J Korean Ophthalmol Soc.  2013 Jun;54(6):994-999. 10.3341/jkos.2013.54.6.994.

A Case of Pigmentary Glaucoma after Posterior Chamber Phakic Intraocular Lens Implantation

• Pak KY
• Kim HS
• Lee JW

• KMID: 2217281
• DOI: http://doi.org/10.3341/jkos.2013.54.6.994

Abstract

PURPOSE
To report a case of secondary pigmentary glaucoma after implantable contact lens (ICL) implantation successfully treated with trabeculectomy without ICL removal.
CASE SUMMARY
A 29-year-old woman presented with refractory intraocular pressure (IOP) increase in both eyes. IOP was 22 mm Hg in the right eye and 39 mm Hg in the left eye. The patient received posterior chamber phakic intraocular lens implantation in both eyes 22 months prior. Slit lamp examination revealed patent iridotomy sites in both eyes. Gonioscopy revealed open angles with 4-degree pigment deposits on the trabecular meshwork in both eyes. Ultrasound biomicroscopy examination confirmed contact between ICL and the posterior surface of the iris. In spite of well tolerated medical therapy and selective laser trabeculoplasty, IOP was 46 mm Hg in her left eye. Trabeculectomy was performed in her left eye without ICL removal. At 6 months postoperative, IOP measured 6 mm Hg without any anti-glaucoma medication and bleb was maintained in good condition in the left eye.
CONCLUSIONS
The results from this case study indicate that ICL implantation can lead to secondary pigmentary glaucoma and trabeculectomy without ICL removal may help to decrease the IOP.

Keyword

Implantable contact lens; Pigmentary glaucoma; Trabeculectomy

MeSH Terms

Blister
Eye
Female
Glaucoma, Open-Angle
Gonioscopy
Humans
Intraocular Pressure
Iris
Lenses, Intraocular
Microscopy, Acoustic
Phakic Intraocular Lenses
Trabecular Meshwork
Trabeculectomy

Figure

• 

  Figure 1. Automated visual field examination before ICL im-plantation shows no glaucomatous visual field defects in both eyes.

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  Figure 2. (A) Slit lamp photograph at the initial visit shows patent laser iridotomy sites (white block arrows) at the 10 and 2 o’clock positions. (B) Gonioscopy reveals open angles with 4 degrees of pigment deposited on the trabecular meshwork (black arrow heads) and forward vaulting of the iris overlying the ICL. (C) Ultrasound biomicoscopy examination confirms contact and rubbing between ICL and posterior surface of the iris (white open block arrows).

• 

  Figure 3. (A) Disc photograph shows vertical cup-disc ratio of 0.75 in the right eye and 0.8 in the left eye consistent with glaucoma-tous optic disc change. (B) Red-free fundus photography shows superior and inferior retinal nerve fiber layer (RNFL) defects. (C) Visual field examination reveals nasal step defect in the right eye and superior arcuate with inferior nasal step defect in the left eye. (D) Optical coherence tomography shows RNFL thinning in the superotemporal and inferotemporal region in TSNIT graph con-sistent with visual field examinations.

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  Figure 4. Slit lamp photography of the left eye shows a well elevated bleb of medium height, 4 clock hour horizontal ex-tent, and mild vascularity 6 month after trabeculectomy with mitomycin C.

Reference

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