Fractured Anterior Chamber Intraocular Lens (ACIOL) Complicating Nd: YAG Laser for Peripheral Iridotomy
A 74 year old lady on anticoagulation therapy for atrial fibrillation, referred to our department complaining for blurred vision in her left eye (LE). Her best corrected visual acuity (BCVA)was 1/10 and intraocular pressure (IOP) was 17mmHg. Slit-lamp examination revealed a hypermature cataract with pseudoexfoliation. Fundoscopy did not reveal any macular disease although it was performed with difficulty due to the hypermature cataract. She underwent left eye phacoemulsification; after the removal of the cataract, the capsular bag was not stable enough to insert an intraocular lens (PCIOL) in the bag and an ACIOL (MTA3UO ALCON) was inserted in the anterior chamber (AC). Even though the insertion of the ACIOL wasuneventful there was massive bleeding from the iris angle as soon as the lens was supported on the iris angle.\nAt this time it was decided that a peripheral iridotomy could not be performed safely. The first day after surgery, the AC was filled with blood and intraocular pressure was 28mmHg. Dexamethazone, Chloramphenicol as well as anti-glaucoma drops were administered and the patient was followed up every 2 days. Eventually, in 3 weeks postoperatively, best corrected visual acuity improved to 6/10LE and intraocular pressure (IOP) was within normal limits with no additional medication. The patient was advised that a PI should be performed with Nd:YAg laser, however, she refused further treatment.\nFifteen days later, the patient presented complaining for LE pain. BCVA was 2/10, there was corneal edema and IOP was 40mmHg due to the development of pupillary block. Anti-glaucoma eye drops and acetazolamide were administered to reduce IOP. As soon as the IOP was reduced and the corneal edema partially subsided the patient consented to undergo Nd:YAG iridotomy in order to release the pupillary block. The iris was dark brown (Fig. ) and the energy was increased to 6mj; after one single shot on the iris, the haptic of the lens was fractured in pieces (Figs. , ).\nIn the following days after a consultation with her cardiologist the anticoagulant treatment was reduced and the patient was taken to theatre; the fractured IOL was removed, a new ACIOL was inserted and a PI was performed surgically. Three months later BCVA was 6/10 and IOP within normal levels.