A 57-year-old male patient presented to our clinic with a history of blurred vision in the right eye for 10 days. He had no recent systemic disease or ocular trauma history, but he remembered that blurred vision developed just after straining to lift a heavy object. His medical record showed that he underwent uneventful phacoemulsification with capsular bag implantation of a posterior chamber IOL in the right eye under local anesthesia 11 years ago in our institute. The IOL (model AQ2003V, STAAR® Surgical Co., Monrovia, CA, USA) was a three-piece biconvex lens with a 6.3-mm optic and polyimide haptics, and the overall diameter was 12.5 mm. The haptics had a C-shaped configuration and a flat angulation. Postoperatively, the uncorrected visual acuity (UCVA) was 20/20.\nAt presentation, the visual acuity of right eye was 20/60, and the intraocular pressure (IOP) was 11 mmHg by noncontact tonometer. Best corrected visual acuity (BCVA) was 20/20 (−2.25 Dsph = −1.00 Dcyl Ax 90). On slit-lamp examination, the pupil was distorted, and the IOL optic and a proximal part of a nasal fractured haptic were found in the anterior chamber, with cells 3+. After dilation, both ends of the fractured IOL haptic fragment were found to be aligned close to each other at the margin of the capsulotomy, with most of the haptic loop located in the bag []. Severe capsular fibrosis was also noted. Fundus examination revealed no specific abnormality. The corneal endothelial count was 2075/mm2 by specular microscope.\nTo prevent further complication, an operation was performed. Under retrobulbar anesthesia, the dislocated IOL including attached haptic fragment was removed. During operation, the fractured distal haptic fragment was noted and left in the bag. Then, a three-piece IOL (ZA9003, Tecnis®, Abbott Medical Optics, Santa Ana, IL, USA) was fixed in the ciliary sulcus. The extracted IOL was checked grossly, and the fracture site of the haptic was near the optic–haptic junction [].\nOn postoperative day 1, the UCVA was 20/25 and IOP was 10 mmHg. The IOL was fixed in the sulcus and postoperatively there were no further complications. At the most recent presentation, which was 3 weeks after operation, the UCVA was 20/25 and the IOL was well positioned.
A 45-year-old Caucasian male presented with right eye cataract secondary to previous bilateral uveitis in 2008 at the age of 39. Background history includes type 2 diabetes diagnosed in 2011. Ocular history included herpetic keratouveitis with bilateral acute retinal necrosis diagnosed in 2006 (now quiescent) and bilateral relapsing remitting macular oedema treated with multiple IVTA injections. His preoperative right eye vision was counting fingers, and he underwent an uncomplicated phacoemulsification with a 19.0D Alcon SN60WF PCIOL inserted into the bag. Postoperatively, the patient continued to have intermittent severe macular oedema and received three further right eye IVTA injections between 2008 and 2013. His right eye vision has improved to 6/9 by February 2013; however, some right eye PCIOL dislocation was noted. Sixty-four months after his initial PCIOL implant, the patient was found to have right eye in-bag PCIOL dislocation and a vision of 6/24−1 in June 2013. Two months later, he underwent a right-sided anterior approach IOL extraction and secondary anterior chamber IOL implantation. On last review, his right eye vision was 6/36.