A 64-year-old woman with a cortex cataract in the right eye received phacoemulsification with implantation of the LENTIS L-312 lens (Oculentis; +21.0 D, SN: 91306104022). It had taken over one hour for the supplyer to deliver the IOL at an outdoor temperature of around −3 °C. After kept in the theater (21 °C) for about 2 hours, the IOL was implanted into the eye, but the lens optic became cloudy immediately (Fig. 1A). This was the first time that we encountered such a situation. The surgeon replaced the IOL with another LENTIS L-312 lens at once, and the same phenomenon was observed (Fig. 1B). The second IOL was not removed, and the surgery was completed. Under a slit-lamp microscope, the opacification was found to be alleviated after 2 hours (Fig. 1C). On postoperative day 1, the IOL became transparent (Fig. 1D). Best corrected visual acuity (BCVA) was improved from preoperative 20/40 to 20/25.
Uneventful cataract surgery was performed on the left eye of a 54-year-old man with a cortex cataract, and a +19.5 D acrylic IOL (AL LISA tri 809M; Carl Zeiss, SN 1S1710870057) was implanted. His preoperative BCVA was 20/50. Before implantation, the lens had been stored at room temperature for 1.5 hours following 1-hour transportation at an outside temperature of -8 °C. A few seconds after the IOL was placed into the capsular bag, clouding occurred (Fig. 2A) and failed to clear after 5 minutes. The surgery was completed. On the following day, the lens was detected to be clear without any abnormality (Fig. 2B), and BCVA was measured to be 20/20.
A 62-year-old woman with cortex cataracts in both eyes was scheduled to undergo phacoemulsification. A +21.5 D acrylic IOL (AL LISA tri 809M; Carl Zeiss, SN 1S1713970329) was first implanted into the left eye after 1-hour delivery when the temperature outside was −8 °C and 2-hour placement in the theater. The IOL was transparent prior to implantation (Fig. 3A). As the IOL was implanted into the capsular bag, it became cloudy immediately (Fig. 3B). The opacification disappeared spontaneously on the following day (Fig. 3C). Three days later, another +22.0 D IOL (AL LISA tri 809M; Carl Zeiss, SN 1S1715830258), which had been stored in the theater for 3 days, was inserted into the right eye after cataract extraction, and no opacification occurred.
Cataract surgery was uneventfully performed on the left eye of a 46-year-old man with a cortex cataract, and a +19.0 D acrylic IOL (AL LISA tri 839M; Carl Zeiss, SN 1S1706750238) was implanted to correct his vision, which was finger counting before the eye. The IOL was delivered to the theater at an outdoor temperature of −4 °C and 3 hours ahead of the implantation. As the IOL was placed into the eye, it became opacified (Fig. 4A). After irrigation, the IOL started to clear (Fig. 4B).