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Mechanically-Induced Pigment Dispersion despite Endocapsular Intraocular Lens Implantation

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

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Mechanically-Induced Pigment Dispersion despite Endocapsular Intraocular Lens Implantation

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

  2. 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.

  3. 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

  4. Methods • Underwent phaco/IOL OD • 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

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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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).

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