Polypseudophakia with the J&J synergy lens in high myopia: case report
David Durgan, Noah Collins, Jessica Kim, Frank HwangIntroduction and importance:
As clinicians strive to provide personalized recommendations for patients, polypseudophakia may be an option for those outside the range of traditional extended depth-of-focus lenses. We describe a case with initial refractive success but the development of a potentially vision-threatening complication.
Presentation of case:
A 40-year-old Asian man with high myopia presented for a refractive surgery consultation with a goal of total spectacle independence and underwent bilateral refractive lens exchange with the J&J Synergy lens in the capsular bag, and a minus-power Alcon MA60MA lens in the sulcus. Initially, there was refractive success with post-operative uncorrected distance vision of 20/20 in the right eye and 20/25 in the left eye at 6 months. However, both eyes developed transillumination defects with pigment in the anterior chamber, consistent with Uveitis-Glaucoma-Hyphema (UGH) syndrome. The patient ultimately elected bilateral explantation of the sulcus intraocular lenses (IOLs) due to this complication.
Clinical discussion:
To our knowledge, this is the first case using the J&J Synergy lens in polypseudophakia and the second to correct for high myopia. Surgical techniques for those with high myopia and thin corneas are rare, and this technique initially provided a hopeful refractive outlook. However, loss of the refractive target and the development of UGH syndrome challenged the safety of this technique.
Conclusion:
Further studies are needed to determine which patients can tolerate this procedure. Providers should proceed cautiously and anticipate complications such as UGH syndrome following secondary sulcus IOL placement.