A Case of Repeating Transient Increase in Intraocular Pressure by Instability of an Intraocular Lens Implanted in the Capsular Bag

Abstract

KeywordsIn-the-bag intraocular lens · Dislocation of an intralocular lens · Repeating increase in intraocular pressure and normalization · In situ scleral refixation AbstractWe observed repeated episodes of rapid increases in intraocular pressure (IOP) considered to be caused by an in-the-bag intraocular lens (IOL) instability in a patient with an implanted IOL. As acute glaucoma attack-like increase in IOP was noted in the left eye on November 8, she was admitted to Wakayama Medical University Hospital. The findings at the first examination included an IOP of 62 mm Hg, instability of a PMMA one-piece IOL, shallow anterior chamber, narrow angle, moderate mydriasis, and loss of pupillary light reaction in the left avitreous eye. On November 15, a 6-mm Hg increase in IOP was observed during 60-min dark room prone provocative testing. After the first examination, the patient perceived pain and reduced visual acuity of the left eye and emergently consulted our hospital twice. Despite miosis, normalization of the anterior chamber depth and IOP with widening of the angle were achieved by resting in the supine position. These episodes were thought to be caused by instability and anterior shift of the IOL. On January 17, 2018, suture fixation of the in-the-bag IOL was performed. The IOL was fixed by transscleral suturing of the bilateral supporting parts to the sclera. Recurrence of sudden ophthalmalgia, instability of the in-the-bag IOL, and an increase in IOP have not been observed for 1 year after surgical treatment. Instability of an in-the-bag IOL caused Case

May consultation #6

“…Failure to achieve normal eye pressure postoperatively would be consequently dealt with by a glaucoma specialist. 5 intraocular pressure (IOP). Since further surgery is planned for intraocular lens (IOL) exchange, I would reduce the IOP with transscleral cyclophotocoagulation (CPC) using the G-probe (OcuLight SL, Iridex) and adjust the number of laser pulses (2000 mW and 2000 ms) to the IOP of 38 mm Hg; in this case, I would apply 28 laser spots to coagulate the ciliary body.…”

May consultation #5

“…Failure to achieve normal eye pressure postoperatively would be consequently dealt with by a glaucoma specialist. 5…”