Iris transillumination defect and microhyphema syndrome

We present a previously undescribed delayed complication attributable to sulcus-fixated posterior chamber lenses with elliptical polypropylene haptics containing a 10 degrees anterior angulation. Clinical signs of this complication are crescent-shaped iris transillumination defects overlying the lens haptics in the peripheral iris; in some cases these are associated with single or recurrent visually significant microhyphemas. This series describes 41 eyes that contain these transillumination defects; eight of the eyes have had lens-induced intraocular hemorrhage. We estimate the overall incidence of transillumination defects in our sulcus-fixated posterior chamber lens patient population to be between 5% and 15%. Those patients who have had lens-induced hemorrhage represent slightly greater than 1%, which is higher than our incidence of cystoid macular edema or retinal detachment. It is important for all ophthalmologists to be aware of this syndrome in evaluating patients with posterior chamber lenses who present with a transient obscuration of vision.