Case Reports

Fibrosed viscoelastic (HPMC) on anterior capsule under phakic IOL

Case Report Details

First Author: S.Chaudhary INDIA

Co Author(s):    R. Chaudhary                    

Abstract Details

Purpose:

Phakic IOL like ICL (Implantable Collamer Lens) with central hole, is injected into the Anterior Chamber under cover of visco-elastic like HPMC (Hydroxy Propyl Methyl Cellulose) 2%. All HPMC should be irrigated out after insertion. Residual HPMC, trapped under ICL optics or near its foot plates, can migrate to the centre and get deposited on the crystalline lens as a thin translucent film, seen on the first post-op day. This usually becomes patchy and dissolves in a month. Excessive deposit can get fibrosed over the anterior capsule, and can last for 6 months or more, as an opaque band.

Setting:

Eye7 group of eye hospitals, New Delhi, India

Report of Case:

HPMC 2% was used while inserting an ICL. Usual Irrigation Aspitation (IA) was used to removes the visco material after ICL insertion. The first post-op day showed a continuous translucent membrane on anterior capsule of about 4mm x 4 mm. The vision recorded was 20/30. One-month follow-up showed the membrane to be continuous, though slightly contracted in size. At 3 months, it appeared a little denser in the central 2 mm area. At 6 months, the central 2 mm appeared opaquer, round and fibrosed, giving an impression of Anterior capsular with sub-capsular cataract. ASOCT showed anterior capsule well defined from the centre to periphery, though dented by the fibrous visco plaque.

Conclusion/Take Home Message:

Membranous or granular deposit of HPMC on anterior capsule is sometimes encountered on the first post-op day and mimics a cataract. The deposit thins out, becomes patchy, and dissolves over a few weeks, and results in no visual loss. Some deposits are seen to continue for 6 months, but they too get resolved with no visual loss. This is the first case where the deposit appeared fibrosed at 6 months, with one line drop of vision, and overall loss of clarity. We decided not to intervene, and follow it up further for its natural course.

Financial Disclosure:

None