P 261
Inverse pupillary block, secondary melanin dispersion and open angle-glaucoma after lens extraction and posterior chamber lens implantation with transscleral fixation in a patient with subluxation of the lensJ. K. Hayler, C. Y. Mardin
Background: The case report demonstrates an acquired melanin dispersion and open-angle-glaucoma following lens extraction and transscleral fixation of a posterior chamber lens.
Patient: A 28-year-old myopic male with bilateral temporal downward subluxation of the lens presented with a slowly progressive decrease in visual acuity. Corrected visual acuity (contact lens) was 20/70 OD and 20/80 OS. The refractive error was -17,0 dpt sph -1,5 dpt cyl/A 160° OD; -18,0 dpt sph -7,5 dpt cyl/A 0° OS. Axial length: 26.59 mm OD, 26.70 mm OS. Lens extraction with transskleral fixation of a posterior chamber lens and anterior vitrectomy was performed OS.
Result: Ten weeks later OS showed a massive melanin dispersion in the anterior chamber, increased intraocular pressure (34 mm Hg), and a backward bulging of the iris. On retroillumination the structures of the intraocular lens were shining through the iris. Laser flare count of melanin granules showed 7.0 OD, 17.0 OS melanin granules/0,075 mm3 (norm: < 4). After regulation of the intraocular pressure OS the same operation on the lens was performed OD with an additional iridotomy. Nine weeks later no significant melanin dispersion was noticed OD (0.8 OD, 4.0 OS). Nd:YAG-Laser-Iridotomie was then performed OS. On slit lamp examination postoperatively the backward bulging of the iris had resolved.
Conclusion: Patients without iridotomy before or during cataract surgery with implantation of posterior chamber lens with transscleral fixation can develop inverse pupillary block, subsequent secondary melanin dispersion and open-angle-glaucoma. These complications may be prevented by iridotomy before or during surgery.
Dept. Ophthalmology Univ. Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen