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 ().
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.