Hypotony And Vitreous Haemorrhage Post Scleral Buckling In Patient With Phakic Iol – A Hidden Source.

Phakic intra ocular lenses have emerged as efficient modality of correction of high refractive errors where cornea-based laser surgeries are not an option. Vitreoretinal complication associated with pIOL is uncommon. Retinal detachment following pIOL is seen scantily, however high incidence of retinal detachment in high myopes is a confounding factor. Such cases are usually managed by scleral buckling, pars plana vitrectomy alone, and PPV combined with SB with good post operative results. Here we report a case of ciliary shut down & vitreous haemorrhage following a scleral buckling procedure for RRD in a patient with posterior chamber Phakic intra ocular lens. To the best of our knowledge this complication has not been reported earlier.

Nethradhama Superspeciality Eye Hospital, Bangalore.

A 34year male presented with sudden painless loss of vision in right eye since 4 hours. No h/o trauma noted. He gave history of implantation of phakic intra ocular lens 12 years ago.

On examination, the best corrected visual acuity in the RE was counting fingers at 0.5 metre. The RE had phakic IOL & temporal retinal detachment involving the macula. A horse shoe tear in the infero-temporal quadrant was noted.

Patient underwent RE cryotherapy with scleral buckling after subretinal fluid drainage.

On post operative day 1, RE had an IOP of 10mmhg with a shallow anterior chamber. Periphery showed buckle indent with a flat break. On B scan, flat retina noted.

On POD 4, RE BCVA was counting fingers close to face and IOP was 6 mmhg with shallow AC. Hazy vitreus media obscured the view. Bscan showed, hyper echoic vitreous. On follow up visits on POD 6 & 8, the eye remained hypotonus and inferior vitreous haemorrhage was noted.

Patient underwent RE pIOL explant with phacoemulcification with IOL implantation along with pars plana vitrectomy. Subretinal fluid was drained & endolaser done and silicone oil implanted. Biometry was done considering silicon oil in posterior segment.

Next day, RE had an IOP of 14mmhg with well formed AC. Retina was well attached with buckle indent.

On POD 30, BCVA was 6/18, IOP was 21mmhg, IOL was in situ, retina was attached, 360 buckle indent was noted.

Scleral bucking causes increase in the axial length and reduces the sulcus to sulcus diameter. In such a scenario, the rigid pIOL can cause friction on the ciliary body causing ciliary shut down and vitreous haemorrhage. Explanting the pIOL is the plan of treatment in such cases. Combining the explanation procedure with phacoemulcification and foldable IOL implantation with give spectacle free BCVA to the patient.