ESCRS - PO239 - Posterior Chamber Phakic Intraocular Lens For Hyperopia Correction

Posterior Chamber Phakic Intraocular Lens For Hyperopia Correction

Published 2024 - 42nd Congress of the ESCRS

Reference: PO239 | Type: Case Report | DOI: 10.82333/cktm-6q63

Authors: Shritu Shail* 1 , Gaurav Luthra 1 , Kumar Himanshu 2 , Kumar Anshuman 3

1Ophthalmology,Drishti Eye Institute,Dehradun,India, 2Dermatology,Shri Mahant Indresh Medical College,Dehradun,India, 3Ophthalmology,James Cook University Hospital,Middlesbrough,United Kingdom

Purpose

To report a case of Implantable Collamer Lens (ICL) in hyperopic eye warranting exchange in one eye due to high vault and conservative management in the other eye following raised IOP.

Setting

Ophthalmology Department, Drishti Eye Centre, Dehradun, India

Report of case

A patient with hyperopia in both eyes underwent ICL implantation.ICL was implanted first in the right eye .ICL size was determined using the STAAR Surgical Online Calculation and Ordering System (OCOS). WTW was measured using Digital Caliper.

Vision on 1st post operative day was 20/25.On the 2nd post op day vision decreased to 20/63.On examination patient had Shallow AC in RE in the inferotemporal quadrant with minimal pigments seen on ICL and endothelium.IOP was raised. PI was patent .RE vault was within the normal range.IOP lowering drugs was started. 2 weeks later the size of the vault was raised to 1.16mm and vision decreased to 20/125.O/E pupil was slightly peaked with iris plugging at the incision site .ICL exchange surgery was planned with ICL of one size less following which vision improved to 20/25. IOP and vault returned to normal range.

For LE one size smaller ICL was implanted than that determined by OCOS. PI enlargement was done pre operatively.Vault was maintained but IOP spiked in the 1st post operative day which was managed with IOP lowering drugs.Dose of steroid was reduced to BD .2 days later IOP was lowered and was maintained .

Conclusion/Take home message

Keratorefractive procedures, such as PRK and LASIK, have poor predictability of the refractive outcome when hyperopia exceeds 4.0 D.Corneal higher-order aberrations and regression are important challenges in post-LASIK ablation for high hyperopia.                                                                                                                               Although ICL in hyperopia  is a safe and  effective method some patients might experience complications that warrant explantation or exchange.

Pupillary block is the most important complication reported  in various studies.ICL implantation is a procedure with complications that are easily treatable and do not result in a loss of Snellen lines of BCVA in most cases.