Pseudophakic Angle Closure In Posterior Chamber Intraocular Lens In The Presence Of Large Soemmering Ring
Published 2025 - 43rd Congress of the ESCRS
Reference: PP01.17 | Type: Poster | DOI: 10.82333/e66p-ra29
Authors: Hnin Hnin Oo 1 , Aaron Wei Wen Ng 1 , Jeanne Joyce Ogle 1 , James Jie Sng Sng 1 , Don Chern Kuok Pek 1 , Yu Qiang Soh 2 , Vernon Khet Yau Yong 1 , Lin Ru Koong* 1
1Ophthalmology,National Healthcare Group Eye Institute, Tan Tock Seng Hospital,Singapore,Singapore, 2Ophthalmology,National Healthcare Group Eye Institute, Woodlands Health Campus,Singapore,Singapore
Purpose
Pseudophakic angle closure is a well-known complication of anterior chamber intraocular lenses (IOL) but is rarely reported with posterior chamber IOLs. This case series describes two cases of angle closure in pseudophakic eyes with posterior chamber IOLs, secondary to a bulky Soemmering ring.
Setting
Both patients were seen and managed at a tertiary hospital in Singapore.
Case 1: A 74-year old Chinese woman presented with a one-week history of right eye pain and headache. She had undergone cataract surgery 10 years earlier.
Case 2: A 69-year old Chinese woman presented with three-months of subacute blurring of vision, five years after cataract surgery.
Neither patient reported any history of trauma.
Methods
On examination, the intraocular pressure (IOP) were 50mmHg in Case 1 and 37 mmHg in Case 2. Case 1 exhibited features of acute angle closure, including a mid-dilated pupil and corneal edema. Both patients had shallow anterior chambers (AC), and gonioscopy revealed synechiae angle closure. Posterior chamber IOLs were present in both patients without evidence of subluxation.
Optic disc cupping was observed, with cup-to-disc ratios of 0.8 and 0.9 in Cases 1 and 2, respectively. Ultrasound biomicroscopy revealed shallow AC, iris bombe, and prominent fibrotic IOL-capsular bag-Soemmering ring complex in both cases.
Results
Both patients were treated with topical glaucoma medications, intravenous acetazolamide, peripheral iridotomies and iridoplasty, but their IOPs remained elevated (22-34mmHg).
Case 1 underwent anterior vitrectomy, IOL explantation, and scleral-fixed IOL implantation. Case 2, initially treated as primary angle closure glaucoma, underwent trabeculectomy, but her post-operative IOP remained high, and the AC was persistently shallow. Aqueous misdirection was suspected, but repeat iridotomy and YAG hyaloidectomy failed to reduce IOP or deepen the AC. She later underwent pars plana vitrectomy and hyaloido-zonula-iridectomy with a large tract created through the Soemmering ring.
Postoperatively, IOP normalised, and the AC deepened in both cases.
Conclusions
The initial angle closure in both patients was likely caused by the apposition of the fibrotic IOL-capsular bag-Soemmering ring complex against the iris, inducing angle closure through mechanical apposition and pupil block. Both patients required surgical intervention, including explantation of the fibrotic IOL-Soemmering ring complex. The second case highlights that creating a large surgical tract through the Soemmering ring can effectively relieve angle closure.
Secondary angle closure glaucoma, though rare, can occur in pseudophakic eyes with posterior chamber IOLs. Significant Soemmering rings should be considered, and prompt surgical intervention is crucial when IOP remains refractory to medical treatment.