripheral part largely unaffected behind the iris. We classified the cases of snowflake opacification of the PMMA IOLs into four grades according to density and the severity of the lesions. This entity possibly attributed to breakdown of PMMA polymer within the biomaterial. We have termed these lesions “snowflake opacifications” on the basis of morphology. SEMs of the bisected IOL revealed that these lesions were clustered in the anterior 1/3 of the optic substance and the posterior 2/3s remained free.