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ABSTRACT
A 67-year-old woman examined 12 months following extracapsular cataract extraction had a massive Pseudophakie pigment dispersion associated with diffuse corneal epithelial edema, mild uveitis, and secondary glaucoma. She underwent penetrating keratoplasty following removal of a posterior chamber intraocular lens (IOL), anterior vitrectomy, capsulectomv, and iris biopsy. Histopathologic examination revealed a pigmented iris nevus and signs of iris erosion by the IOL loop. Because 3 months later the eye developed streptococcal endophthalmitis and had to be eviscerated, we had the opportunity to examine the eye contents; we found no evidence of phakoanaphylactic uveitis.
Posterior chamber lens implantation has now become the preferred method of visual rehabilitation following cataract surgery. However, there are complications associated with insertion of a foreign body in the anterior segment of the eye. Histopathologic studies have shown that after extracapsular cataract extraction (ECCE) the supporting loops of the posterior chamber intraocular lens may insert either in the iridociliary sulcus or in the original lens capsule.1-7 Contact between the artificial lens haptic and the uvea may elicit cellular and vascular responses such as inflammation, hemorrhage, erosion, atrophy, pigment dispersion, glaucoma, and macular edema.8,11 Additionally, phakoanaphylactic endophthalmitis may develop following ECCE combined with intraocular lens (IOL) implantation11-12 and an adverse reaction to the implant itself is also possible.10 We present a case of massive Pseudophakie pigment dispersion associated with an iris nevus following ECCE and IOL implantation.
CASE REPORT
A 67-year-old woman was referred to our outpatient clinic with left Pseudophakie corneal edema associated with low grade uveitis and massive pigment dispersion. She had undergone ECCE with a C-loop posterior chamber lens implantation 1 year previously. Three months following this operation she began to suffer from recurrent uveitis associated with massive pigment dispersion which was treated with local and systemic steroids.
Visual acuity was 6/8 RE and 1 m counting fingers LE. Intraocular pressure was 16 mm Hg in the right eye and 30 mm Hg in the left. The anterior and posterior segments of the right eye were unremarkable, but there was diffuse corneal epithelial edema in the left eye, and the whole endothelial surface was covered with very large pigmented deposits (Figures 1 & 2). In the deep anterior chamber we noted a + 1 flare and cells with...