EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/276058
E W CATARACT 6 5 capsulorhexis is centrally located and smaller than the size of the optic. When placed in the ciliary sulcus, the square edges of the lens may contact the posterior iris and ciliary sulcus uveal tissue. Such was the case of the patient described h ere. The pigmented deposits were found concentrated on the anterior surface of the haptic that was dis- placed from the capsular bag and on the corresponding optic-haptic junc- tion. 1 Other clinical and pathological reports describe iris pigment epithe- lial damage following implantation o f a single-piece hydrophobic acrylic lens in which a haptic had displaced from the capsular bag into the cil- iary sulcus. 2 -4 The authors hypothe- size that the unpolished/textured edges and lateral surface of the dis- placed haptic may cause pigmentary glaucoma because of pigment epithelial disruption of the iris and ciliary body. They speculate that the haptic may have become displaced because of an excessively wide cap- sulorhexis. This is similar to the case we describe, in which the proximal portion of the haptic was in the capsular bag, but the distal portion coursed around the capsulorhexis margin, resting in the ciliary sulcus in direct contact with iris pigment epithelium. Although the thick haptics, squared edges, and unpolished side wall likely contribute to sulcus irritation, the presence of a large Soemmering's ring may also be a contributing factor. The excess corti- cal material can result in the IOL resting closer to the posterior iris, and pigment dispersion occurs be- cause of the optic margin rubbing against the iris epithelium. One of the interesting characteristics seen in these cases is the pigment disper- sion on the anterior surface of the lenses and the haptics located in the ciliary sulcus. Associated with this finding is usually a rise in IOP, indi- cating pigment dispersion syndrome secondary to the IOL. This syn- drome is thought to occur when contact exists between the IOL and the posterior iris, which causes an excess liberation of pigment from the iris epithelium with subsequent obstruction of the trabecular mesh- work outflow pathway. Reports of glare phenomena have been associated with implanta- tion of IOLs having square optic edges and manufactured from a hydrophobic acrylic material with a high refractive index. The finishing of the single-piece side walls were modified to give the side walls an unpolished or textured appearance. This unpolished appearance on the flat side wall of the haptics along with haptic thickness may make these lenses more likely to create iris chafing when in the sulcus. The case described here demon- strates that various postoperative complications may develop from single-piece AcrySof IOLs (and other ) At Santen, our single focus in ophthalmology enables research of novel therapies in uveitis, glaucoma, and dry eye/corneal disorders—therapies determined to challenge eye disease, one patient at a time. Inspiring ophthalmic medicines Our motivation. Her eye disease. To learn how Santen is advancing the ophthalmic fi eld, scan this code with your mobile device or visit www.santeninc.com. Image is designed to represent nondescript visual impairment and is not intended to be medically accurate. For illustrative purposes only. © 2012 Santen Pharmaceutical Co., Ltd. All rights reserved. SAN-269.00 07/12 continued on page 66 March 2014 64-75 Cataract_EW March 2014-DL2_Layout 1 3/7/14 9:34 AM Page 65