Korean J Ophthalmol.  2008 Jun;22(2):130-132. 10.3341/kjo.2008.22.2.130.

Recurrent Occlusion of Laser Iridotomy Sites After Posterior Chamber Phakic IOL Implantation

• Park IK
• Lee JM
• Chun YS

• KMID: 1099008
• DOI: http://doi.org/10.3341/kjo.2008.22.2.130

Abstract

We report a case of recurrent occlusion of laser iridotomy (LI) sites after a Visian ICL (Implantable contact lens version 4, Staar Surgical AG, Nidau, Switzerland) implantation. A 45-year-old woman had bilateral ICL implantation after placement of two peripheral LI sites in each eye to prevent pupillary block. At one month after the operation, severe narrowing or occlusion of four LI sites occurred. After this, although she received four additional LIs at postoperative months 1, 6, 9 and 10 in both eyes, the narrowing or occlusion recurred. Mild chronic anterior chamber inflammation was observed intermittently throughout the follow-up period. We performed clear lens extraction in both eyes (at postoperative month 11 in the left eye and month 26 in the right eye) due to recurrent occlusion of the LI sites and excess trabecular meshwork pigment deposition presumably caused by the four repeated LIs. Recurrent obstruction of LI sites can occur after ICL implantation. These problems were unresolvable despite four repeated laser iridotomies. The risks associated with anterior uveitis must be considered when planning an ICL implantation.

Keyword

Anterior uveitis; ICL implantation; Laser iridotomy

MeSH Terms

Female
Humans
Iridectomy/*methods
Iris/*surgery
*Laser Therapy
Lasers, Solid-State
Lens Implantation, Intraocular/*adverse effects
Middle Aged
*Phakic Intraocular Lenses
Pigment Epithelium of Eye/pathology
*Postoperative Complications
Recurrence
Reoperation
Trabecular Meshwork/pathology
Uveitis, Anterior/etiology

Figure

• 

  Fig. 1 Laser iridotomy (LI) sites at 9 months after ICL surgery. Pinpoint openings (solid arrow) of LI sites with regeneration of dark-brown iris pigment epithelium (hollow arrow) were observed. The Iris was distorted toward LI sites due to repeated LI. 25 ×, Goldmann 3 mirrors.

• 

  Fig. 2 Width of iridocorneal angle at 9 months after ICL surgery. (A) Peripheral iris was very steep and convex. Iridocorneal angle was narrowed because of the obstruction of LI sites. (B) After additional LI, although the angle width increased, trabecular pigment also increased. 25 ×, Goldmann 3 mirrors.

Reference

1. Gonvers M, Bornet C, Othenin-Girard P. Implantable contact lens for moderate to high myopia-relationship of vaulting to cataract formation. J Cataract Refract Surg. 2003. 29:918–924.

2. Sanchez-Galeana CA, Smith RJ, Sanders DR, et al. Lens opacities after posterior chamber phakic intraocular lens implantation. Ophthalmology. 2003. 110:781–785.

3. Bylsma SS, Zalta AH, Foley E, et al. Phakic posterior chamber intraocular lens pupillary block. J Cataract Refract Surg. 2002. 28:2222–2228.

4. Smallman DS, Probst L, Rafuse PE. Pupillary block glaucoma secondary to posterior chamber phakic intraocular lens implantation for high myopia. J Cataract Refract Surg. 2004. 30:905–907.

5. Jimenez-Alfaro I, Benitez del Castillo JM, Garcia-Feijoo J, et al. Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation. Ophthalmology. 2001. 108:90–99.

6. Brandt JD, Mockovak ME, Chayet A. Pigmentary dispersion syndrome induced by a posterior chamber phakic refractive lens. Am J Ophthalmol. 2001. 131:260–263.

7. Abela-Formanek C, Kruger AJ, Dejaco-Ruhswurm I, et al. Gonioscopic changes after implantation of a posterior chamber lens in phakic myopic eyes. J Cataract Refract Surg. 2001. 27:1919–1925.

8. Sanchez-Galeana CA, Zadok D, Montes M, et al. Refractory intraocular pressure increase after phakic posterior chamber intraocular lens implantation. Am J Ophthalmol. 2002. 134:121–123.

9. Chun YS, Lee JH, Lee JM, Park IK. IOP and Gonioscopic Changes after Implantable Contact Lens Implantation in Myopic Eyes. J Korean Ophthalmol Soc. 2005. 46:336–344.

10. Perez-Santonja JJ, Iradier MT, Benitez del Castillo JM, et al. Chronic subclinical inflammation in phakic eyes with intraocular lenses to correct myopia. J Cataract Refract Surg. 1996. 22:183–187.

11. Hoffer KJ. Pigment vacuum iridectomy for phakic refractive lens implantation. J Cataract Refract Surg. 2001. 27:1166–1168.

12. Khan AJ, Percival SP. 12 year results of a prospective trial comparing poly(methyl methacrylate) and poly(hydroxyethyl methacrylate) intraocular lenses. J Cataract Refract Surg. 1999. 25:1404–1407.