"Pseudophakic Reverse Pupillary Block" Following Yamane Technique Scleral-fixated Intraocular Lens

Area of Science:

• Ophthalmology
• Surgical Complications

Background:

• Elevated intraocular pressure (IOP) can occur after cataract surgery.
• Scleral-fixated intraocular lenses (SFIOLs) are used for secondary lens implantation.
• Reverse pupillary block is a rare complication following intraocular lens surgery.

Observation:

• A 52-year-old male presented with uncontrolled IOP post-cataract surgery and SFIOL implantation.
• Examination revealed iris chaffing, posterior iris bowing, pigment dispersion, and elevated IOP, suggestive of reverse pupillary block.
• Ultrasound biomicroscopy confirmed posterior iris bowing and iridolenticular contact with the SFIOL.

Findings:

• Laser peripheral iridotomy was performed, which repositioned the iris, relieved iridolenticular contact, and resolved the pupillary block.
• The patient's IOP decreased from 28 mmHg to 14 mmHg post-procedure.
• The probable mechanism involves reduced iris-IOL gap due to haptic stretching, leading to increased iridolenticular contact and IOP elevation.

Implications:

• Reverse pupillary block is a treatable complication following glued SFIOL implantation.
• Laser peripheral iridotomy is an effective treatment for pseudophakic reverse pupillary block.
• Preoperative or intraoperative iridotomy may be considered to prevent this complication in patients receiving glued IOLs.