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 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.