Peace After The Storm: Implantable Collamer Lens Repositioning And Gonio Wash Halt Pigment Release Post Implantation

To report a case of pigment dispersion post ICL implantation which was managed successfully with ICL repositioning and gonio wash. Pigment dispersion syndrome post ICL implantation can lead to catastrophic complication of glaucomatous optic neuropathy if the drainage angle blockage was not reversed in time.

This is retrospective case report of a young patient who had ICL implantaion done both eyes but only one eye developed pigment dispersion syndrome.

This is a 22-year-old male patient who had bilateral Implantable Collamer Lens (ICL) performed. His anterior chamber measurements both eyes were different and thus ICL sized 12.1 was implanted for right eye and 12.6 was implanted for left eye. Postoperative day one and day seven, the patient achieved good visual outcome of UCVA of 6/6. His IOP remained in the normal range during the first two postoperative visits.

However, patient started to develop pigments dispersion and anterior chamber cells on day 13 post ICL implantation and he was restarted on topical steroids. There was no signs of resolution of pigments release and his IOP started to raise. He was then started on topical antiglaucoma G.Combigan to stop further IOP spike. Gonioscopy revealed heavily clogged trabecular washwork. There was also pigments deposition on the corneal endothelium and ICL optics.

The patient then underwent a second procedure to rotate his ICL from horizontal to vertical position combined with gonio wash. His gonio wash was performed copiously with tran cannula. Three weeks later, patient's anterior chamber returned to quiescence and his topical antiglaucoma was managed to taper off.

Pigment dispersion syndrome can lead to irreversible damage of trabecular meshwork if the pigments are not removed in time. This is a case report of a patient who had early intervention to control pigments release by vertically rotating the ICL and also gonio wash.