ICL and Sequential Bilateral Pupillary Block

Abstract

The refractive surgeon should be aware of the risk of pupillary block after Implantable Collamer Lens (ICL) implantation. If surgery before a neodymium:YAG (Nd:YAG) laser iridotomy is performed, the surgeon must be aware of the complete permeability of these iridotomies. The Visian Implantable Collamer Lens (ICL; STAAR Surgical) is a sulcus-placed, phakic, posterior chamber intraocular lens (PIOL) used to manage myopia, hyperopia, and myopic compound astigmatism in phakic patients [1, 2]. The ICL is designed to vault anteriorly to avoid contact with the crystalline lens. The vault is at risk of causing pupillary block; thus ICL surgery requires prophylactic placement of laser peripheral iridotomies. If the peripheral iridotomies are imperforate, pupillary-block angle closure can develop. Block can be treated with additional laser peripheral iridotomies [3, 4]. The new model of ICL surgery includes a small central hole to ensure adequate aqueous humor circulation, even in the absence of a peripheral iridotomy.