Implantable Collamer Lens - Induced Severe Pigment Dispersion Syndrome - Uncommon Yet Consequential

To report a case of severe pigment dispersion syndrome post  Implantable Collamer lens (ICL) implantation requiring explantion due to uncontrolled pigment dispersion and inflammation.

The patient had both eyes ICL implantation but he developed left eye severe pigment dispersion requiring explantation even though both eyes had the same vaulting and sizing.

This is a 31-year-old male with myopia of -4.00DS had both eyes ICL implantation. His UCVA was 6/6 the next day with vaulting of 250um both eyes and inflammation was grade 1. He started to experience blurring of vision of left eye 2 weeks later where pigments and inflammatory cells amounted to grade 4 filled up his left eye anterior chamber. His intraocular pressure then spiked to 52 two days later which could only be controlled with 4 topical antiglaucoma eyedrops, oral diamox and oral glycerol. Anterior segment OCT showed optimal sizing and vaulting of both eyes ICL. His left eye trabecular meshwork was heavily clogged with iris pigment. He was monitored with careful taper of antiglaucoma eyedrops but yet his pigments and inflammatory cells were not reduced at all. He then proceeded with ICL explantation. His ICL was noted to have rotated 90 degree away from original axis intraoperatively. Despite explantation, he still developed prolonged anterior chamber inflammation and pupil dilatation due to iris sphincter ischaemia. He also had lanterior lens capsule vacuoles which resolved a few weeks later. Undersizing of ICL was proposed to have resulted in free chafing of ICL with patient's iris and ciliary body. Also patient could have underlying concave iris contour that predisposed him to severe pigments release and inflammation post ICL implantation.

Pigment dispersion syndrome can be a consequential complication if it is not managed timely and effectively giving the possibility of irreversible glaucomatous optic nerve damage.