Occult iris erosion. A treatable cause of recurrent hyphema in iris-supported intraocular lenses.

A 78-year-old man underwent intracapsular cataract extraction with implantation of a Binkhorst four-loop lens. Two years later he developed recurrent hyphema, glaucoma, diffusion of blood into the vitreous, and reduction of visual acuity to 3/200. Iris fluorescein angiography demonstrated a localized network of prominent collateral vessels without fluorescein leakage above the pupil, deflection and compression of radial iris vessels by the superior lens posts, and a focal area of leakage adjacent to one of the posts. Argon laser photocoagulation obliterated the abnormal vessels in each of these areas, eliminated the recurrent hyphema and glaucoma, and permitted recovery of 20/80 visual acuity. The patient died suddenly three months after iris photocoagulation. Histopathologic study of the eye demonstrate erosion of iris stroma and displacement of iris vessels by the lens posts, as well as the vascular effects of successful photocoagulation therapy.