Incidence rate and occurrence of visually significant cataract formation and corneal decompensation after implantation of Verisyse/Artisan phakic intraocular lens
A 23-year-old man with microspherophakia presented in 2006 for correction of high myopia, with SE of −14.375 and −14.25 in the right and left eye, respectively. Preoperative anterior chamber depth (ACD), measured from the epithelium, was 2.87 mm in the right eye and 2.80 mm in the left eye. Preoperative mean endothelial cell density was 3,077 cells/mm2 in the right eye and 2,825 cells/mm2 in the left eye. The patient subsequently underwent pIOL implantation, in the right and left eyes, 2 months apart. At 4-year follow-up, UDVA was 20/25 in both eyes. ACD was 2.46 mm in the right eye and 2.30 mm in the left eye. Mean endothelial cell density was 2,890 cells/mm2 in the right eye and 2,785 cells/mm2 in the left eye.\nIn 2012, on routine follow-up, the patient reported worsening visual acuity in the right eye, associated with irritation and dryness. The patient admitted to rubbing the right eye secondary to localized irritation. UDVA in the right eye was 20/100, correctable to 20/80. Slit-lamp examination showed localized peripheral edema and bullous changes in the superonasal region of the cornea. The nasal enclavation site appeared closer to the corneal endothelium and less securely attached than the temporal site. The patient was treated with prednisolone acetate 1%, Muro 128 5% and Combigan® eyedrops (Allergan, Inc., Irvine, CA, USA) in the right eye for elevated IOP – 24 mmHg. The left eye did not require these treatments. Two weeks later, the corneal edema had only slightly improved, and it was decided to remove the right pIOL. At the most recent follow-up, 10 weeks post-pIOL removal, CDVA was 20/80, with SE of −12.50. The corneal edema was significantly improved. The lower-than-expected visual acuity was attributed to a combination of residual corneal edema, irregular astigmatism, and a secondary glaucoma associated with microspherophakia. The patient has been referred for further glaucoma workup and a fitting of rigid gas-permeable contact lens to see if this will improve his vision.