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

TL;DR

Six patients developed temporary lens opacities after a type of glaucoma surgery called Tanito microhook trabeculotomy.

Contribution

Identifies a new early complication of ab interno glaucoma surgery involving transient lens opacities.

Findings

All six patients developed anterior subcapsular vacuolar lens opacities post-surgery.

The opacities resolved spontaneously within 21 months without affecting vision.

The opacities may be linked to viscosurgical devices and excessive irrigation during surgery.

Abstract

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

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.

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.

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.

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