Cat Eyes - Iris Capture As Unusual Complication After Phakic Posterior Chamber Intraocular Lens Implantation

This case study describes a rare complication of iris capture behind the optic edge of an implantable phakic intraocular lens (pIOL) in a young patient with myopic astigmatism. It depicts the presumable underlying causes, clinical presentation and possible management strategies, and emphasizes the importance of preoperative planning and pIOL design.

A 24-year-old patient underwent binocular phakic IOL implantation at a tertiary care medical center. Following an uneventful surgery and early postoperative period, an unusual complication occurred one month after the procedure.

In this case study, a 24-year-old student presented with myopic astigmatism and a strong aversion to wearing glasses due to her active lifestyle. She opted for implantable phakic intraocular lenses (pIOL) over laser vision correction, desiring the option of reversibility if needed. The patient had no significant medical or ocular history. Following extensive preoperative evaluations, pIOL implantation was chosen. The procedure was performed bilaterally (sequentially) without intraoperative complications. The patient reported mild postoperative symptoms, including pupil distortion, blurred vision, pressure sensation, and occasional tearing, predominantly in the left eye. The distortion was more pronounced in low-light conditions but often resolved in well-lit environments. Subtle pigment deposits on the pIOLs were observed. Iris capture behind the pIOL optic edge, an uncommon complication not extensively documented, was identified as the cause of pupil distortion. The curvature of the pIOL optic-haptic junction, combined with a high vault, was thought to contribute to this phenomenon. The report underscores the importance of careful patient selection, considering pupil size, lens design, and surgical planning to minimize the risk of iris capture. Management options include repositioning, pIOL exchange, or, in rare cases, explantation followed by laser vision correction

The study emphasizes the need for further research into pIOL design, materials, sizing, and predictive models to enhance surgical outcomes. It also highlights the importance of manufacturers disclosing their sizing algorithms to improve accuracy in pIOL selection. Ultimately, this report adds valuable insights into a rare but noteworthy complication that refractive surgeons should consider when performing pIOL implantation.