A 56-year-old man presented with a 15-day history of sudden, painless blurring of vision in his right eye.\nPrevious ophthalmic history included an uneventful MSICS (manual small incision cataract surgery) and successful extraction of a mature cataract with a foldable hydrophilic acrylic intraocular lens in the right eye 36 months before presentation.\nAt 1 month follow-up the patient had a visual acuity of 20/20 with –0.25 DS.\nAt 18 months after the surgery, the best corrected visual acuity (BCVA) decreased to 20/40 and in the slit lamp examination, a visually significant posterior capsular opacification was found with no other significant ocular finding. Nd: YAG capsulotomy was performed and BCVA of 20/20 achieved at an uneventful follow-up 10 days post procedure.\n17 months after capsulotomy the patient presented with painless diminution of vision. BCVA was 20/60. Slit lamp examination showed anterior in-the-bag intraocular lens dislocation (Figure 1 ). Intraocular pressure was 15 mm Hg. There were no abnormal findings in the fundus on examination by indirect ophthalmoscopy with 20D lens.\nIt was managed with intraocular lens explantation with bag, anterior vitrectomy and scleral fixated intraocular lens using scleral flap and four point technique.\nThird day follow-up was uneventful with visual acuity of 20/30 and one month follow-up with a best corrected visual acuity of 20/20 (Figure 2 ).\nFigure 3 shows the result a month after surgery. End result was uncomplicated pseudophakia at end of 6 weeks.
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.