1. Nathalie M. Guibord,MD Geisinger Medical Center
Mechanically-Induced Pigment Dispersion despite Endocapsular Intraocular Lens Implantation
Nathalie M. Guibord,MD
Geisinger Medical Center
Author has no financial interest

2. Purpose
To report a case of severe pigment dispersion that began on post-operative day one after cataract surgery with endocapsular implantation of a square-edge intraocular lens (IOL) .
The cause of the pigment dispersion in this unique case is discussed.

3. Methods 70 year old Caucasian female
Retinal detachment repaired by scleral buckle OD in 1995
High myopia with lattice OU
Pigment dispersion syndrome OU
Krukenberg spindle, pigmentation on gonioscopy and q configuration to iris
No iris trans-illumination defects (TID’s)
Status-post uneventful phaco/IOL OS

4. Methods Underwent phaco/IOL OD CTR model 14A (14.5 mm) inserted
Two clock hours of weak zonules noted during chopping
CTR model 14A (14.5 mm) inserted
SA60AT 7.5 D in the bag
Lens centered very well, in the bag

5. Methods POD #1 4+ pigmented cells in anterior chamber
IOL well-centered and in the bag

6. Methods POD #3 Still had 4+ pigmented cells
IOL confirmed to be endocapsular
Vitreous was clear
Laser peripheral iridectomy was performed due to q configuration of the iris

7. Methods Pigment-induced ocular hypertension occurred by POD #13 Ta 31
4+ pigmented cells
4+ Iris TID’s in configuration of IOL, raising doubts that IOL was fully endocapsular
IOL seemed very close to the iris
Started on acetozolamide p.o.
Schedule to return to O.R. the next day

8. Results OR POD #14 IOL found to be 100% endocapsular
IOL explanted as pseudophacodonesis with square-edge iris chaffing suspected
MA60AC 7.5 D was inserted in sulcus

9. Results IOP controlled by POD #2 status-post IOL exchange
patient gradually improved over the next few weeks
3 months post-op
Va cc 20/20
Ta 15 mmHg
Trace flare
Off all eye meds
Has continued to do well since then

10. Results
Pseudophacodonesis occurred secondary to zonular dialysis (needing a CTR), large scleral buckle and vitreous pressure
SA60AT should not be placed in the sulcus
Zero angulation between optic and haptics
Square edges anteriorly (optic and haptics)
High risk for iris chaffing
Not indicated in direction-for-use labeling

11. Conclusion
There are several reports of mechanically-induced pigment dispersion associated with the implantation of a SA60AT in the sulcus
No reported cases of pigment dispersion from this IOL when positioned completely within the capsular bag

12. Conclusion
The primary cause of pigment dispersion in this case was pseudophacodonesis with an IOL with anterior square edges.
This case demonstrates how it is prudent to insert a three-piece IOL with rounded anterior edges, in cases when the zonular integrity has been compromised and posterior vitreous pressure is present (as with a scleral buckle).