a 55-year - old man with a 28-year history of diabetes was referred to our retina clinic for a regular ophthalmic examination for diabetic retinopathy . at the time of the first visit , the patient presented with proliferative diabetic retinopathy in both eyes and clinically significant macular edema . he had undergone pars plana vitrectomy for proliferative diabetic retinopathy in combination with phacoemulsification and implantation of a hydrophilic acrylic iol in the capsular bag of the right eye at another hospital two months prior . in addition four months later , the bcva of the right eye had decreased to a finger count at 10 cm and the intraocular pressure was 38 mmhg as measured by applanation tonometer . he underwent ahmed valve implantation through pars plana vitrectomy at our hospital immediately after the diagnosis of neovascular glaucoma . iol opacification , causing decreased visual acuity , was found five months following the surgery for glaucoma ( ten months following the implantation of the iol ) during monitoring of the clinical course ( fig . 1 ) . there was a concurrent presence of microhyphema as we monitored the clinical course . however , after the disappearance of hyphema , his visual acuity of the right eye dropped to hand motion and did not improve . the iol was explanted from the right eye 45 months after implantation . for the explantation of the lens , the optics were relieved from the capsular bag by manual dissection with a spatula and viscodissection . the iol was explanted , piece by piece , through a 3.0 mm corneal incision . a hydrophobic acrylic iol ( ya-60bb ; hoya inc . , there was a well - circumscribed centrally and paracentrally located opacification of the original iol optic . the opacification was generalized , white , homogenous and it affected the entire surface inside of the iol . postoperatively , the patient did not exhibit specific complications and the visual acuity improved to 0.04 . six months after the operation , the corrected visual acuity was maintained at 0.06 due to macular edema . to date , the exchange of iols due to postoperative opacification has been reported in many cases . these hydrophillic acryl iols include hydroview ( bausch & lomb ) , acrl-60 ( ophthalmed inc . , carlsbad , nm , usa ) , memorylens ( ciba vision , duluth , ga , usa ) [ 3 - 5 ] and aquasense ( ophthalmic innovations international , ontario , ca , usa ) . several tens of cases of postoperative opacification have also been reported following the use of sc60b - ouv ( medical developmental research , clearwater , fl , usa ) [ 6 - 8 ] . in addition , two cases of postoperative opacification after implantation of centerflex 570h ( rayner , east sussex , uk ) have been reported . it is theorized that the deposition of minerals , including ca , on the optical surface of iols produces the opacification . in the case outlined here , iol opacification developed in the optical substance of akros fit ( bausch & lomb ) . it is important to note that histopathological assessments were not performed for iol that were removed in the current study . considering that the clinical characteristics of the current case are analogous to previous reports , the deposition of minerals , including ca , on the surface of optical part is assumed to be the causative factor [ 1 - 12,14 ] . werner et al .   showed that the opacification of iols that were implanted in the eye following cataract surgery was not associated with the substance used during surgery . recently , sher et al .   suggested that the intraoperative use of viscoat ( alcon , fort worth , tx , usa ) has a facilitating role in the development of late opacification of the hydroview ( bausch & lomb ) iol . based on results of studies that have been conducted up to the present , a higher rate of opacification was observed in patients with systemic diseases such as diabetes . ha et al .   reported that all three patients with ca deposition on the surface of their hydrophilic acrylic iols had a proliferative diabetic retinopathy . suggested that the occurrence of proliferative ophthalmic diseases is associated with some growth factors and some of these exist within the vitreous body . in cases of proliferative diabetic retinopathy , in the vitreous body of patients with proliferative diabetic retinopathy a higher concentration of protein is identified . this is involved in the production of angiotensin i and elevates the concentration of serum ca . with the activation of some growth factors within the vitreous body , inositol phosphate five of eighteen patients who developed opacification of iols following cataract surgery were noted to have diabetes . however , the authors noted that no methods were available to establish a correlation between these complications and diabetes . interestingly , in cases in which the disease duration of diabetes is prolonged the opacification occurs rapidly . in patients who had a proliferative diabetic retinopathy opacification developed more rapidly and with a greater severity . in the current case , there was a 28-year history of diabetes and proliferative diabetic retinopathy in both eyes . the type and duration of the diseases might be associated with the development of opacification in this case . it may also be that the inflammatory responses due to the anterior chamber bleeding that developed during the clinical course in some cases affected the opacification of iols . further histopathological studies are warranted to analyze the opacification of the akreos adapt iols . with the high frequency of postoperative opacification observed , it may be better to use hydrophobic acrylic iols rather than hydrophilic ones . we report our case of the opacification of the hydrophilic akreos adapt iol , which was not previously reported . in patients with diabetes mellitus further histopathological studies are warranted to analyze the causes of opacification of the hydrophilic akreos adapt iol .