IOL-induced pigmentary glaucoma

A 52-year-old black man with no myopia and no family history of glaucoma had uneventful cataract surgery by phacoemulsification and in-the-bag implantation of an AcrySof S60AT IOL in the left eye.

Four days postoperatively, he developed pigmentary dispersion syndrome (PDS). Slitlamp examination, anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) showed that the posterior surface of the iris was being rubbed by the inferior haptic of the IOL, which was in the bag but deformed. The IOP increased and was controlled with maximum antiglaucoma medications, while visual acuity remained 20/20.

To control IOP, filtering surgery was performed. Intraoperatively, capsular bag placement of the IOL was confirmed. The inferior haptic was deformed and in contact with the posterior iris via the anterior capsule. The haptic shape was restored by pushing the haptic downward with a Lester hook, after which the filtering surgery was completed. Visual function was stabilized and IOP remained normal without medication.

Researchers hypothesized that during IOL loading, the haptics were deformed and the normal shape was not recovered. UBM was useful in understanding the pathogenesis. It clearly showed the contact between the inferior hepatic and the posterior surface of the iris.

When faced with persistent elevated IOP after posterior chamber implantation, PDS and pigmentary glaucoma should be considered. Mechanisms for the complication, suggested by ophthalmologic examination, can be confirmed by UBM and OCT.