ESCRS - PO223 - Challenges In Toric Implantable Collamer Lens Implantation: Elevated Intraocular Pressure And Plateau Iris – A Case Report

Challenges In Toric Implantable Collamer Lens Implantation: Elevated Intraocular Pressure And Plateau Iris – A Case Report

Published 2025 - 43rd Congress of the ESCRS

Reference: PO223 | Type: Case Report | DOI: 10.82333/r46y-s412

Authors: Joana Alves Pargana* 1 , Bruno Dias 1 , Afonso Lima-Cabrita 1 , Rui Nunes Ferreira 1 , Patrícia José 1 , Ana Miguel Quintas 2 , Paulo Guerra 2

1Ophthalmology,Hospital de Santa Maria,Lisbon,Portugal, 2Ophthalmology,Hospital de Santa Maria,Lisbon,Portugal;Ophthalmology,Hospital da Luz,Lisbon,Portugal

Purpose

To describe a case of elevated intraocular pressure even after the exchange of Implanted Collamer Lens (ICL) V4c model due to excessive vaulting and appositional angle closure in a patient with high myopic astigmatism.

Setting

Ophthalmology Department of Hospital da Luz, a private hospital in Lisbon, Portugal.

Report of case

A 30-year-old patient with high myopic astigmatism presented to Hospital da Luz for ICL evaluation. Patient's medical record was unremarkable. Right best corrected visual acuity (-18.50 -1.50x20º) was 0.10 (logMAR). Right eye endothelial cell density (ECD) was 2792cells/mm2. Lenstar LS 90® (Haag-Streit) measured a white-to-white distance of 11.90mm and an anterior chamber depth of 2.98mm. These measurements and the online calculator provided by the manufacturer were used to determine lens size. An EVO Visian toric ICL V4c (13.2mm) was implanted in the right eye. At 1-week post-operative follow-up, uncorrected visual acuity was 0.06 (logMAR) and intraocular pressure (IOP) was 13mmHg. Gonioscopy displayed an angle 1/2 (Schaffer). Pentacam HR® (OCULUS Optikgerate GmbH) revealed a vault of 950µm. A superior iridotomy was performed. At 3-week post-operative follow-up IOP was 32mmHg, ICL was explanted and a new EVO Visian toric ICL V4c (12.6mm) was implanted. At 1-week post-operative follow-up of the second ICL implantation revealed an IOP of 17mmHg and a vault of 440µm. Gonioscopy displayed an angle 2/3 (Schaffer). At 2-week post-operative visit, presented an IOP of 41mmHg and some pigment in the lens. Ultrasound biomicroscopy (UBM) showed an anterior displacement of ciliary body, and was diagnosed with plateau iris and recurrent closure of the iridocorneal angle. Explant of ICL was performed. At the 3-week post-operative revealed an IOP of 16mmHg and an ECD of 2447cells/mm2.

Conclusion/Take home message

Plateau iris is not usually detected in preoperative evaluation of an ICL implantation.  In these cases, neither an accurate sizing nor an ideal vault are enough to avoid an ICL explant. Gonioscopy and/or UBM should be considered to exclude anatomical variations in the anterior chamber angle when we evaluate a patient for ICL implantation.