Complications following implantation of posterior chamber phakic intraocular lens (pIOL)

Abstract

A male patient in his 20s presented with right eye aphakic corneal decompensation and left eye intumescent cataract with phakic intraocular lens (pIOL) lenticular touch. He had a history of pIOL implantation in both eyes 6 months ago. On first postoperative day, uncorrected distance visual acuity was 20/400 and 20/20 in right and left eye, respectively. Postoperatively, a diagnosis of right eye toxic anterior segment syndrome (TASS) was made and pIOL was explanted. Subsequently, the patient developed intumescent cataract for which lens aspiration with posterior chamber intraocular lens (PCIOL) implantation was performed in the right eye. Ongoing uveitis with membrane formation warranted PCIOL explantation. The patient developed aphakic corneal decompensation in the right eye and underwent penetrating keratoplasty with intrascleral haptic fixation of an intraocular lens. Central pIOL-lenticular touch with intumescent cataract was diagnosed in the left eye for which pIOL explant with lens aspiration and PCIOL was done. TASS and post-pIOL cataract are rare but vision-threatening complications require judicious management for visual rehabilitation.

Keywords: Anterior chamber; Iris; Ophthalmology.

Figure 1

(A) Slit-lamp photograph reveals corneal oedema, fibrinous reaction in anterior chamber with 360° peripheral anterior synechia and aphakia in the right eye and (B) intumescent cataract with phakic intraocular lens lenticular touch in the left eye.

Figure 2

(A) Clear corneal graft 6 months following penetrating keratoplasty and intrascleral haptic fixation of an intraocular lens in the right eye; and (B) pseudophakia with single-piece foldable hydrophobic acrylic intraocular lens in bag in the left eye.