Black intraocular lens: another cosmetic approach to leukocoria

• Author(s): Pedrosa, C ; Pina, S ; Azevedo, A ; Pêgo, P ; Feijóo, B ; Prieto, I
• Date: 2012
• Persistent ID: http://hdl.handle.net/10400.10/1120
• Origin: Repositório do Hospital Prof. Doutor Fernando Fonseca
• Subject(s): Pupil disorders; Doenças da pupila
• Document Type: Conference Object
• Language: English

Description

Purpose – To present a case report of a black intraocular lens implantation for cosmetic improvement of a blind eye with leukocoria. Setting – Ophthalmology Department - Professor Dr. Fernando Fonseca Hospital, EPE - Amadora, Lisboa, Portugal Methods – We report a 32-year-old woman who was evaluated because of the undesired cosmetic appearance of her amblyopic left eye with exotropia and leukocoria due to traumatic cataract and total retinal detachment during childhood. The Examination revealed no light perception in the left eye and 20/20 visual acuity in the right eye. An external examination showed an obvious leukocoria and exotropia of the left eye and a normal right eye. Biomicroscopy of the left eye showed a clear cornea, quiet anterior chamber, normal iris and a white pupillary reflex due to subluxated white cataract and fibrotic retinal detachment. We proceeded to cosmetic surgery that consisted of retropupillary implantation of an Artisan pupil occluder without cataract extraction, and strabismus correction within the same surgical procedure. Despite the uneventful immediate postoperative course, reevaluation two weeks later revealed dislocation of one of the lens haptics and the increase of the cataract subluxation with need of re-intervention. Intracapsular cataract extraction was done and IOL was repositioned over the iris. A video of the surgeries will be presented. Results - Two months later the eye was still quiet. The exotropia was corrected and the pupil occluder remained well centered with an excellent cosmetic appearance, despite of the optic diameter of 5.4 mm. The leukocoria was thus treated with implantation of a black IOL providing a significant improvement in the patient self-image. Conclusions – This Artisan lens is usually used to pupil occlusion in cases of intractable diplopia. Because of its vaulted configuration, Artisan pupil occluder can be applied in phakic and aphakic eyes but due to the features of this type of lens it´s not very suitable to the retropupillar enclavation . Nevertheless this case shows that in cases of white reflex the use of this pupil occluder can be a cosmetic correction alternative to the classic treatment with contact lenses, corneal tatooing or single crystaline lens extraction.