Myopic shift in a pseudophakic eye with an accommodating IOL following vitrectomy with gas tamponade

Abstract

PurposeTo report the case of a patient with Crystalens, an accommodating posterior-chamber intraocular lens (IOL), who experienced a myopic shift following subsequent vitrectomy with gas tamponade. We propose a hypothesis as to why this myopic shift occurred and analyze its validity based on current literature.ObservationsA patient had cataract surgery with implantation of a Crystalens AT-50AO +21D. Preoperative A-scan measured anterior chamber depth (ACD) to be 3.69 mm. The refraction was emmetropic following cataract surgery. Nine months later, the patient required pars plana vitrectomy with gas tamponade for a rhegmatogenous retinal detachment, followed by vitrectomy, membrane peel, and air/fluid exchange for epiretinal membrane. The retinal repair was anatomically successful, however, the patient experienced a −1.0 D myopic shift. ACD measurement following vitrectomy was 5.08 mm.Conclusions and importanceMyopic shift following vitrectomy with gas tamponade in pseudophakic eyes is widely reported. This patient's myopic shift was assumed due to anterior movement of the Crystalens caused by a gas bubble placed during retinal detachment repair as this is the prevailing theory in the literature [1]. However, a comparison of the patient's ACD measurements does not support the above hypothesis. Further study is needed to determine the mechanism of myopic shift seen in pseudophakic patients following vitrectomy, specifically those with gas.

Large air bubble in the Berger space during cataract surgery

“…3–6 Although intraocular gas injection shows positive treatment efficacy, it is imperative to consider the potential complications associated with it in clinical practice, such as elevation of intraocular pressure (IOP), hydrophilic intraocular lens (IOL) opacification, progressive lens nuclear sclerosis, gas bubble migration, and myopic shift in pseudophakic eyes. 7–11…”

“…[3][4][5][6] Although intraocular gas injection shows positive treatment efficacy, it is imperative to consider the potential complications associated with it in clinical practice, such as elevation of intraocular pressure (IOP), hydrophilic intraocular lens (IOL) opacification, progressive lens nuclear sclerosis, gas bubble migration, and myopic shift in pseudophakic eyes. [7][8][9][10][11] It is crucial to deal effectively with unexpected intraocular air bubbles during cataract surgery. The Berger space, located between the posterior lens capsule and the anterior vitreous hyaloid, is an important circular interspace formed by the Wieger ligment.…”