Epithelial cell proliferation on anterior surface of intraocular lens after Descemet stripping automated endothelial keratoplasty (DSAEK) surgery: a case report

BACKGROUND: We report a rare case of histopathologically confirmed epithelial cell proliferation on the anterior surface of an intraocular lens (IOL) following Descemet stripping automated endothelial keratoplasty (DSAEK). CASE PRESENTATION: A 61-year-old female with a history of multiple ocular surgeries, including phacoemulsification cataract extraction and DSAEK, was referred for progressive visual deterioration. Clinical examination revealed resistant deposits on the anterior surface of the posterior chamber IOL, confined to the pupillary zone. Despite repeated interventions-including Nd: YAG laser treatment and surgical polishing of the IOL surface-the opacities persisted, ultimately necessitating IOL explantation and histopathological analysis. Light microscopy confirmed epithelial cell proliferation on the IOL surface. Examination of the stained lens revealed a sheath of cellular imprints and ghost cells. Unlike previously reported cases of IOL opacification, von Kossa staining demonstrated no calcium phosphate deposits, suggesting a distinct pathological mechanism originating from epithelial cell proliferation, likely derived from the capsular bag. CONCLUSIONS: Epithelial cell proliferation should be considered in the differential diagnosis of unexplained, persistent IOL surface opacities following DSAEK. In this case, definitive diagnosis was established only through histopathological evaluation of the explanted lens.