A 71-year-old male presented with decreased visual acuity in the left eye for 2-month duration. On ocular examination, the best-corrected visual acuity in the right and left eyes was 20/20 (MR−, +0.50Ds -0.50Dc Ax90) and 20/60 (MR-error), respectively. On slit lamp examination, an empty capsular bag with anterior continuous curvilinear capsulorhexis (CCC) was found in the anterior chamber []. In addition, the slit lamp examination showed downward subluxation of a three-piece IOL and some vitreous strands in the anterior chamber in the mydriasis test []. The medical history of this patient was as follows. In 2009, he was diagnosed with a senile cataract (posterior subcapsular opacity type) in both eyes and underwent cataract surgery on both eyes in our clinic. There was no zonular weakness or pseudoexfoliation in the crystalline lens on the preoperative examination. The cataract surgery consisted of one-stitch, a 2.8-mm temporal clear corneal incision, phacoemulsification, and implantation of a three-piece hydrophobic acrylic IOL (TECNIS ZA9003, Abbott Medical Optics, Santa Ana, CA, USA) in the left eye and a one-piece hydrophobic acrylic IOL (TECNIS ZCB00, Abbott Medical Optics, Santa Ana, CA, USA) in the right eye. He denied accidental trauma before or after the cataract surgery. He also had no hereditary genetic diseases, including Marfan syndrome, homocystinuria, spherophakia, and retinitis pigmentosa. However, he stated that he had a habit of rubbing his eyes.\nThree years postoperatively, he presented with decreased visual acuity in the left eye and anterior dislocation of the capsular bag. The IOL was dislocated into the posterior chamber. We planned to reposition the IOL with scleral fixation of the existing lens. The dislocated capsular bag was extracted from the anterior chamber and spread on the corneal surface, and we observed a partial circumferential laceration along the equator of the capsular bag; that is, at the junction of the anterior and posterior capsular bags. The bag had an intact margin of anterior capsular curvilinear capsulorhexis [Fig. and ]. To reposition the IOL, two partial-thickness, limbal-based scleral flaps were created about 1.5 mm from the limbus, under which sclerotomies were performed. The IOL was repositioned through two 1-mm side punctures made using two 23-gauge end-gripping micro-capsulorhexis forceps (Micro Surgical Technology, Redmond, WA, USA), and both haptics were externalized under the scleral flap with Colibri forceps. The haptic ends were tucked into intralamellar scleral tunnels made with a 26-gauge needle. The scleral flaps and conjunctiva were closed with fibrin glue (Tisseel; Baxter, Deerfield, IL, USA; []). The surgery was completed with an anterior vitrectomy. This method, called a glued intrascleral fixation of the posterior chamber of the IOL, was introduced by Kumar et al.[] The uncorrected visual acuity recovered to 20/30 in the left eye [].
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.