Recurrent Occlusion of Laser Iridotomy Sites After Posterior Chamber Phakic IOL Implantation

We report a case of recurrent occlusion of laser iridotomy (LI) sites after a Visian ICL (Implantable contact lens version 4, Staar Surgical AG, Nidau, Switzerland) implantation. A 45-year-old woman had bilateral ICL implantation after placement of two peripheral LI sites in each eye to prevent pupillary block. At one month after the operation, severe narrowing or occlusion of four LI sites occurred. After this, although she received four additional LIs at postoperative months 1, 6, 9 and 10 in both eyes, the narrowing or occlusion recurred. Mild chronic anterior chamber inflammation was observed intermittently throughout the follow-up period. We performed clear lens extraction in both eyes (at postoperative month 11 in the left eye and month 26 in the right eye) due to recurrent occlusion of the LI sites and excess trabecular meshwork pigment deposition presumably caused by the four repeated LIs. Recurrent obstruction of LI sites can occur after ICL implantation. These problems were unresolvable despite four repeated laser iridotomies. The risks associated with anterior uveitis must be considered when planning an ICL implantation

Long-term biocompatibility and visual outcomes of a hydrophilic acrylic intraocular lens in patients with uveitis.

PURPOSE To report the long-term visual outcomes and biocompatibility of a single-piece hydrophilic acrylic intraocular lens (IOL) in patients with uveitis having cataract surgery. SETTING Tertiary referral center, Birmingham, United Kingdom. DESIGN Retrospective case review. METHODS The review included consecutive uveitis patients in whom phacoemulsification and acrylic IOL implantation was performed by the same surgeon. Outcomes measures are reported as rate/eye-year and included visual acuity and signs of bioincompatibility. RESULTS The review identified 171 eyes (140 patients; mean age 51 years [range 16 to 85 years]) with uveitis. The mean follow-up was 3.8 years (range 0.9 to 10.3 years). Signs of uveal bioincompatibility were found in 31 eyes, with visually insignificant deposits on the IOL in 17 eyes. The rate of uveal bioincompatibility was 0.06/eye-year. Signs of capsule bioincompatibility were found in 107 (63%) of 171 eyes (0.31/eye-year). Posterior capsule opacification was documented in 102 eyes (0.29/eye-year); neodymium:YAG laser capsulotomy was required in 31 eyes (0.05/eye-year). The rate of failure to maintain a 3 logMAR line improvement in corrected distance visual acuity (CDVA) was 0.08/eye-year; to maintain better than 0.3 logMAR, 0.15/eye-year; and to maintain either, 0.04/eye-year. At 1 year, 85% of eyes had a CDVA of better than 0.3 logMAR or maintained a 3 logMAR-line improvement. Eyes with preexisting macular or optic nerve disease had significantly worse visual outcomes. CONCLUSIONS The long-term safety profile of the hydrophilic acrylic IOL was good in uveitis cases, leading to good visual outcomes and a low rate of vision-impairing uveal and capsule complications. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned