Malignant glaucoma induced by a phakic posterior chamber intraocular lens for myopia

Abstract

A 23-year-old woman with -14.00 diopters of myopia requested emmetropia for professional reasons. An ICM 130 V2 myopic phakic intraocular lens (IOL) (Staar Surgical AG) was implanted in the posterior chamber. Three days later, the patient developed malignant glaucoma. Pupillary block glaucoma and choroidal hemorrhage or effusion were ruled out. As maximum medical treatment failed, rapid secondary surgery was performed with sclerotomy, aspiration in the midvitreous cavity, and removal of the IOL. The follow-up was 43 months.

Phakic intraocular lenses outcomes and complications: Artisan vs Visian ICL

“…There have been case reports of malignant glaucoma, 11 and intractable elevation of IOP requiring filtration surgery after ICL implantation. 12 We did not report any case of cataract after implantation of either Artisan or ICL, but this may be attributed to the relatively short follow-up period.…”

Posterior chamber phakic intraocular lens sizing based on iris pigment layer measurements by anterior segment optical coherence tomography

“…Improper position of the pIOL in the posterior chamber of the eye might affect neighboring anatomic structures (natural lens, iris, cornea, anterior chamber angle), raising the risk for postoperative complications. [1][2][3][4]15 Ultrasound biomicroscopy with a 50 MHz probe has a resolution (axial and lateral) of 50 mm. 6 It is the only commercially available method that allows the user to define and measure every structure of the anterior segment of the eye, including the ciliary sulcus area.…”

“…The distance between the posterior surface of the pIOL and the anterior pole of the natural lens in the center (pIOL vault) is the main criterion for correct pIOL position and is dependent on the correspondence between the PC pIOL size and the ciliary sulcus diameter. Correct sizing of pIOLs is critical to minimize the risk for some postoperative complications associated with insufficient vault (eg, subclinical or clinically significant anterior subcapsular opacities 1 ) or excessive vault (eg, pigment dispersion syndrome, secondary glaucoma [2][3][4] ).…”

Acute angle closure after implantable contact lens insertion unresponsive to surgical peripheral iridectomy

“…7 In this situation, pupillary block can be relieved temporarily with cycloplegic agents, the mechanism of which is analogous to conditions in which ectopia lentis is the source of the pupillary block, as in Marfan syndrome or Weill-Marchesani syndrome. In most cases, acute pupillary block is caused by poorly functioning PIs, which are thought to be clinically patent on retroillumination but not fully perforated, in which case the block can be resolved with surgical or laser enlargement of existing iridotomies or the creation of new iridotomies.…”