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Unstable angle-supported anterior chamber phakic lens and secondary glaucoma
First Author: R. Maroto Cejudo SPAIN
Co Author(s): R. Maroto Cejudo N. Puerto Amorós F. Gonzalez Lopez A. Moreno Valladares D. Espinosa Encalada A. Moreno Martinez
To describe a case report of a secondary glaucoma caused by an unstable angle-supported anterior chamber phakic intraocular lens (IOL).
Albacete University complex, Albacete, Spain
24-year-old man with a history of refractive surgery (angle-supported phakic lens and lasik) for the correction of high myopia 4 years earlier, who presents high intraocular pressure (IOP) levels in his right eye (RE). Visual acuity was 20/20. IOP measured 26 mmHg in RE and 14 mmHg in left eye (LE). Slit-lamp examination revealed an angle-supported phakic intraocular lens that was slightly displaced in RE. Endothelial cell count was 900 cells/mm3 in RE and 1800 cells/mm3 in LE. He had a cup-disc ratio of 0.8 in RE with a diffuse optic nerve thinning consistent with a glaucomatous visual field defect.
Due to high IOP levels despite maximum medical therapy, non?penetrating deep sclerectomy was performed in RE with preservation of the IOL according to the patient�s wish. Months later, he returned to consultation complaining of episodes of hyperemia and pain related with physical activity. Slit lamp examination revealed a change in IOL position not manifested previously (comparing with previous anterior segment photographs). Axial length of RE was 30.7mm, higher in comparison with LE (28.10mm), and therefore consistent with a lens instability as the cause of these episodes. At that moment, it was decided removal of the IOL. The evolution was favorable.
Glaucoma screening after refractive surgery is a challenging process. As tonometric accuracy is diminished, funduscopic and tomographic changes become more important. In a case of refractive surgery with implantation of an angle-supported anterior chamber IOL is important to take into account that in eyes with high axial length (higher than 30mm), angle-supported IOLs can be unstable and produce irreversible inflammatory changes in the trabeculum, and therefore apparition of a secondary glaucoma.
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