Secondary pigment dispersion syndrome with single-piece acrylic IOL

Hadid, Omar H; Megaw, Roly; Owen, Rona I; Fraser, Scott

doi:10.1016/j.jcrs.2010.06.019

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…At the later stage, IOP elevation in the patients with sulcal foldable IOL implantation may be resulted from chronic iridocyclitis and pigment dispersion. Iris chafing by the IOL can arise because of the closer contact between the IOL and the iris that results from the sulcal placement of the IOL [2-5,7-12]. In addition, the flexible haptics of a foldable IOL facilitate the rubbing-induced detachment of iris pigments.…”

Section: Discussionmentioning

confidence: 99%

Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study

Chang

2013

BMC Ophthalmol

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BackgroundTo review the long-term outcomes of eyes with secondary pigmentary glaucoma associated with the implantation of foldable intraocular lenses (IOL) in the ciliary sulcus.MethodsThe study retrospectively reviewed a series of cases who developed secondary pigmentary glaucoma after cataract operations. Data were collected from cases that were referred between 2002 and 2011.ResultsTen eyes of 10 patients who developed secondary pigmentary glaucoma after foldable IOLs implantation in the sulcus were included in this study.Intraocular pressure (IOP) elevation was present in 2 eyes (20%) within the first 2 weeks following the initial cataract operation. The onset of glaucoma was delayed in the other 8 eyes (80%); the average onset time in these eyes was 21.9 ± 17.1 months after the initial cataract operation. Six eyes (60%) received surgical treatment because of large fluctuations and poor control of IOPs. Only 3 eyes (30%) achieved final visual acuities better than 20/40.ConclusionSecondary pigmentary glaucoma accompanying the implantation of a foldable IOL in the ciliary sulcus may present as acute IOP elevation during the early postoperative period or, more commonly, late onset of IOP elevation accompanied by advanced glaucomatous optic nerve damage. Despite treatment, the visual prognosis for these patients can be poor. Placing a foldable IOL in the ciliary sulcus could pose a threat to the vision of the patients and long-term follow-up of IOP in these patients is necessary.

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Section: Discussionmentioning

confidence: 99%

Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study

Chang

2013

BMC Ophthalmol

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“…This accumulated pigment might contribute to impaired aqueous flow through the trabecular meshwork, and resistance to aqueous outflow might be a risk factor of RPB. A squared-edge IOL design has been reported to be a risk factor for chafing of the iris in the absence of the lens capsule [25–27] but preoperative angle pigmentation was not aggravated by IOLs with a squared-edge design after scleral-sutured PC IOL implantation in our study.…”

Section: Discussionmentioning

confidence: 42%

Reverse pupillary block after implantation of a scleral-sutured posterior chamber intraocular lens: a retrospective, open study

2017

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BackgroundTo report the clinical features of patients with reverse pupillary block (RPB) after scleral-sutured posterior chamber intraocular lens (PC IOL) implantation and biometric changes after laser peripheral iridotomy (LPI).MethodsEight patients attending our hospital’s ophthalmology outpatient clinic, who developed RPB after implantation of a scleral-sutured PC IOL due to subluxation of the crystalline lens or IOL, were investigated in this retrospective, observational study.ResultsPreoperative evaluations showed angle pigmentation in all cases and iridodonesis in 2 cases. Two subjects had used an α1A-adrenoceptor antagonist for benign prostatic hyperplasia. Pars plana or anterior partial vitrectomy was performed in all cases. All eyes showed an extremely deep anterior chamber, a concave iris configuration, and contact between the IOL optic and the iris at the pupillary margin. Pupil capture was detected in 2 cases. The mean (± SD) anterior chamber angle (ACA) was 89.91 ± 10.06°, and the anterior chamber depth (ACD) was 4.42 ± 0.16 mm before LPI. After LPI, the iris immediately became flat with a decreased ACA (51.70 ± 2.59°; P = 0.018) and ACD (4.14 ± 0.15 mm; P = 0.012). After LPI, the intraocular pressure decreased from 19.75 ± 3.77 mmHg to 15.63 ± 4.30 mmHg (P = 0.011), and the spherical equivalent decreased from -0.643 ± 0.385 D to − 0.875 ± 0.505 D (P = 0.016).ConclusionConcomitant vitrectomy, angle pigmentation, and iridodonesis may be risk factors for RPB after scleral-sutured PC IOL implantation. LPI is effective for relieving the RPB.

