ADVANCED BILATERAL GLAUCOMA AFTER FIRST-GENERATION FYODOROV ‘COLLAR BUTTON’ ANTERIOR-POSTERIOR PHAKIC IOL IMPLANTATION

The aim is to describe a case of a 45-year-old male with advanced glaucomatous optic neuropathy, after bilateral implantation of first-generation Fyodorov ‘collar button’ anterior-posterior phakic IOL 25 years ago.

Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland;

Department of Ophthalmology, Professor K. Gibinski University Clinical Center, Medical University of Silesia, Katowice, Poland;

The patient presented to our outpatient clinic due to vision worsening in both eyes. He had been implanted with first-generation Fyodorov ‘collar button’ anterior-posterior phakic IOL 25 years ago. He did not present medical documentation and claimed that since that time had not visited an ophthalmologist. Visual acuity, slit lamp examination, static visual field, optical coherent tomography, pattern electroretinography, pattern and flash visual evoked potentials.

The patient was referred to the ophthalmology department because of high intraocular pressure (IOP), despite pharmacological treatment. Micropulse transscleral cyclophotocoagulation (MP-TSCPC) was performed in the right eye (RE)  because after pharmacological treatment IOP was still too high.

BCDVA was 0.9 and 1.0 in the RE and in the left eye (LE), respectively on the Snellen chart. BCNVA was 0.5 on the Jaeger chart in both eyes. IOP was 26 mmHg in the RE and 24 mmHg in the LE, despite antiglaucoma medications. Slit lamp examination revealed in both eyes anterior-posterior phakic IOL. In the LE, the IOL had an additional small aperture in the middle and was more convex in comparison to the IOL in the RE. Anterior capsular cataract was present in both eyes. In fundus examination severe glaucomatous optic neuropathy was present in both eyes. Gonioscopy of both eyes: angle width of 30 degrees with grade 3 pigmentation of the trabecular meshwork. The static visual field of both eyes revealed advanced scotomata, more advanced in the RE. OCT presented severe ganglion cell and retinal nerve fibre loss in both eyes. In PERG the amplitudes of P50 and N95 waves in the RE were extinguished. In the LE P50 wave amplitude was reduced and the N95 wave was absent. PVEP/FVEP showed reduced amplitudes of the P100 wave, more abnormal on the RE. After MP-TSCPC of the RE, the IOP was 16 mmHg, and LE was treated pharmacologically with good results.

Pupillary block glaucoma and iridocyclitis were common complications of Fyodorov ‘collar button’ anterior-posterior phakic IOL, which caused the withdrawal of these lenses.
Among numerous complications related to phakic IOL, glaucoma is undoubtedly the most sight-threatening issue. Early diagnosis of glaucoma could have prevented advanced optic nerve damage in the presented patient. In complex cases, electrophysiological examinations are helpful in setting the right diagnosis.