A Case Of Secondary Uveitis With Ankylosing Spondylitis Following Icl Implantation During The Covid-19 Pandemic

Purpose：To report a case of secondary uveitis with ankylosing spondylitis (AS) and abnormal exudative deposits with pigment adhesion on the surface of an implantable Collamer lens (ICL) in a highly myopic eye following coronavirus disease 2019 (COVID-19) infection, and to analyze its etiology and treatment.

Setting：Common complications following posterior chamber phakic intraocular lens (ICL) implantation include high or low vault, glaucoma, and cataract. Delayed-onset uveitis, is considered a rare immune complex-mediated hypersensitivity reaction, seldom resulting in deposition on the ICL surface. This report discusses the etiology and management of a case of delayed-onset uveitis following ICL implantation.

Report of case：An 18-year-old male underwent bilateral implantable Collamer lens (ICL) implantation for progressive blurred vision over a decade. Preoperative evaluation revealed:· Refraction: OD: -9.50 DS/-1.00 DC × 15°, OS: -9.25 DS/-1.00 DC × 175°· Ocular examination: Transparent corneas bilaterally; normal corneal topography and biomechanical analysis.The anterior segment and fundus of the eye are normal.Postoperatively, uncorrected visual acuity (UCVA) reached 1.0 in both eyes with normal intraocular pressure (IOP). At 22 months postoperatively, the patient presented with right ocular hyperemia, photophobia, pain, epiphora, and vision decline (VOD: 0.5, VOS: 1.0) following a recent influenza-like illness. Slit-lamp examination demonstrated:· Right eye: Clear cornea, deep anterior chamber, no keratic precipitates (KP), round pupil with normal light reflex, and multiple lipid-like granules with punctate/linear pigment deposits on the ICL surface (Figure 1).Immunological screening confirmed ankylosing spondylitis (AS). Treatment included:· Topical therapy: Tobramycin/dexamethasone eye drops, ganciclovir ophthalmic gel, and levofloxacin eye drops (4 times daily);· Systemic therapy: Sulfasalazine and loxoprofen sodium tablets.At 1-week follow-up, right UCVA improved to 0.6 with partial absorption of exudates, though persistent deposits remained on the ICL surface.

Conclusions: For patients with systemic autoimmune diseases or virus-induced uveitis undergoing ICL implantation, preoperative immunological screening should be actively performed to minimize postoperative complications. Early comprehensive therapy is critical to prevent progressive vision loss and rare transparency alterations of the ICL surface caused by pigment-laden exudates.