Case Reports

Pseudophakic posterior iris chafing syndrome following uncomplicated phacoemulsification

Case Report Details

First Author: O.Williams UK

Co Author(s):    W. Kincaid   V. Chadha                 

Abstract Details

Purpose:

We report the case of a patient who presented with painful transient episodes of visual loss resulting from Posterior Iris chafing syndrome (PICS). This was secondary to uncomplicated phacoemusification surgery 10 years previously. Clinical examination and ultrasound biomicroscopy (UBM) confirmed the diagnosis. She underwent explantation of this intraocular lens and secondary iris clip lens implantation which resulted in complete resolution of her symptoms. This case highlights the use of UBM in confirming this clinical diagnosis and the importance of in-the-bag intraocular lens implantation during phacoemulsification.

Setting:

Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.

Report of Case:

A 72 year old bilaterally pseudophakic patient presented with sudden onset painful transient episodes of loss of vision in her right eye. Each episode lasted a few hours and was associated with headaches; there was complete resolution of her symptoms between episodes. She had a background of hypertension and had been previously diagnosed with multiple transient ischaemic attacks (TIAs). She presented twice to the emergency department and was discharged without referral to an ophthalmologist. On the third occasion, she was referred to the eye clinic. On examination, her visual acuity was hand movements in the affected eye and 6/9 in the left eye. Anterior segment examination of her right eye showed revealed circumciliary injection, diffuse corneal oedema and a small non-reacting pupil. Intraocular pressure measured 12mmHg in both eyes. A B-scan ultrasound was performed which showed no evidence of retinal detachment. The left eye showed no anterior chamber activity. She was treated with topical steroids and cycloplegics. On review one week later, the visual acuity in her right eye improved to 6/9 and the intraocular inflammation and corneal oedema had resolved. Examination revealed the right intraocular lens haptic lying posterior to the surface of the iris in the nasal quadrant causing a large area of iris atrophy. Ultrasound biomicroscopy showed a tilted intraocular lens partially positioned in the sulcus touching the central portion of the posterior iris in the two to six o'clock position. The adjacent haptic was also found to be closely opposed to the posterior iris with an intact posterior capsule. Based on these findings a diagnosis of pseudophakic posterior iris chafing syndrome was made. She underwent removal of the intraocular lens during which the intraocular lens. An iris-clip lens (Verysise) was implanted as a secondary procedure and she achieved a best corrected visual acuity of 6/9.

Conclusion/Take Home Message:

This case illustrates the importance of early diagnosis with ultrasound biomicroscopy used as a tool to evaluate the position of the IOL haptics in suspected cases of PPIS. With this imaging modality, the exact orientation of the lens haptics and the relationship to nearby ocular structures can be determined which aids in early surgical planning. It is also important to highlight the advantages of symmetric in-the bag posterior chamber intraocular lens (IOL) fixation with complete coverage of the optic periphery by the capsulorhexis edge when placing the IOL in the bag.

Financial Disclosure:

None