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. 2024 May 29;24(1):227.
doi: 10.1186/s12886-024-03498-3.

Transient anterior subcapsular vacuolar lens opacities after Tanito microhook trabeculotomy: report of six cases

Hiroshi Shimizu  1   2 , Masaki Tanito  3
Affiliations

Transient anterior subcapsular vacuolar lens opacities after Tanito microhook trabeculotomy: report of six cases

Hiroshi Shimizu et al. BMC Ophthalmol. .

Abstract

Objective: To present six cases exhibiting transient anterior subcapsular vacuolar lens opacities following early postoperative Tanito microhook trabeculotomy (TMH) performed by the same surgeon.

Methods: Six patients who underwent lens-sparing TMH at Meizankai Shimizu Eye Clinic from November 2021 to May 2023, and developed anterior subcapsular vacuolar lens opacities postoperatively were reviewed. Detailed records of surgeries, follow-up findings were collected and reported.

Results: In all six cases, anterior vacuolar subcapsular lens opacities were observed on the day after surgery, gradually decreasing without affecting visual acuity or contrast sensitivity. In all cases, without any specific interventions, the opacities disappeared by 21 months postoperatively.

Conclusion: Anterior subcapsular cataracts, characterized by a vacuolar appearance and transient existence, should be recognized as an early complication of ab interno glaucoma surgery, possibly linked to use of distributed ophthalmic viscosurgical devices and excessive anterior chamber irrigation leading to traumatic cataracts on the lens surface.

Keywords: Anterior subcapsular cataract (ASC); Minimally invasive glaucoma surgery (MIGS); Surgical complication; Tanito Microhook trabeculotomy (TMH); Transient cataract.

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Conflict of interest statement

The microhooks used were co-developed by Masaki Tanito, and Inami & Co., Ltd. (Tokyo, Japan). Tanito receives royalties from Inami & Co., Ltd. The company had no role in the design of the study, in the collection, analysis, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. H.S. reports no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Case 1. A Slit-lamp photographs and AS-OCT images. No preoperative anterior subcapsular cataract (A). Mydriasis increases to a maximum of about 7 mm as intraoperative IOP increased (B). POD1 showed vacuolar anterior subcapsular opacities of the lens (arrows) within 6 mm of the pupil center (C). Opacities are observed beneath the anterior lens capsule (arrow) on AS-OCT (D), and observed as small cysts with inner hypointense and outer hyperintense signals (arrow) in the magnified image (E). Nine months after surgery, the opacity had almost disappeared, but some remained (arrow) (F). cysts on AS-OCT had disappeared (G, H)
Fig. 2
Fig. 2
Slit-lamp photographs of POD1 (A, E, G, I, K), early postoperative AS-OCT images (B, C, L, M) and slit-lamp photographs during later follow-up periods (D, F, H, J, N) of Cases 2-6,. All cases showed subcapsular vacuolar opacities under the anterior lens (arrows) as in Case 1 (A, E, G, I, K). Cases 2 and 6 showed cysts under the anterior capsule (arrows) on AS-OCT similar to Case 1 (B, C, L, M). After the midterm postoperative periods, Cases 4 and 5 show almost complete disappearance of opacity (H, J), while Cases 2, 3, and 6 show a decrease of opacities (arrows) (D, F, N)
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References

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