Lessons learned from unsuspected binocular zonular dehiscence in a high myope cause for subluxation of ICL

Session Details

Session Title: Presented Poster Session: Intraocular Refractive Surgery

Venue: Poster Village: Pod 2

First Author: : S.Rachapalle Reddi INDIA

Co Author(s): :    P. Padmanabhan                       

Abstract Details

Purpose:

To report a case of a high myope who underwent Implantable Collamer Lens (ICL) in eye but required explanation of the ICL 3 days  later when there was a unusual rotation and subluxation of ICL

Setting:

Department of Cornea and Refractive surgery in a tertiary eye care centre.

Methods:

This is a case report of a 21 year old woman, who attended our Refractive Surgery clinic.   Her corrected distance visual acuity (CDVA) was 6/9 in both eyes, with a refraction of -16.75Dsph/-1.50 Dcyl x 20 in the right eye and -13.50 Dsph / -2.00 Dcyl x 160 in the left eye. Her Keratometry was 41.32@70/43.25@160 in right eye and 41.32@1150/43.56@25 in the left. The keratometric axis in both eyes did not correlate with axis of subjective refraction. After being counseled about the pros and cons for all the options,she elected to have ICL in both eyes

Results:

Patient underwent  toric ICL (-17.50Dsp/1.5Dcylx900) implantation in the right eye.  Surgery was uneventful but on the 1st postoperative visit an inferior subluxation of the ICL was noted along with rotation.  On retro illumination after complete dilatation there was abnormal reflex at the edge of the lens on tilting the eye down. Zonular patholology was suspected and  UBM  was done  to rule out the same,  which   revealed a  zonular absence in the inferotemporal quadrant in both eyes.  The ICL was explanted the next day and CDVA restored to 6/9. Similar problem in other eye was averted by cancelling the surgery

Conclusions:

Congenital / spontaneous zonular weakness may be missed, unless specifically looked for.   We recommend that a UBM be done as a routine preoperative workup  before any intraocular surgical intervention  especially in high myopes and when the keratometric astigmatism do not correlate with subjective refraction and  suspected significant lenticular astigmatism. Also ensure full dilated exam to pick any abnormal reflex from the edge of the lens.

Financial Disclosure:

None