Pseudophakic Posterior Iris Chafing Syndrome: Two Case Reports

Abstract

Purpose: To report two rare cases of posterior chamber intraocular lens (PCIOL) loops malpositioned into the anterior chamber through the full thickness of the iris without subluxated PCIOL. Method: Interventional case report. Results: Two female patients (case 1: 76 years old, case 2: 72 years old) underwent an uneventful extracapsular cataract extraction (ECCE) with PCIOL implantation in the sulcus in 1994. Case 1 suffered from recurrent red eye and irritation in April 2005, and case 2 suffered from sudden loss of right-eye vision in May 2005. Slit-lamp examination revealed malpositioning of the PCIOL loops into the anterior chamber through the full thickness of the iris. Gonioscopy showed open angles with mild peripheral anterior synechiae. Conclusion: Pseudophakic posterior iris chafing syndrome (PPICS) is part of a spectrum of IOL-related iris abrasion syndromes. The pathogenesis of iris erosion in PPICS is linked to the friction between the posterior surface of the iris and the haptics of the sulcus-fixed IOL. Sulcus placement is successful in most cases, but if the capsular bag is intact, in-the-bag fixation of posterior chamber IOLs is preferred: the latter configuration prevents subluxation and protects the ciliary body and the iris from the haptics.