Pigment Dispersion Glaucoma Secondary To Uncomplicated Bilateral Eye Phakic Intraocular Collamer Lens Implantation

We report a case of unilateral eye pigment dispersion glaucoma secondary to uncomplicated bilateral eye phakic intraocular collamer lens (ICL) (Visian ICL™, Staar Inc.) implantation.

Cataract and Refractive Centre, Vista Eye Specialist Malaysia

A 25 years old lady with no known co-morbid, had uncomplicated bilateral phakic intraocular collamer lens (ICL) implantation. Pre-operative gonioscopy showed open angles and anterior chamber (AC) depth was >2.8 mm. Patient's 1 week post-operative review had been unremarkable. On 3rd week post operation, she presented with high intraocular pressure (IOP), 40mmHg in RE and normal eye pressure 17mmHg in LE. Anterior segment examination of RE showed diffuse iris pigments on ICL and corneal endothelium, deep AC with cells3+, well-centered and good vaulting of ICL. There was no iris transillumination defects seen. Right optic nerve was pink with CDR 0.3. Left eye anterior segment had similar evidence of pigment dispersion but no IOP elevation, with well-centered and good vaulting of ICL. Intensive topical steroid and IOP lowering agents were started on RE for IOP and AC inflammation control. She was monitored closely for her ocular condition for 6 months duration and her RE AC inflammation and IOP were well-controlled medically. Unfortunately patient defaulted her follow up for 3 months duration. She came back at 9 months post operation, her RE IOP was normal with quiet AC during the visit. However, her right optic nerve head showed glaucomatous changes with optic nerve thinning. Anterior segment of LE was normal with no IOP elevation or glaucomatous optic nerve damage. She was proceeded with bilateral ICL explantation in view of evidence of right eye pigment dispersion glaucoma.

Pigment dispersion glaucoma is a serious vision-threatening post-operative complication that may occur either early or even several years after phakic ICL implantation due to dynamic changes in the posterior chamber over time. Reduced space in the posterior chamber post phakic ICL implantation may precipitate pigment dispersion and chronic uveitis due to iris chaffing from direct implant-iris contact.

In view of the risk of permanent visual field loss, both patients and healthcare providers should be aware the importance of vigilant long term monitoring for glaucoma in patients with phakic ICL implants. The availability of UBM can aid in evaluation of changes in phakic ICL positioning over time.