Nathalie M. Guibord,MD Geisinger Medical Center

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Presentation transcript:

Nathalie M. Guibord,MD Geisinger Medical Center Mechanically-Induced Pigment Dispersion despite Endocapsular Intraocular Lens Implantation Nathalie M. Guibord,MD Geisinger Medical Center Author has no financial interest

Purpose To report a case of severe pigment dispersion that began on post-operative day one after cataract surgery with endocapsular implantation of a square-edge intraocular lens (IOL) . The cause of the pigment dispersion in this unique case is discussed.

Methods 70 year old Caucasian female Retinal detachment repaired by scleral buckle OD in 1995 High myopia with lattice OU Pigment dispersion syndrome OU Krukenberg spindle, pigmentation on gonioscopy and q configuration to iris No iris trans-illumination defects (TID’s) Status-post uneventful phaco/IOL OS

Methods Underwent phaco/IOL OD CTR model 14A (14.5 mm) inserted Two clock hours of weak zonules noted during chopping CTR model 14A (14.5 mm) inserted SA60AT 7.5 D in the bag Lens centered very well, in the bag

Methods POD #1 4+ pigmented cells in anterior chamber IOL well-centered and in the bag

Methods POD #3 Still had 4+ pigmented cells IOL confirmed to be endocapsular Vitreous was clear Laser peripheral iridectomy was performed due to q configuration of the iris

Methods Pigment-induced ocular hypertension occurred by POD #13 Ta 31 4+ pigmented cells 4+ Iris TID’s in configuration of IOL, raising doubts that IOL was fully endocapsular IOL seemed very close to the iris Started on acetozolamide p.o. Schedule to return to O.R. the next day

Results OR POD #14 IOL found to be 100% endocapsular IOL explanted as pseudophacodonesis with square-edge iris chaffing suspected MA60AC 7.5 D was inserted in sulcus

Results IOP controlled by POD #2 status-post IOL exchange patient gradually improved over the next few weeks 3 months post-op Va cc 20/20 Ta 15 mmHg Trace flare Off all eye meds Has continued to do well since then

Results Pseudophacodonesis occurred secondary to zonular dialysis (needing a CTR), large scleral buckle and vitreous pressure SA60AT should not be placed in the sulcus Zero angulation between optic and haptics Square edges anteriorly (optic and haptics) High risk for iris chaffing Not indicated in direction-for-use labeling

Conclusion There are several reports of mechanically-induced pigment dispersion associated with the implantation of a SA60AT in the sulcus No reported cases of pigment dispersion from this IOL when positioned completely within the capsular bag

Conclusion The primary cause of pigment dispersion in this case was pseudophacodonesis with an IOL with anterior square edges. This case demonstrates how it is prudent to insert a three-piece IOL with rounded anterior edges, in cases when the zonular integrity has been compromised and posterior vitreous pressure is present (as with a scleral buckle).