Myopic Shift Following Clear Lens Extraction in a Patient With Plateau Iris Syndrome Reversed by Synechiolysis: A Case Report.

This case report describes a rare mechanical etiology of postoperative refractive surprise - anterior displacement of an intraocular lens (IOL) secondary to localized posterior synechiae - in a patient with plateau iris syndrome (PIS) following combined clear lens extraction (CLE) and minimally invasive glaucoma surgery (MIGS). A 29-year-old man with PIS and medically refractory chronic angle-closure glaucoma underwent an uneventful left-eye CLE, goniosynechiolysis, implantation of a toric extended depth-of-focus (EDOF) IOL, and insertion of three iStent infinite® (Glaukos Corporation, Aliso Viejo, CA, USA) devices. Five weeks postoperatively, he presented with blurred vision, asthenopia, and binocular diplopia associated with a sudden -2.50 D myopic surprise. Dynamic slit-lamp examination revealed localized posterior synechiae extending from 1 to 5 o'clock. These adhesions exerted asymmetrical traction on the capsular bag, resulting in anterior displacement and temporal tilt of the IOL complex without pupillary block. The patient subsequently underwent targeted synechiolysis under local anesthesia. Postoperative biometry demonstrated an increase in anterior chamber depth (ACD) from 2.90 mm to 3.02 mm, confirming posterior repositioning of the IOL. Restoration of the effective lens position (ELP) reversed the myopic shift and resolved the patient's symptoms. This case highlights localized posterior synechiae as a rare but reversible cause of postoperative refractive surprise and underscores the importance of meticulous dynamic slit-lamp evaluation and ACD monitoring in patients with complex anterior segment conditions presenting with unexpected refractive outcomes. Timely synechiolysis may serve as a definitive and restorative intervention.