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 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.