Anterior Chamber Hemorrhage During Posterior Chamber Phakic Intraocular Lens Implantation: A Case Report

Posterior chamber phakic ICLs are widely utilized for refractive correction due to their predictability and safety. Intraoperative anterior chamber hemorrhage, however, remains rare. This case highlights the interplay between anatomical limitations (WTW: 10.81 mm, near the lower ICL size threshold) and mechanical trauma from haptic-angle contact. Epinephrine irrigation, acting via α-receptor-mediated vasoconstriction, effectively controlled bleeding.

A 26-year-old female underwent bilateral posterior chamber phakic intraocular lens (ICL) implantation for myopia correction. Acute anterior chamber hemorrhage occurred intraoperatively immediately after the ICL contacted the anterior chamber angle. 

A 26-year-old female presented with bilateral refractive errors (OD: −7.75 −1.25 ×10, CDVA 1.0; OS: −5.25 −1.00 ×10, CDVA 1.0). Intraocular pressure (IOP) was 14.5 mmHg OD and 15.5 mmHg OS. Preoperative measurements included horizontal white-to-white (WTW) diameter (10.81 mm OD/OS), sulcus-to-sulcus (STS) distance (10.78 mm OD, 10.75 mm OS), anterior chamber depth (3.18 mm OD, 3.07 mm OS), and lens thickness (3.17 mm OD, 3.20 mm OS). No systemic hypertension, bleeding disorders, or anticoagulant use were reported. After preoperative mydriasis, bilateral ICL (Model 12.1; −9.50 D OD, −6.50 D OS) implantation was performed under topical anesthesia. In the right eye, a 1.2 mm paracentesis was created at 6 o’clock. Following viscoelastic injection, a 2.8 mm main incision was made at the temporal cornea. Upon ICL insertion, hemorrhage arose from the 3–4 o’clock angle as the haptics contacted the anterior chamber angle. Immediate irrigation with 0.3 mL 1:100 diluted epinephrine (1%) halted bleeding. Subsequent haptic repositioning into the ciliary sulcus triggered recurrent hemorrhage, controlled by additional epinephrine (0.1 mL) and thorough irrigation (Figure 1). The left eye surgery proceeded uneventfully except for minor hemorrhage at 10 o’clock during haptic adjustment, resolved similarly (Figure 2). Postoperative follow-up at 1 year revealed stable ICL positioning, normal vault height, and corrected distance visual acuity (CDVA) of 1.0 in both eyes.