Abstract

P 170

Unilateral myopic shift after bilateral intraocular lens (IOL) implantation in pseudoexfoliation syndrome

Osvald A., Schröder A. C., Lang H. M., Brückner K. A., Seitz B.
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes

Objective: Pseudoexfoliation syndrome (PES) is associated with secondary glaucoma and a specific PES related keratopathy. Extreme caution is required when performing intraocular surgery. Especially cataract surgery may be a high risk procedure due to zonular weakness or dialysis will subsequent intraocular lens (IOL) dislocation.
Results: A 70-year old patient underwent surgery in December 2006. PES fibres were detected on the right lens prior to surgery while the left lens displayed no signs of PES. With cornea guttata and a shallow anterior chamber, surgery of the right eye was difficult. A capsular tension ring was implanted to stabilize the capsular bag for IOL implantation. After surgery of the fellow eye the patient achieved a very satisfying visual acuity of 1.0 for both eyes with -0.25D spherically. The same patient re-visited our out-patient clinic in February 2007:
OD: -3.75 / -0.50 / 110° = 1.0 intraocular pressure (IOP): OD 29mmHg OS: s.c. = 0.9 IOP OS: 11mmHg
The right anterior chamber was remarkably shallower than the left one. Anterior chamber depth was 3.93mm on the right and 5.21mm on the left as measured by Pentacam. We prescribed a a2-receptoragonist to lower IOP. After one week refraction was:
OD: -2.50 / -0.75 / 110° = 1.2 IOP: OD: 22mmHg
A peripheral YAG-iridotomy was performed to increase anterior chamber depth. Unfortunately, this procedure had not the desired effect. However, refraction and anterior chamber depth stabilized, enabling prescription of glasses satisfying patient’s visual comfort. Occasionally, monovision is achieved unintentionally. In this specific case, the patient felt comfortable with the final refraction.
Conclusions: Even months after cataract surgery PES can lead to axial intracapsular IOL subluxation accompanied by change in refraction and increase of IOP. Therefore, patients should be extensively counseled about the risks associated with PES subsequently undergoing medical supervision for a longer period of time.

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