Hemodynamic central retinal artery occlusion following pigment dispersion glaucoma after implantable collamer lens surgery

Introduction: Implantable collamer lenses (ICLs) are widely regarded as safe and effective for refractive correction, with complications typically limited to anterior segment changes such as elevated intraocular pressure (IOP), pigment dispersion, or cataract. Retinal vascular occlusion after ICL implantation is exceedingly rare. This case describes central retinal artery occlusion (CRAO) shortly after ICL surgery. Patient and Clinical Findings: A 42-year-old woman with high myopia underwent bilateral ICL implantation at an outside institution. 13 days later, she developed sudden pain and profound vision loss in the left eye. Visual acuity was hand motion in the left eye and 20/20 in the right eye, with IOP of 51 mm Hg in the left eye. Slitlamp examination showed asymmetric anterior chamber pigment and dense trabecular meshwork pigmentation in the left eye. Fundus examination revealed diffuse retinal whitening and a cherry-red spot. Diagnosis, Intervention, and Outcomes: Hemodynamic CRAO secondary to acute IOP elevation was diagnosed. Maximal glaucoma medical therapy was initiated, surgical intervention deferred, and stroke evaluation arranged because of delayed presentation and severe ischemia. Conclusions: Acute IOP elevation from pigment dispersion, likely related to subtle ICL malposition, may overcome retinal perfusion pressure and cause arterial occlusion. Careful postoperative monitoring and IOP control are critical to preventing vision-threatening complications.