Spontaneous resolution of early postoperative intraocular lens opacification in a patient with uveitis

Abstract

pseudophakia are accompanied by clear, clinical descriptions of an immobile iris that is tethered to the anterior capsule where the rhexis edge lies, typically in the mid periphery. 3-5 In the largest case series, Gaton et al describe 'iris bombé and a shallow anterior chamber with a fixed, non-reacting pupil and increased IOP (40 and 60 mm Hg)'. In our case, the pupil was mobile, and B2-3 mm smaller than the adequately sized anterior rhexis. The iris did not have the typical bombé appearance and pupil dilated uniformly without any signs of pigmentation on the anterior capsule suggestive of prior iridocapsular adhesion. Choroidal effusions are increasingly being implicated in primary angle closure. It remains unclear if they are a causative factor or consequence. We could find no reports where choroidal effusions were seen in the context of seclusio pupillae, and the findings in phakic primary angle closure may not be directly transferrable to our case. In the paper by Sakai et al, 6 inclusion into the acute primary angle closure (APAC) group required bilateral narrow angles, IOP 440 mm Hg, nausea/ vomiting, and corneal oedema in phakic patients. This is quite different from the case we present. Of their APAC patients, only 2 of 70 had grade 3 effusions and they make no mention of these extending beyond the equator. Our patient had large choroidal detachments, with folds visible at the posterior pole through an undilated pupil. Utilizing the facilities available to us, we performed dynamic ultrasonography and were happy that the iris was fully mobile. High-resolution ultrasound biomicroscopy would have been helpful in confirming the pathology, however, this modality was unavailable at our institution. Peripheral iridotomy is not without risk. It is only of value in cases of pupil block and as such would be ineffective in this case. We were fortunate enough to be able to document what we recognized as an unusual case and have included a video highlighting some of the salient features that we believe support our interpretation (Supplementary Video).