Anterior segment complications and neovascular glaucoma following implantation of a posterior chamber intraocular lens.
Lens implantation is now a highly successful operation. Although follow-up over 5 to 10 years with posterior chamber lenses is incomplete, the complication rate appears to be as low or lower than other lens styles. We present an exception: a clinicopathologic analysis of a globe, enucleated 4 years postoperatively, which in spite of uneventful implantation of a posterior chamber lens, developed neovascular glaucoma. Microscopic studies suggest several mechanisms for this rare complication including deep erosion of a prolene loop into the ciliary body, anterior segment ischemia, and breakdown of the blood-aqueous barrier. Scanning microscopy showed cracking of this deeply embedded loop, a finding we interpret as possible stress cracking and/or oxidation. The more flexible loops now used in modern lenses may decrease the chance of deep erosion. Implantation of a loop in the capsular bag may minimize the danger of both erosion and loop degradation. Patients should be followed long-term in order to recognize and treat these rare, but potentially disastrous complications.
D000867:Anterior Chamber / Q000473:pathology; D002924:Ciliary Body / Q000473:pathology; D005260:Female; D005901:Glaucoma / Q000473:pathology*; D006801:Humans; D007429:Intraocular Pressure; D007498:Iris / Q000098:blood supply* / Q000473:pathology; D007910:Lenses, Intraocular; D008269:Macular Edema / Q000473:pathology; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology*; D009900:Optic Nerve / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology; D014792:Visual Acuity