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Correspondence

Iris chafing syndrome after scleral-fixated intraocular lens implantation

Zayed, Mohammed G. MB ChB; Winder, Stephen FRCOphth

Journal of Cataract & Refractive Surgery: November 2014 - Volume 40 - Issue 11 - p 1927-1928
doi: 10.1016/j.jcrs.2014.09.019
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Intraocular lens (IOL)–related iris abrasion syndrome in relationship to anterior chamber IOLs was reported as early as 1977.1 Posterior iris chafing syndrome has been documented in relationship to sulcus-fixated IOLs.2 This is associated with transient visual obscuration, microhyphemas, intermittent spikes in intraocular pressure (IOP), and pigment dispersion.3 It is part of a spectrum of IOL-related iris abrasion syndromes, the first of which was described by Ellingson1 in relationship to anterior chamber IOLs (uveitis-glaucoma-hyphema syndrome).

Scleral-fixation of an IOL has been associated with complications including suture erosion, a tilted or decentered IOL, fibrin reaction, and vitreous prolapse into the anterior chamber.4 We report a case of iris chafing syndrome after scleral-fixated IOL implantation using the Agarwal technique.5

Case report

An 80-year-old woman presented with a 2-day history of a shadow over her right eye. The corrected distance visual acuity (CDVA) was hand motion (HM) in the right eye and 6/9 in the left eye. The patient had a history of uneventful phacoemulsification and IOL implantation in the right eye a few years earlier.

On presentation, the right fundus examination showed rhegmatogenous macula-off retinal detachment. The eye was treated with vitrectomy, cryotherapy, and gas tamponade. One month postoperatively, the CDVA was 6/12 and the IOL was noted to be slightly dislocated.

Three months later, the CDVA was 6/36 and examination showed a subluxated IOL and iris trauma. The IOL was removed and a secondary scleral-fixated IOL implanted using the Agarwal technique. Iris hooks were placed because of poor dilation, and sclerotomies for the haptics were placed 2.0 mm behind the limbus.

Although there was an initial postoperative improvement in CDVA, at 3 weeks the CDVA was HM and cavity hemorrhage and diffuse hyphema were noted (Figure 1). After initial conservative management, cavity washout was performed. The CDVA improved initially, but the patient returned with an IOP of 36 mm Hg, hyphema, and cavity hemorrhage. She was again managed conservatively, but the IOP proved difficult to control and she became confused on acetazolamide.

Figure 1
Figure 1:
Slitlamp picture of the right eye showing conjunctival injection, microhyphema, and iris trauma.

The diagnosis of posterior iris chafing syndrome was considered, and the IOL was removed. This resulted in resolution of the hyphema, cavity hemorrhage, and IOP.

At the 6-month follow-up, the CDVA was 6/18 aphakic and the anterior chamber was quiet with a normal IOP on no medication.

Discussion

To our knowledge, this is the first report of posterior iris chafing syndrome in a patient with a scleral-fixated IOL. Many patients are seen in outpatient clinics after scleral-fixated IOL implantation. Considering posterior iris chafing syndrome in cases of transient visual obscuration, microhyphemas, intermittent spikes in IOP, or pigment dispersion in pseudophakic patients can avoid unnecessary investigations and interventions associated with an incorrect diagnosis.

References

1. Ellingson FT. Complications with the Choyce Mark VIII anterior chamber lens implant (uveitis-glaucoma-hyphema). Am Intraocular Implant Soc J. 1977;3:199-201.
2. Masket S. Pseudophakic posterior iris chafing syndrome. J Cataract Refract Surg. 1986;12:252-256.
3. Ferguson AW, Malik TY. Pseudophakic posterior iris chafing syndrome. [letter] Eye. 17, 2003, p. 451-452, Available at: http://www.nature.com/eye/journal/v17/n3/pdf/6700322a.pdf. Accessed July 23, 2014.
4. Evereklioglu C, Er H, Bekir NA, Borazan M, Zorlu F. Comparison of secondary implantation of flexible open-loop anterior chamber and scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2003;29:301-308.
5. Kumar DA, Agarwal A, Jacob S, Prakash G, Agarwal A, Gabor SGB, Prasad S., 2011. Sutureless scleral-fixated posterior chamber intraocular lens [letter], J Cataract Refract Surg, 37, 2089-2090.
© 2014 by Lippincott Williams & Wilkins, Inc.