Unilateral toxic anterior segment syndrome after immediate sequential bilateral phakic intraocular lens implantation

Introduction: The requirement to perform immediate sequential bilateral cataract surgery (ISBCS) is controversial. Most surgeons who do not adhere to this approach cite the possibility of bilateral complications occurring. Patient and Clinical Findings: A 35-year-old woman underwent bilateral implantation of phakic intraocular lenses the same day. She complained of pain and significantly decreased quality of vision in her right eye 12 hours postoperatively and was immediately examined. Physical examination of the right eye showed significant corneal edema extending from limbus to limbus and a dilated fixed pupil unresponsive to light. Diagnosis, Intervention, and Outcomes: Physical examination showed toxic anterior segment syndrome ensued in one eye. The complication was timely managed, preventing further damage to the eye. The contralateral eye showed no signs of complication. Conclusions: This case highlights that, when performed with utmost care, protocols designed to avoid bilateral occurrence of complications in same-day surgeries can work in the real-world settings. This is further evidence that ISBCS may not pose an additional risk to patients.