ICL Explant Due to Ocular Hypertension, Reduced Endothelial Cell Count and Anterior Sub Capsular Cataract Due to Patient Selection Error

Abstract

Implantable Collamer Lenses (ICL) are phakic lenses that are implanted in the posterior chamber of the eye for the correction of myopia, hyperopia, and astigmatism in those patients who cannot undergo corneal refractive surgery, the main feature of the latest models. Of ICL is a hole in the optical center of the lens, which facilitates the natural flow of aqueous humor. Among the contraindications for ICL implantation are: Corneal pathologies, cataracts, glaucoma, retinal pathologies such as degenerations or detachments, diabetic retinopathy, patients allergic to collagen, pseudo-exfoliative syndrome, pigment dispersion syndrome, pupillary abnormalities, endothelial count less than 2000 mm2, uveitis, under 20 years of age or with unstable refraction. We present the case of a 24-year-old female patient who came to the clinic for refractive surgery due to high myopia, an ICL -18.00 D implant was proposed in the left eye. In the preoperative examinations: the UBM presented an iris plateau with multiple angle-closing cysts. In the optic nerve OCT she presents a moderate and severe decrease in nerve fibers and the visual field with PHG: outside normal limits, MD: -12.84 dB. After the postoperative period, the patient presented with ocular hypertension that was controlled with antihypertensive, he achieved IOP control a month after the operation, but after a few months postoperatively he presented a low endothelial cell count and an anterior sub capsular cataract, for which it was decided to explant the ICL. Finally, cataract surgery was performed and a monofocal IOL was implanted.