Journal of Current Glaucoma Practice

Register      Login

VOLUME 18 , ISSUE 1 ( January-March, 2024 ) > List of Articles


Managing Pigment Dispersion Glaucoma Postbilateral ICL Implantation in High Myopia: A Case Report on the Crucial Role of Gonioscopy in Correcting a Misdiagnosis

Prasanna V Ramesh, Sathyan Parthasarathi, Ashik Azad, Aji K Devadas, Tejaswi Ragolu, Shruthy V Ramesh, Meena K Ramesh, Ramesh Rajasekaran

Keywords : Angle-closure glaucoma, Case report, Glaucoma, Implantable collamer lens, Misdiagnosis, Pigment dispersion syndrome, Secondary open-angle glaucoma

Citation Information : Ramesh PV, Parthasarathi S, Azad A, Devadas AK, Ragolu T, Ramesh SV, Ramesh MK, Rajasekaran R. Managing Pigment Dispersion Glaucoma Postbilateral ICL Implantation in High Myopia: A Case Report on the Crucial Role of Gonioscopy in Correcting a Misdiagnosis. J Curr Glaucoma Pract 2024; 18 (1):31-36.

DOI: 10.5005/jp-journals-10078-1433

License: CC BY-NC 4.0

Published Online: 30-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Secondary open-angle glaucoma (SOAG) is a rare yet consequential complication following implantable collamer lens (ICL), also known as a phakic intraocular lens insertion, particularly in high myopia patients. This case report emphasizes the importance of recognizing SOAG and details the diagnostic complexities, reevaluation procedures, and successful long-term management of a 24-year-old bilateral high myopia (−7.00 D) patient who initially received an erroneous diagnosis of secondary angle-closure glaucoma (SACG) after ICL insertion at an external medical facility. Persistent visual issues prompted the patient to seek a second opinion, leading to a comprehensive reevaluation that eventually unveiled pigment dispersion syndrome (PDS) as the underlying cause, subsequently resulting in SOAG. This case not only highlights the diagnostic challenges but also elucidates the re-evaluation process and effective 5-year management strategies employed to restore the patient's visual health and quality of life.

PDF Share
  1. Huang D, Schallhorn SC, Sugar A, et al. Phakic intraocular lens implantation for the correction of myopia: a report by the American Academy of Ophthalmology. Ophthalmology 2009;116(11):2244–2258. DOI: 10.1016/j.ophtha.2009.08.018
  2. Wang X, Zhou X. Update on treating high myopia with implantable collamer lenses. Asia Pac J Ophthalmol (Phila) 2016;5(6):445–449. DOI: 10.1097/APO.0000000000000235
  3. Senthil S, Choudhari NS, Vaddavalli PK, et al. Etiology and management of raised intraocular pressure following posterior chamber phakic intraocular lens implantation in myopic eyes. PLoS One 2016;11(11):e0165469. DOI: 10.1371/journal.pone.0165469
  4. Mohindra VK, Pereira S. An interesting case of implantable contact lens. Med J Armed Forces India 2015;71(Suppl 1):S69–S72. DOI: 10.1016/j.mjafi.2013.02.018
  5. Ye C, Patel CK, Momont AC, et al. Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant. Am J Ophthalmol Case Rep 2018;10:65–67. DOI: 10.1016/j.ajoc.2018.01.046
  6. Ramesh PV, Parthasarathi S. A neophyte gonioscopist's animative and videographic atlas with focal points for effective practice. Indian J Ophthalmol 2022;70(2):708–709. DOI: 10.4103/ijo.IJO_151_22
  7. Ramesh PV, Ramesh SV, Ray P, et al. Wolf in sheep's clothing: cough syrup–induced synergistic idiosyncratic mydriatic reaction precipitating a bilateral acute angle–closure attack in a predisposed hypermetropic patient. Kerala J Ophthalmol 2023;35(1):96–99. DOI: 10.4103/kjo.kjo_26_21
  8. Abela-Formanek C, Kruger AJ, Dejaco-Ruhswurm I, et al. Gonioscopic changes after implantation of a posterior chamber lens in phakic myopic eyes. J Cataract Refract Surg 2001;27(12):1919–1925. DOI: 10.1016/s0886-3350(01)01229-9
  9. Brandt JD, Mockovak ME, Chayet A. Pigmentary dispersion syndrome induced by a posterior chamber phakic refractive lens. Am J Ophthalmol 2001;131(2):260–263. DOI: 10.1016/s0002-9394(00)00606-1
  10. Ramesh SV, Ramesh PV, Rajasekaran R, et al. A rare case report of isolated bilateral congenital ectropion uveae without secondary glaucoma. Indian J Ophthalmol Case Rep 2021;1(4):872. DOI: 10.4103/ijo.IJO_54_21
  11. Ramesh PV, Ramesh SV, Varsha V. An unusual presentation of Urrets–Zavalia syndrome After minimally invasive glaucoma surgery in a case of pigmentary glaucoma. Indian J Ophthalmol Case Rep 2023;3(2):368–371. DOI: 10.4103/IJO.IJO_3394_22
  12. Sánchez-Galeana CA, Zadok D, Montes M, et al. Refractory intraocular pressure increase after phakic posterior chamber intraocular lens implantation. Am J Ophthalmol 2002;134(1):121–123. DOI: 10.1016/s0002-9394(02)01414-9
  13. Ramesh PV, Ramesh SV, Ramesh MK, et al. The mirage of a perfect bleb – studying morphological appearance of a pseudobleb using anterior segment optical coherence tomography and Scheimpflug imaging. Indian J Ophthalmol Case Rep 2021;1(2):172. DOI: 10.4103/ijo.IJO_2673_20
  14. Ramesh PV, Ramesh SV, Kodnani A, et al. Augmented trabeculectomy – the surgical journey and road trip forward. Indian J Ophthalmol 2023;71(6):2600–2601. DOI: 10.4103/IJO.IJO_687_23
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.