One Case Of Transient Myopia In The Contralateral Eye After Posterior Chamber Phakic Intraocular Lens Implantation

To report a complication after Posterior Chamber Phakic IOL surgery in the non-operated eye, which developed a transient acute myopia. 

Instituto Oftalmológico Hoyos. Fundació Hospital Esperit Sant.

We present a 36-year-old female patient with keratoconus in both eyes, treated thirteen years ago with Corneal Collagen Crosslinking (CXL). Uncorrected visual acuity (UCVA) in the right eye (RE) was 20/20 and in the left eye (LE) was 20/400. Best corrected visual acuity (BCVA) was 20/15 in the RE with a refraction of -0.5 -0.5 x 130º and 20/40 in the LE with -8 -3.5 x 180º. The keratoconus was stable after CXL for years and we decided to solve the anisometropia by implanting a posterior chamber toric PIOL (ICL -13.0/3.5/92º, 13.2 mm) in the LE. Our protocol after this surgery included acetazolamide tablets to prevent ocular hypertension and eye drops of tobramycin with dexamethasone.

One day after surgery UCVA was 20/30 without complications and the intraocular pressure (IOP) was 10 mmHg. However, the patient reported blurred vision in the contralateral eye (non-operated eye) showing a refraction of -3 -1.25 x 150º, macular folds and a narrowing of the anterior chamber depth (ACD) from 3.5 mm to 2.08 mm, without ocular hypertension. We stopped the acetazolamide tablets and added cycloplegic eye drops to the affected eye. After 48 hours UCVA improved to 20/20, the macular folds disappeared and the ACD recovered a depth of 3.31 mm.

One of the side effects of acetazolamide is the possibility of forward displacement of the irido-lenticular complex, with myopization and choroidal detachment, all of which we found in the contralateral eye to the operated one.  We need to take into account this side effect of systemic acetazolamide.