Iol Exchange-The Plan; Izhv- The Saviour

To present a case which underwent Intraocular lens (IOL) exchange and Irido-Zonulo-Hyaloido-Vitrectomy (IZHV) for secondary glaucoma post cataract surgery

Tertiary eye care center

A 70 years old female underwent Right eye (RE) Small incision cataract surgery (SICS) with foldable Intraocular lens(IOL). Post operative week 1 the Best corrected Visual acuity (BCVA) was 20/40 and Intraocular pressure (IOP) was 12mmHg. Post operative week 5 the BCVA dropped to 20/125 and IOP increased to 42mmHg. Patient deveoped corneal edema and shallow AC. Patient was suspected to have sulcus IOL induced pigment dispersion or Aqeuous misdirection syndrome (AMS). YAG peripheral iridotomy was done, cycloplegics, oral and topical AGMs were started. Patient was planned for IOL exchange, intra operative shallow AC and hard globe was observed. IZHV was performed. Post IZHV the AC was well formed and IOL was stable. Post operatively the patient's BCVA improved to 20/40 and IOP was 14mmHg.

A single piece acrylic IOL placed in sulcus can result in pigment dispersion and secondary glaucoma. Timley and adequate IZHV helps in management of aqueous misdirection syndrome. Cycloplegics must be continued post operatively in patients with aqueous misdirection syndrome.