Creeping posterior synechiae following hyperopic iris-fixated phakic implants

Abstract

The purpose of this study was to report on the occurrence and management of posterior synechiae (PS) in three hyperopic eyes after iris-fixated anterior chamber phakic IOL implantation. This is a case report of a 55-year-old man and a 55-year-old lady who had undergone iris-fixated anterior chamber phakic IOL implantation to correct hyperopic astigmatism (one eye) and hyperopia (both eyes), respectively. The three eyes developed creeping PS and pigment dispersion within 4-6 weeks of surgery. Synechiolysis and pupil stretching in one eye did not work as the synechiae promptly recurred. Definitive management in the form of removal of the phakic implant and phacoemulsification with lens implant was successful in restoring normal vision in all three eyes. Although implantation of phakic intraocular lenses has been reported to be very effective for the correction of moderate to high degrees of ametropia, this complication can occur in hyperopic eyes. Pigment dispersion has been reported in myopic eyes also, but PS seem to be more an issue with hyperopic eyes. Age of the patient may also be a factor. This information is important in the selection and counselling of patients.

A novel surgical approach for fixation of a posterior chamber intraocular lens of Rayner 620 H with Gore-Tex suture

“…ACIOL placement may increase the risk of glaucoma, inflammation, and corneal decompensation [ 3 ]. For placement of an iris-fixated IOL, postoperative anterior chamber inflammation is considered a major concern due to the enclavation of iris tissue in the lens haptic [ 4 ], and the surgery is greatly restricted if the iris is injured by the trauma [ 5 ]. Scleral fixation of PCIOL with polypropylene suture has been associated with suture erosion with endophthalmitis, and late suture breakage leading to lens dislocation and exposure of the thread [ 6 , 7 ].…”

Implantation of an iris-fixated phakic intraocular lens for the correction of hyperopia: 15-year follow-up

“…Messina et al additionally hypothesized that enclavating the full thickness of the iris, including the iris pigment epithelium, might predispose eyes to pigment dispersion. 36 The slightly less concave shape of the hyperopic IF-pIOL might also play a role. We believe that the high incidence of pigment dispersion in the hyperopic IF-pIOL population is multifactorial.…”

Severe pigment dispersion after iris-claw phakic intraocular lens implantation

“…Pigment dispersion has been reported as a complication of Artisan™ pIOL, mainly in hyperopic eyes. [ 1 2 3 4 5 6 7 8 ] It has been hypothesized that the cause of this could be ocular movements that in turn produce friction between the lens and iris. [ 5 8 ] Baikoff et al .…”

“…Pigment dispersion may occur following iris-claw phakic intraocular lenses (pIOLs). [ 1 2 3 4 5 6 7 8 ] Herein, we report a case of a unilateral severe pigment dispersion associated with an Artisan ® pIOL (Ophtec, Groningen, The Netherlands).…”