Management and toxicological analysis of ocular hypertension after EyeCee^® ONE intraocular lens implantation: a case series

Background: The EyeCee^® ONE intraocular lens (Nidek, Gamagori, Japan) has been withdrawn from the market due to a high number of reports of severe ocular hypertension (OHT) following phacoemulsification with implantation of this intraocular lens (IOL). In this case series, we report the results of a toxicological analysis and the surgical management of five patients with severe OHT following the implantation of defective EyeCee^® ONE IOLs during cataract surgery.

Cases presentation: Five patients developed early, severe OHT refractory to maximal medical therapy following uneventful phacoemulsification (PCE) cataract surgery with implantation of an EyeCee^® ONE IOL from a defective lot. Glaucoma filtering surgeries were required to control intraocular pressure (IOP). Toxicological analyses were carried out on the aqueous humor of one patient. IOP levels were monitored during postoperative follow-up, but three patients required postoperative adjustments (reintroduction of IOP-lowering therapy, goniopuncture or needling) in order to maintain IOP at satisfactory levels. Toxicological analysis revealed a high concentration of silicon in the aqueous humor of the patient from whom the sample was obtained.

Conclusions: These cases of OHT following cataract surgery with a defective IOL were of early onset severe, all requiring filtering surgery. The exact mechanism of this OHT has not been determined, but we did find high concentrations of silicon in the aqueous humor of one of these patients. Patients who received EyeCee^® ONE IOLs during the same period of time should have their IOP and optic nerve monitored to detect any potential OHT or glaucoma that might appear over time.