A 76 year-old woman presented with decreased visual acuity of the right eye. The patient has a known history of arterial hypertension and underwent surgery for bilateral cataracts 10 years prior. The best corrected visual acuity was 5/10 in the right eye and 10/10 in the left eye. Biomicroscopic examination revealed pseudoexfoliative fibrillar deposits attached to a pleated membrane on his lower nasal side (Figure 1). This pseudoexfoliative membrane is attached to the anterior surface of the posterior chamber intraocular lens (IOL). The examination of the left eye showed white fleck-like particles circulating in front of the iris and in-the-bag IOL in place (Figure 2). The intra-ocular pressure was within normal range, and fundus examination showed bilateral excavation at 5/10 in both eyes.

Five years later, the patient presented with a sudden spontaneous decrease in visual acuity in the left eye. The visual acuity of the left eye was limited to counting fingers. An inferior subluxation of the capsular bag and IOL was found (Figure 3). The right eye examination was unchanged.

Late in-the-bag dislocation of the IOL has been reported with increasing frequency in recent years.^(1,2) This dislocation occurs as a result of progressive pseudoexfoliative zonular dehiscence many years after even uncomplicated surgery. There are few reports of this complication in the literature.^(1,2) This can be explained partially by a limited follow-up period. We report herein a rare case of a pseudoexfoliative membrane deposit in an IOL which can be confused with a secondary cataract.⁽³⁾