SULCUS IOL IMPLANTATION: A NEXT-DAY CHALLENGE—ACUTE INTRAOCULAR PRESSURE ELEVATION FOLLOWING SULCUS INTRAOCULAR LENS
DOI:
https://doi.org/10.48165/abr.2026.28.01.42Keywords:
Intraocular pressure, pupillary block, posterior capsular rupture, sulcus IOL implantationAbstract
Sulcus intraocular lens (IOL) implantation is a recognized salvage technique when capsular fixation is not possible due to posterior capsular rupture or inadequate support. Although effective, the ciliary sulcus is a vascularly sensitive anatomical space with a distinct complication profile, including acute postoperative intraocular pressure (IOP) elevation. We report a case of a patient who developed severe ocular pain, blurred vision, and corneal edema on the first postoperative day following sulcus IOL implantation after complicated cataract surgery with posterior capsular rupture. Systematic anterior segment evaluation identified pupillary block as the primary mechanism, compounded by acute inflammation. Management with topical aqueous suppressants, cycloplegics, systemic carbonic anhydrase inhibitors, and Nd: YAG laser peripheral iridotomy (LPI) achieved rapid IOP normalization and visual recovery. This case underscores the importance of vigilant early postoperative assessment following sulcus IOL implantation, systematic identification of IOP-elevation mechanisms, and prompt targeted therapy. Nd: YAG LPI is the definitive intervention for pupillary block and prevents irreversible glaucomatous optic neuropathy when applied early.
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