Pseudophakic Pupillary Block due to the Capsular Bag Intraocular Lens Implant Located in the Sulcus: A Case Report

Authors

Yusuf Bade, Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Jason Dossantos, Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Alison Hong, Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Salman Dar, Optical Services, Dulles Eye Associates, Lansdowne, VA, USA.
David Belyea, Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

1-1-2024

Journal

Case reports in ophthalmology

Volume

15

Issue

1

DOI

10.1159/000538343

Keywords

Case report; Cataract surgery; Glaucoma; Intraocular lens; Pupillary block

Abstract

INTRODUCTION: Pupillary block, a concerning complication of cataract surgery, is heightened when a single-piece acrylic (SPA) intraocular lens (IOL) is implanted in the ciliary sulcus. We report an unusual occurrence of relative pupillary block and chronic angle-closure glaucoma (ACG) identified in the late postoperative period due to unintentional SPA IOL implantation in the sulcus. CASE PRESENTATION: An 82-year-old woman presented with a history of chronic ACG 5 years after bilateral cataract extraction. Postoperatively, she experienced anterior chamber shallowing, elevated intraocular pressure (IOP), and two acute angle-closure attacks in the left eye, successfully managed with laser peripheral iridotomies (LPIs). Despite neodymium:YAG capsulotomy, elevated IOP persisted. Maximal medical therapy effectively controlled IOP; however, a shallow anterior chamber remained, prompting referral to our glaucoma service. Slit-lamp examination revealed a shallow peripheral anterior chamber, patent LPIs, and an Alcon SA60WF SPA IOL situated posteriorly with the optic against the pupil margin OS. Gonioscopy indicated a closed angle with peripheral anterior synechiae (PAS). Ultrasound biomicroscopy (UBM) confirmed haptics in the sulcus, with the lens optic and haptics anterior to the bag. These findings suggest relative pupillary block as the cause of her chronic ACG. The SPA IOL's bulky haptics in the sulcus likely induced iris bowing, leading to prolonged appositional angle-closure and chronic PAS formation. CONCLUSION: IOLs designed for the capsular bag should not be placed in the sulcus. Therefore, IOLs of varying dimensions should be taken to the operating room in the event of complicated cataract extraction. Finally, UBM proves valuable in identifying causes of pupillary block.

APA Citation

Bade, Yusuf; Dossantos, Jason; Hong, Alison; Dar, Salman; and Belyea, David, "Pseudophakic Pupillary Block due to the Capsular Bag Intraocular Lens Implant Located in the Sulcus: A Case Report" (2024). GW Authored Works. Paper 4739.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4739

Department

Ophthalmology