Posterior synechias following implantation of a foldable silicone iris-fixated phakic intraocular lens for the correction of myopia

Abstract

A 45-year-old white woman with unilateral high myopia had uneventful implantation of a -9.0 diopter, foldable, iris-fixated Artiflex I anterior chamber phakic intraocular lens (pIOL) (Ophtec B.V.) in the right eye. Despite application of topical antibiotic and steroid agents for 4 weeks after surgery, iris pigment dispersion developed on the anterior surface of the crystalline lens. Two weeks later, the iris dispersion increased and posterior synechias developed from the iris to the crystalline lens next to the pIOL haptic at the 3 o'clock position. Consequently, pIOL re-enclavation was performed without surgically removing the posterior synechias. Initial and interim mydriatic and steroid eyedrops were administered 4 times a day. Regular follow-up examinations after re-enclavation (at 2, 3, 6, 12, and 24 months) confirmed a stable pIOL position by Scheimpflug photography. Two years after implantation, posterior synechias persisted at the 3 o'clock position, with iris dispersion on the crystalline lens and the posterior side of the pIOL, but with no signs of anterior chamber inflammation and no visual acuity loss.

Iris-fixated toric phakic intraocular lens for myopic astigmatism

“…43 The postoperative corneal endothelial cell loss associated with iris-fixated pIOLs via potential mechanical contact between the lens and corneal endothelium should be considered. We found a mean ECC loss of 9.4%.…”

Correction of myopic astigmatism with a foldable iris-claw toric phakic intraocular lens: Short-term follow-up

“…Mechanical irritation of iris tissue during pupil constriction and dilation may trigger a foreign-body response and lead to breakdown of the blood-aqueous barrier, with subsequent cell adhesions to the IOL. 28,29 Correction of myopic astigmatism with keratorefractive procedures such as femtosecond laser in situ keratomileusis has limitations. Excimer laser treatment can be associated with an increased risk for corneal ectasia and decreased visual quality, especially in eyes with high refractive errors.…”

Transient myopic shift after phakic intraocular lens implantation

“…However, using the Gullstrand formula, they reported that this effect would induce only a 0.05 diopter (D) refractive change. Other reports of differences in the final positioning of pIOLs in the anterior chamber 7 or the presence of a partially or completely fixed pupil 8 have not demonstrated significant unexpected postoperative refractive results. As in the case by Kohnen et al, 5 we did not find significant (from a theoretical refractive point of view) intraindividual pIOL positioning differences between eyes in any patient.…”