Reverse Pupillary Block After Retinal Detachment Surgery in an Eye with Toric Implantable Collamer Lens

To report an interesting phenomenon, after vitreoretinal surgery, in an eye with toric implantable collamer lens (ICL).

A 20-year-old male presented with raised intraocular pressure (IOP) after the retinal detachment surgery in the left eye. He had toric ICL in both the eyes, and left eye showed shallow peripheral anterior chamber depth (ACD), narrow iridocorneal angle (ICA), increased ICL vault and pigments debris blocking central hole. After dilation, peripheral ACD deepened, ICL vault decreased and ICA increased, with posterior bowing of iris.

Patient was managed with topical steroids and antiglaucoma medications. A month later, after inflammation subsided, central hole of ICL became patent, peripheral ACD deepened, ICA increased and IOP was normal without medications, however, after dilation, posterior bowing of iris persisted. He was speculated to have unusual presentation of reverse pupillary block in the left eye after mydriasis. This phenomenon was not observed in the right eye.

Reverse pupillary block, after dilation is an unusual phenomenon, which was seen in a silicone-filled eye with toric ICL implant. In cases of inflammatory debris blocking Aquaport opening of ICL, conservative management with topical steroids and antiglaucoma medications can help reduce inflammation and IOP, alleviating need for any intervention, such as laser iridotomy.