J Korean Ophthalmol Soc.  2016 Oct;57(10):1661-1665. 10.3341/jkos.2016.57.10.1661.

Pigment Dispersion Syndrome and Reverse Pupillary Block after Implantable Collamer Lens with Central Hole Implantation

• Lee SC
• Chung HJ
• Chung YS
• Choi JY
• Choi KY
• Kim MJ

• KMID: 2355426
• DOI: http://doi.org/10.3341/jkos.2016.57.10.1661

Abstract

PURPOSE
To report a case of pigment dispersion syndrome and reverse pupillary block secondary to the implantation of implantable collamer lens (ICL) with a central hole (AQUA ICL®) that was treated with ICL removal and laser peripheral iridotomy (LPI).
CASE SUMMARY
A 29-year-old woman with myopia in both eyes underwent implantation of AQUA ICL®. Four weeks postoperatively, the intraocular pressure (IOP) increased to 34 mm Hg and the patient showed pigment dispersion syndrome in both eyes. Since the IOP did not reduce with the maximum tolerable medical therapy, the ICLs were removed 8 weeks after implantation. The pigment dispersion subsided and IOP reduced shortly after ICL removal. However, 4 weeks after removal of ICL, posterior iris bowing and reverse pupillary block occurred in the right eye and the IOP increased to 46 mm Hg. LPI was performed in the right eye, and the reverse pupillary block was dissolved after a reduction in pigment dispersion. The IOP subsequently normalized to 13 mm Hg. Two weeks later, prophylactic LPI was performed in the left eye. Four weeks after prophylactic LPI, selective laser trabeculoplasty was performed on both eyes. As a result, the IOP was 11 mm Hg in the right eye and 12 mm Hg in the left eye after 4 weeks of treatment with topical IOP-lowering medications.
CONCLUSIONS
The present case indicates that implantation of ICL with a central hole can lead to early postoperative pigment dispersion syndrome. When this condition persists and is accompanied by reverse pupillary block after ICL removal, LPI can be partially effective.

Keyword

Implantable collamer lens; Laser peripheral iridotomy; Pigment dispersion syndrome; Reverse pupillary block

MeSH Terms

Adult
Female
Humans
Intraocular Pressure
Iris
Myopia
Trabeculectomy

Figure

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  Figure 1. Changes in the iris contour of patient's right eye. Anterior segment optical coherence tomography images showing that the iris of the right eye was planar (white arrow) before implantation of AQUA ICL® (A) and became concave (white arrow) because of posterior iris bowing after AQUA ICL® removal (B). The iris became planar (white arrow) after laser peripheral iridotomy. Thinning of iris stroma (white arrowheads) was observed (C). OD = oculus dexter.

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  Figure 2. Gonioscopy showing open angles with 3 degrees of pigment deposition on the trabecular meshwork (white arrowheads) in the right eye and 2 degrees of pigment deposition in the left eye at 4 weeks after laser peripheral iridotomy (LPI) on the right eye (2 weeks after LPI on the left eye). (A) Inferior, (B) superior, (C) nasal, and (D) temporal side of the gonioscopic view. OD = oculus dexter; OS = oculus sinister.

Reference

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