Ischemic optic neuropathy after intraocular lens implantation to correct high myopia in a phakic patient

Abstract

A 33-year-old patient had uncomplicated anterior chamber intraocular lens implantation (Worst-Fechner biconcave myopia lens) to correct high myopia. Immediately after surgery, she developed anterior ischemic optic neuropathy likely associated with increased intraocular pressure and systemic hypotension. To our knowledge, this is the first documented case of anterior ischemic optic neuropathy after anterior chamber intraocular lens implantation to correct high myopia in a phakic eye.

Clinical results of ZSAL-4 angle-supported phakic intraocular lenses in 190 myopic eyes

“…Iridectomy and chamber depth should be checked within a few hours because prolonged IOP elevation can cause iris or optic-nerve damage. 5 The Hoffer technique 12 provides a small but patent iridectomy and avoids the risk for monocular diplopia caused by large iridectomies.…”

“…Angle-supported phakic IOLs are implanted by the simplest surgical technique and have good refractive results; however, few large series have been published 1-3 and severe complications (vascular, inflammatory, and vitreoretinal) have been reported. [4][5][6][7][8][9] We report a series of 190 myopic eyes of 115 patients who had angle-supported phakic IOL implantation, focusing on the intraoperative and postoperative complications to provide clinicians and patients with a basis for informed consent.…”

Long-term endothelial changes in phakic eyes after Artisan intraocular lens implantation to correct myopia

“…8 In the late 1980s, Worst and Fechner introduced refractive iris-supported IOLs. [9][10][11][12][13][14] Surgeons became hesitant to use these IOLs because the surgical techniques were difficult and invasive and the complications were severe, [15][16][17][18][19] especially those related to endothelial cell damage in eyes with biconcave model IOLs, determining corneal decompensation and bullous keratopathy.…”

Vitreous Hemorrhage following Phakic Anterior Chamber Intraocular Lens Implantation in Severe Myopia

“…Posterior segment complications following this procedure are uncommon. Retinal detachment has been described in a small number of cases (6,(21)(22)(23)(24), as well as endophthalmitis (25) and ischemic optic neuropathy (26). An important distinction in such patients is whether a given vitreoretinal complication has occurred as a consequence of the surgical intervention, the underlying myopia, or a combination of the two.…”

“…Vitreoretinal complications after AC-IOL implantation are infrequent. Retinal detachment has been reported (6,(21)(22)(23)(24), as has endophthalmitis (25) and optical nerve atrophy (26). We describe two cases of vitreous hemorrhage (one with retinal detachment) following uncomplicated phakic AC-IOL implantation (in both cases Worst Myopia Iris-Claw Lens, Ophtec, Groningen, NL) for the correction of high myopia.…”