Pseudophakic Bullous Keratopathy after Anterior Iris-Fixated Intraocular Lens Implantation

Introduction: To report a case of pseudophakic bullous keratopathy (PBK) complication after anterior chamber (AC) iris-fixated intraocular lens (IOL) secondary implantation.

Presentation of Case: A 65-year-old man came with a red, painful, uncomfortable right eye. He felt a blurry vision and a severe headache. Three years ago, he had cataract surgery of the right eye. Afterward, he had IOL luxation and had an IOL exchange surgery. His right eye showed ciliary injection and visual acuity was counting finger at one meter. Examination on his cornea showed edema with deep corneal fold, stromal haze, and epithelial defect due to ruptured bullae. On his right eye, there was an iris-clip AC IOL which the position was a little bit tilted and suspected to had come in contact with the cornea. His left corneal endothelial count exceeded 2000, however, the right cornea endothelial count data could not be taken. He was diagnosed with pseudophakic bullous keratopathy (PBK) and treated with topical antibiotics and an eye lubricant.

Discussion: PBK is a clinical diagnosis of irreversible corneal edema and endothelial damage that occurs after cataract extraction and IOL implantation. Endothelial loss in secondary IOLs is suggested because of the mechanical injury from instruments or IOL during a surgical procedure. The important risk factors are shallow anterior chamber depth, a shorter distance between the IOL edge to the endothelium, inflammation, and design of the IOLs.

Conclusion: A complete preoperative examination, careful selection of IOL types, and modification of surgical techniques could minimize the risk of endothelial damage complications.