A 77-year-old Caucasian woman accessed our Ophthalmic Emergency Unit at the S.Orsola-Malpighi University Hospital in Bologna (Italy) complaining of blurry vision in her right eye. She reported that she suffered a blunt trauma in the same eye the day before. She was under medical treatment for arterial hypertension, while her past ocular history was of pseudoexfoliation syndrome (PEX), defined as the deposition of extracellular fibrillar-granular proteic material produced by the eye on all structures bathed in aqueous humour in the anterior segment. At the ophthalmic evaluation, visual acuity of the affected eye was hand motion, and intraocular pressure (IOP) measured by Goldmann applanation tonometry (Haag-Streit, Koeniz, Switzerland) was 21 mmHg. Ocular motility was normal. Slit lamp biomicroscopy of the anterior segment showed very mild corneal edema, deep anterior chamber, pigment loss from the pupil margin, and no visible crystalline lens in the posterior chamber. Gonioscopy was performed with a Goldmann 3-mirror lens, showing an open angle, pigmentation in the inferior quadrant, and no signs of angle recession in any quadrant. At dilated fundoscopy, luxated lens was found in the vitreous chamber, and no retinal breaks were appreciated. The day after, the patient underwent a 25-gauge pars plana vitrectomy (PPV) and lens explantation from the vitreous chamber under local anesthesia. During surgery, a small inferotemporal retinal detachment and a retinal break in the temporal retinal periphery were incidentally encountered. Once the FIL SSF IOL was implanted in the posterior chamber, according to the surgical technique previously described by Fiore et al. [], the retinal break was laser-treated, and 20% sulfur hexafluoride (SF6) gas was injected into the posterior segment. No adverse events or complications were encountered during surgery. One month postoperatively, the best corrected visual acuity (BCVA) improved to 0,3 logMAR and IOP was 16 mmHg. At the slit lamp examination, the cornea was clear, and SSF-IOL was well-centered in the posterior chamber. Retina appeared well attached at the fundoscopy. However, at the 3-month follow-up visit, the patient presented with a visual acuity dropped to 0,5 logMAR, and rare central deposits were appreciated on the IOL surface during the slit lamp examination. Six months after surgery, the patient complained of severe visual impairment and glare. Visual acuity was 1 logMAR, and the slit lamp examination showed diffuse, dense IOL opacification with a granular pattern. See Fig.. Anterior segment Optical Coherence Tomography (AS-OCT) (CASIA 2, Tomey Corporation, Nagoya, Japan) was performed, showing mild hyperreflectivity of both the anterior and the posterior surface of the IOL. See Fig.. At the last available follow-up at 10 months postoperatively, visual acuity and IOL opacification remained stable. The patient refused any other surgery for IOL explantation and exchange.