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 63-year-old male with history of retinal detachment and remote history of bilateral cataract surgery presented to the ED with blurry vision in his right eye. He described sudden-onset visual disturbance “like a curtain dropping” while walking earlier in the day. His vision transiently improved with bending over but would blur again when he stood upright. He denied any ocular trauma, eye pain or swelling, discharge, headache, or other focal neurological complaints. His past medical history included coronary artery disease, diabetes mellitus, hyperlipidemia, and hypertension.\nOn physical exam, pupils were equal and reactive to light bilaterally. Extraocular movements were intact. Visual acuity was 20/100 in the right eye and 20/30 in the left eye. Slit lamp exam of the right eye revealed a deep, quiet anterior chamber, but a lack of pupillary reflection and inability to visualize the retina.\nPoint-of-care ultrasound of the affected eye was performed in the sagittal and transverse anatomic planes using a high-frequency linear transducer. The prosthetic lens was visualized in the posterior chamber with the temporal side haptic still adherent to the lens capsule consistent with an IOL dislocation (, ), whereas an appropriately positioned prosthetic lens would appear as a hyperechoic curvilinear structure within the lens capsule posterior to the iris. The patient was then asked to perform the six cardinal positions of gaze to maximize visualization of the ocular structures. There was no evidence of retinal detachment, vitreous detachment, or vitreous hemorrhage. The case was discussed with his ophthalmologist, and the patient underwent urgent operative repair of the dislocated lens as an outpatient.