Intraocular Lens Opacification in a Patient With Gyrate Atrophy With a Subluxated Intraocular Lens

BACKGROUND Gyrate atrophy is a rare metabolic disease that profoundly impacts the choroid and retina. This condition is recognized for its ocular comorbidities, including a predisposition to the development of posterior subcapsular cataract and compromised zonular integrity, both of which ultimately necessitate surgical management. While cataract surgery is a common intervention, it can have long-term sequelae. Intraocular lens (IOL) opacity is a known complication, with various morphological patterns documented in the ophthalmic literature. However, no specific pattern of IOL opacification has been previously reported in an individual with gyrate atrophy. This paper describes a novel and previously unreported pattern of intraocular lens (IOL) opacification in a patient with gyrate atrophy. CASE REPORT We present the case of a 37-year-old man with genetically confirmed gyrate atrophy who experienced a significant decline in vision following an initially uncomplicated cataract surgery. He later developed a late subluxation of the IOL and subsequently formed distinctive rosette-shaped opacities on the lens implant. He underwent successful surgical removal and insertion of a scleral-tucked IOL along with anterior vitrectomy. Analysis of the material on microscopy and histopathology revealed unique crystalline deposits that stained positive with von Kossa stain and showed birefringence under polarized light, consistent with calcium oxalate - a finding not previously associated with IOL opacification. CONCLUSIONS To the best of our knowledge, these opacities have never been described in a patient with gyrate atrophy. This case report shows the need for regular monitoring for patients with gyrate atrophy after cataract surgery and proposes a potential pathophysiological mechanism linking this complication to gyrate atrophy.