Advanced bilateral glaucoma decades after first-generation Fyodorov ‘collar-button’ anterior–posterior phakic intraocular lens implantation: a case report and clinical management considerations - Report - MDSpire
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Advanced bilateral glaucoma decades after first-generation Fyodorov ‘collar-button’ anterior–posterior phakic intraocular lens implantation: a case report and clinical management considerations
Clinical Report: Bilateral Advanced Glaucoma Following Long-Term pIOL Implantation
Overview
This report details a case of advanced glaucomatous optic neuropathy in a patient with a history of bilateral implantation of first-generation phakic intraocular lenses (pIOLs). The successful management of elevated intraocular pressure (IOP) through micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) is highlighted.
Background
Phakic intraocular lenses (pIOLs) are utilized to correct high refractive errors but can lead to long-term complications such as glaucoma and cataract formation. The management of elevated IOP in these patients poses significant challenges, often necessitating surgical intervention. Understanding the risks associated with early-generation pIOLs is crucial for preventing severe complications.
Data Highlights
Parameter
Right Eye (RE)
Left Eye (LE)
Corrected Distance Visual Acuity (CDVA)
0.9
1.0
Corrected Near Visual Acuity (CNVA)
0.5
0.5
Intraocular Pressure (IOP) at Presentation
26 mmHg
24 mmHg
IOP Post-MP-TSCPC
16 mmHg
N/A
Key Findings
A 45-year-old male developed advanced glaucomatous optic neuropathy 25 years post bilateral pIOL implantation.
Initial IOP readings were 26 mmHg in the RE and 24 mmHg in the LE, indicating elevated pressure.
Despite pharmacological treatment, IOP remained elevated, prompting the use of MP-TSCPC in the RE.
Post-MP-TSCPC, IOP decreased to 16 mmHg in the RE, demonstrating effective management.
Electrophysiological examinations aided in the differential diagnosis of optic neuropathies in complex cases.
Clinical Implications
Healthcare professionals should maintain a high index of suspicion for glaucoma in patients with a history of pIOL implantation, especially those with long-term follow-up. Early detection and intervention are critical to prevent irreversible optic nerve damage. MP-TSCPC may serve as a viable treatment option for managing refractory IOP in these patients.
Conclusion
This case underscores the importance of long-term monitoring in patients with pIOLs to mitigate the risk of severe complications such as glaucoma. Timely intervention can significantly improve patient outcomes.
