Clinical Scorecard: Removal of Implantable Collamer Lenses Due to Elevated Intraocular Pressure in a Patient with Severe Hyperopia: A Case Study

At a Glance

Key Highlights

• ICL implantation without central port can lead to long-term complications including elevated IOP and secondary angle closure glaucoma.
• Medical therapy with multiple IOP-lowering agents may be insufficient to control IOP in some patients after ICL implantation.
• Combined explantation of ICL and cataract surgery with posterior chamber IOL implantation can effectively reduce IOP and inflammation.

Guideline-Based Recommendations

Diagnosis

• Perform slit-lamp examination to assess ICL position and iris adhesions.
• Use gonioscopy to evaluate chamber angle status and presence of peripheral anterior synechiae.
• Conduct visual field testing and OCT to assess for glaucomatous damage.

Management

• Initiate IOP-lowering medications including prostaglandin analogs, carbonic anhydrase inhibitors, and alpha-agonists.
• Consider combined surgical explantation of ICL and phacoemulsification with posterior chamber IOL implantation in cases of inadequate IOP control or angle closure.
• Administer perioperative anti-inflammatory treatment including topical steroids and subconjunctival dexamethasone.

Monitoring & Follow-up

• Regular follow-up every 3-4 months to monitor IOP and anterior chamber inflammation.
• Assess visual acuity and anterior chamber reaction postoperatively.
• Monitor for postoperative complications such as fibrin deposition and iris defects.

Risks

• Risk of iris trauma and prolapse during ICL explantation due to adhesions.
• Potential postoperative inflammation requiring intensive steroid therapy.
• Loss of accommodation following cataract surgery with posterior chamber IOL implantation.

Patient & Prescribing Data

38-year-old woman with high hyperopia and family history of glaucoma post-ICL implantation

Multiple IOP-lowering agents (bimatoprost, dorzolamide, clonidine) were insufficient; surgical explantation combined with cataract surgery improved IOP control and visual acuity.

Clinical Best Practices

• Careful preoperative assessment of angle status and iris adhesions before ICL explantation.
• Use of iris retractors and intravenous mannitol to minimize intraoperative iris trauma.
• Aggressive postoperative anti-inflammatory therapy including topical steroids and subconjunctival injections to control inflammation.
• Patient counseling regarding risks of surgery, loss of accommodation, and potential postoperative visual symptoms such as glare.

Related Resources & Content

• Reference 1 - Safety and efficacy of PC pIOL implantation in high hyperopia
• Reference 2 - Complications associated with ICLs without central aperture