Liquefied after cataract

We describe the clinical features, and management of liquefied after-cataract mimicking intraocular lens (IOL) opacification in a pseudophakic patient. A 68-year-old woman presented with gradual vision loss eight years after cataract surgery with no intraoperative vitreoretinal interventions. Slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT; ANTERION, Heidelberg Engineering, Germany) was done for arriving at a correct diagnosis. Slit-lamp examination revealed a clear anterior IOL front surface, with a posterior milky fluid level, thicker superiorly and centrally, while AS-OCT demonstrated a concavo -convex fluid layer posterior to the IOL, without any evidence of IOL opacification, confirming liquefied after-cataract. Following Neodymium-doped Yttrium Aluminum Garnet capsulotomy, the fluid resolved and best-corrected visual acuity improved. The presence of a posterior fluid level with a clear anterior IOL surface on indirect illumination, and on AS-OCT, helps differentiate liquefied after-cataract from IOL opacification, thereby avoiding IOL exchange.