A-76-year-old Japanese woman complained of blurred vision in her left eye. She reported that she had undergone cataract surgery with an implantation of an IOL without any complications 8 years earlier. She also reported that she had been diagnosed with presumed sarcoidosis 15 years earlier in another University Hospital based on the Japanese diagnostic criteria. Although mild iritis, vitreous opacities, and peripheral multifocal chorioretinitis were present, the iritis was under control by topical steroids. She had undergone pars plana vitrectomy (PPV) with cataract surgery in an eye with mild vitreous opacities, an epiretinal membrane (ERM), and macular edema (ME) in another eye 12 years earlier. Since then, the ocular inflammation has been stable in both eyes.\nWhen she was referred to our hospital, her best-corrected visual acuity (BCVA) was 20/20 in the eye with the inferiorly subluxed IOL in her left eye (). The intraocular pressure (IOP) was 9 mmHg in the right eye and 10 mmHg in the left eye. Slit-lamp examination revealed no cells in the anterior chamber (AC). Pseudoexfoliation was not observed, but multifocal hyperpigmented chorioretinal atrophy was present in both eyes. After an increase of blurred vison to 20/25, she underwent 25-gauge pars plana vitrectomy in January 2011 during which the 3-piece acrylic IOL was displaced into a bed of intravitreal perfluorocarbon liquid (PFCL). The IOL was then removed through a 7.0-mm corneal scleral incision. A constriction of the capsule of the lens was not observed intraoperatively. A fornix-based conjunctival peritomy was made at 270 degrees followed by the construction of a partial thickness triangular limbal based scleral flaps 180 degrees apart. Then, a one-piece P336UV (Bausch and Lomb, Rochester, NY) was placed in the posterior chamber (PC) using the ab externo method with PAIR-PAKTM needles (Alcon Laboratory). Then, 10–0 polypropylene sutures were passed through the haptic eyelets and sutured to the sclera. The suture knots were buried under the scleral flaps, and scleral flaps were sutured with 8–0 vicryl sutures to avoid suture-related complications. Thereafter, the IOL was stable with minimal cells in the AC, and the BCVA has remained between 20/20 to 20/16 for 8 years (). Confluent pigmented chorioretinal atrophy was clearly observed postoperatively (). The visual field was constricted ().
A 65-year-old male was referred to the ophthalmology department by his optometrist after identification of an anteriorly dislocated posterior chamber IOL. The patient denied vision changes or other ocular symptoms. His past ocular history was significant for uncomplicated bilateral cataract surgery in 1993, twenty-three years prior to presentation. He denied any recent ocular or head trauma. Ten months prior to presentation, the patient underwent coronary artery bypass graft surgery which was complicated by postoperative cardiac arrest for which he required cardiopulmonary resuscitation, which included chest compressions.\nOn examination, the patient was noted to have an IOL dislocated into the anterior chamber of the right eye with inferior iris capture of the optic and a fractured inferior lens haptic as noted in Figure .\nOther findings included mild non-proliferative diabetic retinopathy in both eyes without macular edema. There was no evidence of pupillary block, intraocular inflammation, iris chafing, or vitreous prolapse. The patient’s visual acuity was 20/20 and the intraocular pressure was within normal limits. Given the lack of ocular symptoms and his unstable cardiac condition, observation with close follow up was recommended. The patient remained asymptomatic until five months later when he developed photophobia, hyperemia, and was found on examination to have intraocular inflammation with associated macular edema. Visual acuity in the eye at this time was 20/100. The implant's position had not changed since the previous visit. Due to his unstable cardiac status, surgical options were limited, and the patient was treated with three rounds of subtenon's triamcinolone acetonide (40mg) injections at six- to eight-week intervals along with topical prednisolone acetate 1% drops. Following cardiac clearance, the dislocated IOL was surgically explanted and the patient was left aphakic. The explanted lens was noted to be a three-piece flexible silicone lens with polyimide haptics. In the months following, the patient was noted to have complete resolution of intraocular inflammation and macular edema. His final best-corrected visual acuity was 20/20.