Macular Hole after Phakic Intraocular Lens Implantation: Two Cases with Divergent Manifestations

Abstract

We describe two cases of a macular hole (MH) which had divergent manifestations and clinical courses following implantation of an Implantable Collamer Lens (ICL) in two high myopic patients. The onset of symptoms and shape of the holes, which were observed by optical coherence tomography and fundoscopy, and prognosis of the visual acuity after the surgery of each patient, were quite different. In the first patient, the symptom was an acute onset. Fundoscopy showed a cuneiform-shaped hole with internal limiting membrane defect around the hole. The prognosis after the surgery was very poor, and the best corrected visual acuity was 0.08 after complete anatomical closure. In another patient, the MH showed insidious progression with disease-free interval from ICL implantation to MH onset. After the surgery, the best corrected visual acuity was recovered to 1.0.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

“…If the hiatus appeared within a short period of time after operation and accompanied by internal limiting membrane defect around the hiatus, the prognosis was very poor. If occult progression occurs, surgical treatment results in better best corrected visual acuity [22][23][24].…”

Macular hole following phakic intraocular lens implantation and its management

“…According to them, MH could either be pre-existing that was missed pre-operatively, or a part of natural course of high myopic change or induced by the surgery (pIOL implantation). [4] Our patient developed symptoms of metamorphopsia 4 months after pIOL implantation. Therefore, we assume that pIOL implantation might have accelerated the process of vitreous syneresis, posterior vitreous detachment (PVD) and a resultant MH formation in our patient.…”

“…[3] Its occurrence following pIOL is much rarer. [4] Phakic IOL has become one of the most popular options in high myopes who are unsuitable for surface ablative refractive surgeries. However, the surgery entails the risk of vitreoretinal complications like endophthalmitis, retinal tears and detachment, and giant retinal tear.…”

Macular hole following phakic intraocular lens implantation: A case report

“…However, they may also be correlated to high myopia, trauma, and surgeries, including vitrectomy, pneumatic retinopexy, scleral buckling, laser-assisted in situ keratomileusis and cataract surgery[ 3 , 4 ]. In rare cases, MH can occur following pIOL[ 5 , 6 ].…”

“…To our knowledge, three cases have been described in two previous reports[ 5 , 6 ]. In one of these cases, the MH had a similar morphology as the traumatic MH with a rhomboid-shaped appearance.…”