Early Postoperative Cystoid Macular Edema After Implantation Of A Posterior Chamber Phakic Intraocular Lens

This case report describes the occurrence and management of an early postoperative cystoid macular edema following implantation of a toric posterior chamber phakic intraocular lens (PIOL).

A 43-year-old woman underwent uneventful bilateral PIOL implantation for the correction of high myopia and astigmatism at the Refractive Surgery Department of the University Eye Clinic Graz

Bilateral PIOL implantation (EVO+ Visian ICL VTICM5 13.2, -9,5 +1,5 x 88° (right eye) and VTICM5 13.2, -9,5 +1,5 x 91° (left eye)) under topical (Oxybuprocain hydrochloride 0.4%, Minims) and intracameral anesthesia (Lidocain hydrochloride 10 mg/ml, Xyloneural) combined with the mydriatic agent Epinephrine 1 mg/ml (Suprarenin) was uneventful. Hydroxypropylmethycellulose 2.0% (EYEFILL HD, Bausch + Lomb, Rochester, NY, USA) was used as ophthalmic viscoelastic device. Incision size was 3.1 mm. At the end of the procedure, Carbachol 0.1 mg/ml (Miostat) was injected into the anterior chamber. 

OCT revealed pronounced cystoid macular edema on the first postoperative day. Dorzolamide 20 mg/ml (Trusopt) was added to the existing therapy of bromfenac 0.9 mg/ml (Yellox) twice daily and dexamethasone/gentamycin 1 mg/5 mg/ml (Dexagenta-POS) 4 times daily. The patient reported improvement in metamorphopsia on the second day, coinciding with considerable reduction of macular edema. One week after surgery, UDVA of the left eye improved to 20/30. The CME was completely resolved and OCT of the left eye showed only minimal residual disturbance of the outer retinal layers. Topical dorzolamide and dexamethasone/gentamycin were discontinued. Slight distortion of longer lines (like doorframes) was still reported 3 months postoperatively

This case of a CME constitutes a rare postoperative finding following uneventful bilateral implantation of a PIOL. To the best of our knowledge, only one case of CME, one week after repositioning, has been reported. The CME resolved three months after explantation of the PIOL. The use of topical carboanhydrase inhibitors seems to support the resolution of postoperative CME after PIOL implantation. The persistence of discrete metamorphopsia in the absence of obvious morphological correlates could be due to an inability of OCT to detect small residual irregularities in photoreceptor cells. Further reports are needed to advance our understanding of early CME after PIOL implantation and to help in the development of more specific treatments.