A-76-year old Japanese woman complained of blurred vision in her right eye. She had undergone cataract surgery with an IOL implantation without any complications 12 years earlier. She had also undergone PPV for an ERM and ME in both eyes 8 years earlier. She was diagnosed with sarcoidosis approximately 15 years earlier in another general hospital by a skin biopsy. Oral prednisolone (dose unknown) had been initially prescribed for the vitreous opacities and ME. After the PPV, the uveitis was controlled by topical steroids.\nHer BCVA was 20/25, when she was referred to our hospital in March 2015. The IOP was 13 mmHg and 11 mmHg in the right and left eyes, respectively. Slit-lamp examination revealed no cells in the AC, but a superior subluxation of an in-the-bag IOL was detected (). No pseudoexfoliation or vitreous opacities were present, and pigmented chorioretinal atrophy was found in the peripheary. The foveal ellipsoid zone (EZ) was disrupted in the optical coherent tomographic (OCT) images.\nShe underwent 27-gauge PPV in May 2015. The dislocated 3-piece acrylic IOL was displaced into a pool of PFCL and cut into 3 pieces. The pieces were removed through a 3.5-mm corneal scleral incision. A foldable acrylic IOL (VA-70 AD, HOYA, Tokyo, Japan) was inserted and suture-fixed to the sclera with the ab externo technique as in Case 1. Although the PC-IOL was stable () and the BCVA improved to 20/20 after the surgery, the BCVA decreased to the baseline value at 4 years due to mild macular chorioretinal atrophy. Peripheral pigmented chorioretinal atrophy and mild macular degeneration were clearly observed after the surgery (). A peripheral hypofluorescent lesion was also observed in the fundus autofluorescence images which corresponded with the pigmented lesion ().
An 81-year-old Caucasian male presented with long-standing right-sided multifocal choroiditis and retinal vasculitis complicated by choroidal neovascularization with a macular scar and bilateral moderate glaucoma. He developed progressive anterior and posterior subcapsular cataract. Preoperatively, the patient’s uveitis was controlled with topical steroids only. He underwent uncomplicated phacoemulsification cataract extraction with a 19.0D Alcon SN60WF in-bag implant in 2000. Postoperatively, his vision was initially 6/36. Due to his choroidal neovascular membrane, the vision in his right eye progressively deteriorated to light perception only by 2009. He represented in 2013 at the age of 80, 165 months after his initial right eye IOL implant, with in-bag dislocation of his PCIOL. He was managed conservatively due to the poor visual potential.