A 79-year-old Korean male with complaints of sudden decrease in visual acuity in the right eye was referred to our clinic. He did not present any remarkable medical history except hypertension. Phacoemulsification with capsular bag implantation of a posterior chamber IOL (AQ2003 V, STAAR Surgical Co., Monrovia, CA) was performed in both his eyes, about 10 years ago in a local clinic. Subsequently, Nd:YAG laser posterior capsulotomy was performed in the right eye at a local clinic. On ocular examination, the uncorrected distance visual acuity (UCVA) was 20/400 for the right eye and 20/20 for the left eye. The best-corrected distance visual acuity (BCVA) was 20/20 (x-10.00 Dsph) for the right eye and 20/20 for the left eye. Intraocular pressure (IOP) was 11 mmHg as measured by noncontact tonometer in the right eye. On slit-lamp examination, the cornea and conjunctiva were unremarkable, and there was no evidence of neovascularization in the iris, while dislocated IOL with intact anterior capsulorrhexis margin was observed in the right eye (Fig. ). We removed the dislocated IOL and fixed a 3-piece IOL (Acrysof MN60AC, Alcon Laboratories, Inc) in the ciliary sulcus under retrobulbar anesthesia. During the dislocated IOL removal operation, a fractured distal haptic was observed (Fig. ), and a proximal haptic was broken when held with a pair of smooth forceps (Fig. ). After the operation, the observed UCVA was 20/20 and the measured IOP was 18 mmHg; the IOL was fixed in the ciliary sulcus. The extracted polyimide haptic was fractured in vitro with 13 shots of 5.5 mJ energy (Fig. ). Patient has provided informed consent for publication of the case
A 58-year-old female patient from Tambolaka, Southwest Sumba, Indonesia presented for a follow-up after mass cataract extraction surgery. She graduated from high school and lives as a farmer. Before undergoing mass cataract extraction surgery, she complained of blurred vision in both eyes for 1 year. Upon examination, best visual acuity after correction was 1/300 for the right eye and 1/60 for the left eye. There was no history of other ocular disease prior to surgery. The patient was diagnosed with bilateral mature senile cataract. She then underwent phacoemulsification surgery of her right eye on August 27, 2016 in a mass cataract surgery in the hospital using a regular foldable lens. One week after the surgical procedure, the patient came to the hospital for post-surgery checkup and complained of sudden blurred vision in her right eye. History of eye trauma was denied by the patient. She admitted that before the symptoms appeared, she had often carried heavy loads around 5–10 kg and drawn water from wells as her daily activities. Upon physical examination, blood pressure was 130/90 mm Hg and visual acuity of the affected right eye was 1/60. Ciliary injection was found in the right eye along with IOL in the anterior chamber (Fig. ). Another surgery was later performed on the patient to replace the dislocated IOL with a new one. During the second operation, the trailing haptic was found to be broken. Post-surgery visual acuity of the right eye was 6/21.