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“…1-6 Since the introduction of one-piece hydrophobic acrylic lenses in the market, there have been several reports on complications related to the presence of their relatively thick and bulky haptics in the sulcus, whether this fixation site was inadvertent or elective after complicated cataract surgery. 7-14 Similar complications have also been reported with 3-piece hydrophobic acrylic lenses with a square edge on the anterior optic surface, in a piggyback configuration or standard sulcus placement. 15-20 It is usually recommended to implant an IOL having a smooth anterior optic surface with rounded edges in cases of sulcus fixation to minimize the possibility of iris chafing, should any posterior iris contact occur.…”

Section: Introductionmentioning

confidence: 64%

“…Other similar cases of pigmentary dispersion with this lens have been described in the literature, which were generally managed with explantation/exchange of the lens, or by surgical repositioning within the capsular bag. 8-14 …”

Section: Discussionmentioning

confidence: 99%

Pathologic Assessment of Complications with Asymmetric or Sulcus Fixation of Square-Edged Hydrophobic Acrylic Intraocular Lenses

Kirk¹,

Werner²,

Jaber³

et al. 2012

Ophthalmology

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Objective One-piece hydrophobic acrylic intraocular lenses (IOLs) are not indicated for sulcus fixation because of complications, such as uveitis-glaucoma-hyphema syndrome. Similar complications may also be observed with 3-piece lenses having a square optic edge on the anterior surface. The objective of this study was to provide pathological evidence of complications related to out-of-the-bag fixation of 1-piece or 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges. Design Comparative case series with pathology. Participants 559 pseudophakic cadaver eyes obtained from eye banks within the United States, implanted with different IOLs. Methods Anterior segment scanning of whole eyes with a high-frequency ultrasound system, or with a high-resolution anterior segment magnetic resonance imaging, followed by gross examination. Selected eyes were processed for complete histopathological analysis; some of them were explanted before histopathology to allow for direct light microscopic evaluation of the lenses. Main Outcome Measures Findings from imaging, gross, and histopathological evaluation that could be related to out-of-the-bag fixation of the lenses. Results 256 eyes were implanted with hydrophobic acrylic IOLs with anterior and posterior square optic edges; 18 of them exhibiting asymmetric or sulcus IOL fixation (six 1-piece, and twelve 3-piece IOLs) underwent complete histopathological evaluation and were compared to the contralateral eyes with symmetric in-the-bag IOL implantation. Pathological findings were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, iris transillumination defects, iris changes including vacuolization/disruption/loss of the pigmented layer, iris thinning, and iris atrophy, as well as synechiae and loop erosion in the case of 3-piece lenses. Findings were more significant in comparison with the control contralateral eyes, and were particularly evident in relation to the sulcus-fixated haptic in the case of 1-piece lenses. The majority of the eyes with 3-piece lenses showed signs of complicated surgery. Conclusions This study provides pathological correlation of complications that were clinically reported in the peer-reviewed literature in relation to sulcus fixation of one-piece hydrophobic acrylic IOLs. The eyes with 3-piece lenses generally exhibited evidences of complicated surgery; therefore all pathological findings in those cases may not be strictly attributed to the out-of-the-bag fixation.

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Secondary pigment dispersion syndrome with single-piece acrylic IOL

Cited by 9 publications

References 6 publications

Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study

Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study

Reverse pupillary block after implantation of a scleral-sutured posterior chamber intraocular lens: a retrospective, open study

Pathologic Assessment of Complications with Asymmetric or Sulcus Fixation of Square-Edged Hydrophobic Acrylic Intraocular Lenses

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