Phakic 6 Intraocular Lens And Corneal Decompensation: A Case Report

Phakic VI intraocular lenses, an Angle-Supported Anterior Chamber PIOL have been considered as a suitable refractive option for the correction of myopic patients who are not good candidates for refractive laser surgery procedures such as PRK or LASIK. In this case report we present one of the potential complications of anterior chamber intraocular lenses, whereby the patient had endothelial cell damage and secondary corneal decompensation 14 years after her surgical procedure.

Informed consent was understood and signed by the patient preoperatively. The procedure was done under local anesthesia with monitored anesthesia care.The anterior chamber was entered through a 6.25 mm superior corneoscleral incision. A peripheral iridectomy (PI) was done at 12 o’clock superiorly.The non-foldable Phakic VI lens was inserted into the anterior chamber and positioned at the 6–12 o’clock orientation. The corneoscleral wound was sutured using 10/0 nylon sutures.

This reported case was 29-year-old female patient at the time of surgery and who presented to our attention with blurred vision and irritation in her eye of 2 months duration, after she lost follow up for 15 years. When the patient presented in august 1999 for interest in refractive surgery her best corrected visual acuity (BCVA) was of 20/25 OU with a manifest refraction of  for her right eye and  for her left eye. Slit lamp exam and dilated fundoscopy at that time were unremarkable. Corneal topography was nonrevealing and her pachymetry was not enough for laser refractive surgery. Anterior chamber depth was measured to be of 3 mm OD and 3.19 mm OS, suitable for PIOL insertion. Specular microscope showed adequate cell density and morphology. Surgery was done with no complications and a smooth post operative course. BCVA post operatively was of 20/20 OU on 14/12/2009. On the day of presentation in February 2024,15 years after the original procedure, BCVA was counting fingers at 50 cm OD. Slit lamp examination showed corneal edema (grade 2) with Descemet’s folds and epithelial cystic changes. Phakic VI intraocular lens was still in place in the right eye. Fundoscopic exam was not feasible because of the corneal edema. Ultrasound results were unremarkable. Corneal endothelium parameters were undetectable through specular microscopy because of the advanced endothelial damage.

This case report showed the potential of corneal decompensation in anterior chamber phakic intraocular lenses, even years after the original procedure. This indicates explicitly the need to have close follow up exams for those patients to prevent the possible risk of irreversible endothelial damage and secondary corneal decompensation necessitating corneal endothelial grafting to rehabilitate vision.