title: Corneal decompensation and angle-closure glaucoma after upside-down implantation of an angle-supported anterior chamber phakic intraocular lens.
abstract: We present the case of a 27-year-old man with severe pain, loss of visual acuity, corneal edema, and high intraocular pressure (IOP) in 1 eye after bilateral Acrysof Cachet phakic intraocular lens (pIOL) implantation. Slitlamp examination was limited due to severe corneal edema, but anterior segment optical coherence tomography indicated upside-down implantation of the pIOL. The pIOL was explanted, which confirmed that the haptic indicator had been implanted counterclockwise. Postoperative treatment included antiinflammatory and antiglaucoma topical therapy. Follow-up monitoring showed decreasing corneal edema and normalized IOP. At 6 weeks, the corrected distance visual acuity was +0.1 logMAR, the IOP was within normal limits, and the cornea showed no signs of edema, but there was endothelial cell density loss. This case presents the preoperative and postoperative management of high IOP after pIOL implantation and illustrates the pitfalls of incorrect implantation of angle-supported anterior chamber IOLs with haptic angulation.
authors.affiliation: Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany.
authors.forename: Marko
authors.initials: M
authors.lastname: Ostovic
authors.forename: Christian
authors.initials: C
authors.lastname: Hofmann
authors.forename: Oliver K
authors.initials: OK
authors.lastname: Klaproth
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohnen
mesh_terms: D000328:Adult; D000867:Anterior Chamber / Q000601:surgery*; D001766:Blindness / Q000209:etiology; D015715:Corneal Edema / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D020878:Device Removal; D058447:Eye Pain / Q000209:etiology; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D008297:Male; D019300:Medical Errors; D009216:Myopia / Q000601:surgery*; D054120:Phakic Intraocular Lenses; D012086:Reoperation; D041623:Tomography, Optical Coherence; D014792:Visual Acuity