Secondary pigmentary glaucoma associated with piggyback intraocular lens implantation

A 51 year-old man developed bilateral pigmentary glaucoma with uncontrolled intraocular pressure (IOP) and signs of pigmentary dispersion syndrome after piggyback intraocular lens (IOL) implantation. Cataract surgery had been performed with in-the-bag implantation of poly(methyl methacrylate) IOLs in both eyes. Increasing myopia was subsequently corrected with implantation of an AcrySof(R) IOL (Alcon Laboratories) in the ciliary sulcus of each eye. After the second implantation, the IOP was unresponsive to antiglaucoma medications, the visual field was damaged, and the visual acuity decreased. Ultrasound biomicroscopy showed that the haptics and the sharp edge of the IOL were chafing the posterior surface of the iris. After the IOL in the sulcus was removed, the IOP was stabilized by medications. This case highlights the importance of the IOL choice for sulcus implantation to avoid the complications of pigmentary dispersion syndrome.