Phakic implantable collamer lens exchange for high vault with acute angle closure

Abstract

AbstractPurposeTo describe a case of an early postoperative angle‐closure related to high vault after phakic implantable collamer lens (ICL) implantation managed by smaller size lens exchange.MethodsA case report if a 38‐year‐old woman with high myopia underwent refractive surgery correction with posterior phakic Implantable Collamer Lens (ICL) (STAAR Surgical, V4c) in the right eye. White‐to‐white measurement was 12.28 mm. Preoperative anterior chamber depth was 3.04 mm. ICL implantation with a 13.2 mm lens was performedResultsPostoperative examination showed a shallow anterior chamber with a raised intraocular pressure (IOP) of 28 mmHg. Anterior segment OCT (AS‐OCT) revealed a lens vault of 954 µm raising to 1154 µm after 4 days with iridocorneal angle closure. The diagnosis of acute angle‐closure secondary to non‐pupillary block due to the volume of the ICL was made. Explantation of the ICL and re‐implantation of a smaller sized lens (12.6 mm) was performed 7 days after the first surgery.Postoperative uncorrected visual acuity was 20/20, IOP was 14 mmHg and no crystalline lens opacities or anisocoria were noticed. The patient achieved a reduction in the vault from 1154 to 596 μm, with an open iridocorneal angle. Specular microscopy showed no significant endothelial cell loss.ConclusionsExtreme lens vault in our patient was related to poor correlation between pre‐operative measurements and postoperative lens vaulting. AS‐OCT was a helpful tool in diagnosing and managing high vaults with acute angle‐closure. Early ICL extraction in these cases is necessary to avoid angle‐closure glaucoma, severe endothelial loss, and pupillary defect.Ref‐erenceArjun Srirampur, Tarannum Mansoori, Pasyanthi Balijepalli, Aruna Kumari Gadde. Management of anisocoria and high vault in an eye with implantable collamer lens. Indian J Ophthalmol. 2020 Dec;68(12):3070–3072.