Objective To identify the source of unwanted glare images from a three-piece intraocular lens (IOL) implant following cataract surgery. Method The IOL and posterior capsule were examined under mydriatic and nonmydriatic conditions using direct focal illumination from a slit lamp biomicroscope. Direct focal illumination was undertaken with both a narrow beam (0.1 mm in width) and small spot (0.1 mm in diameter) to identify the points at which the glare images were stimulated. While observing the location of the beam with the slit lamp biomicroscope, the patient indicated when the glare images were stimulated. Results The nasal haptic insertion into the optic was identified as the source of temporal line images arising from lights such as headlamps from oncoming cars and street lamps. The adjacent edge of the IOL was also identified as the likely source of additional cob web-like light rays. Conclusions The haptic insertions in threepiece IOLs may, under certain conditions, interfere with light entering the pupil and produce extraneous images. Large mesopic pupils and decentred IOLs are conditions that increase the likelihood of unwanted glare images.

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New findings concerning the use of anterior chamber angle-fixated lenses, especially with flexible loops, and posterior chamber lenses placed in the ciliary sulcus and in the bag reinforce previous findings that the safest procedure for diabetics is controlled extracapsular surgery with careful cleaning of the cortical material and in-the-bag implantation of a posterior chamber intraocular lens.