Case Reports

Pigment dispersion and chronic intraocular pressure elevation after sulcus placement of 3-piece acrylic intraocular lens

Case Report Details

First Author: C.Porcar Plana SPAIN

Co Author(s):    M. Lledó Riquelme   M. Puzo Bayod   J. Moya Roca              

Abstract Details

Purpose:

We describe a case report of intraocular pressure elevation (IOP) after sulcus placement of a 3-piece acrylic intraocular lens (IOL) in sulcus, caused by unilateral pigment dispersión syndrome.

Setting:

Opthalmology Department, Virgen de los Lirios Hospital, Alcoy (Alicante, Spain).

Report of Case:

An 80-year-old man with no significant medical history except a non complicated cataract surgery in both eyes, attended to his left eye (LE) postoperative day 1 exam. On examination IOP was 60 mmHg so anterior chamber drainage was performed. After a week with hypotensive medication IOP continued high (37mmHg). With complete dilatation, on of the lens haptics could be seen out of the sac. IOL was explanted and a 3-piece acrylic IOL (MA60AC) was placed in the ciliary sulcus and noted to be correctly oriented. On postoperative day 1, the IOP was 31 mmHg. It improved to 18 mmHg with hypotensive medication, which was then discontinued. At 1 month, the IOP was 40 mmHg. On examination, the IOL was well positioned in the sulcus but diffuse peripheral transillumination defects were present in that eye (no defects were present in the other eye). The cornea was clear with no pigment deposition. Gonioscopy showed heavy trabecular meshwork pigmentation compared to the other eye. A concave peripheral iris insertion was noted in both eyes. Over the ensuing months, mild corneal endothelial pigment deposition was noted and IOP control required up to 5 topical medications in addition to oral acetazolamide. Almost a year later, best corrected visual acuity was 20/20, the cup/disc ratio in LE was 0.3, and automated visual field testing in both eyes was normal. IOP in LE was 21 mmHg with the use of 3 topical glaucoma medications.

Conclusion/Take Home Message:

'- A complete examination is necessary in postoperative cataract surgery patients. - Unilateral pigment dispersion after cataract surgery is more likely to occur with sulcus placement of the IOL. 3-piece IOL with angulated haptics and with the thinnest optic (MA60AC) are the most appropriate IOLs to use in the ciliary sulcus and less likely to precipitate pigment dispersion. However, in this case we describe a pigment dispersion syndrome with a MA60AC. - Concave peripheral iris insertion and the square-edge design of the lens, may have contributed to posterior iris chafing and secondary pigment dispersion. - Pigment dispersion syndrome may cause chronic intraocular hypertension after cataract surgery.

Financial Disclosure:

None