Aphakic Pupillary Block After Posterior Nd Yag Capsulotomy In A Patient Implanted With Artisan Phakic Intraocular Lens

Aphakia is a condition in which a crystalline lens is absent because of trauma, subluxation, or dislocation. It is a complication of cataract surgery (surgery to treat lens cloudiness). Pupillary block aphakia is a condition that occurs after round pupil cataract extraction. This condition leads to increased intraocular pressure, optic disc damage, and visual field defects. Here we present a case of a patient who suffer an episode of acute glaucoma attack due to posterior Nd YAG laser capsulotomy and a secondary aqueous misdirection and pupillary block due to a possible aqueous misdirection. The case was resolved after Neodymium-YAG laser therapy to the anterior hyaloid. 

 Intituto de Microcirugía Ocular (IMO Miranza) , Barcelona , Spain

We present a case of a 61- year - old male patient implanted wiht an Artisan Aphakic IOL after a complicated  catarct surgery without vitreous loss due to large radial capsulorhexis tear, no peripheral iridectomy was necessary . At the same surgery three piece  PC Ia OL  was implanted  at the ciliary sulcus but got subluxated and exchange for the Artisan Aphakic IOL without complication.The patient has an WTW of 13.02 mm. After 9 months pos operatively the patient experienced a loss of his BCVA from 0.8 (decimal) to 0.4 (decimal) due to posterior capsule opacification. Nd Yag Posterior Capsulotomy  was performed and after 24 hours the patient presented with an shallow anterior chamber and IOP was 55 mmHg.

The first manouver was to do an peripheral iridectomy and topical brimonidine and timolol ,  acetazolamide 250 mg P.O. was added and after 12 hours the IOP decrease to 12 mmHg . In the second day ACD was 2.70 mm and iris root still was bulged, anterior vitreous bocked peripheral iridectomy and pupilary area. We proceed to do Nd Yag anterior hyaloidotomy until a deep ACD was restored inmediatley. 

Neodymium: YAG laser iridotomy and hyaloidotomy. The laser therapy resulted in immediate deepening of the anterior chamber and reducing of intraocular pressure. No side effect was observed. Neodymium: YAG laser hyaloidotomy is  effective to relieve the aqueous misdirection.