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.
A 71-year-old male presented with decreased visual acuity in the left eye for 2-month duration. On ocular examination, the best-corrected visual acuity in the right and left eyes was 20/20 (MR−, +0.50Ds -0.50Dc Ax90) and 20/60 (MR-error), respectively. On slit lamp examination, an empty capsular bag with anterior continuous curvilinear capsulorhexis (CCC) was found in the anterior chamber []. In addition, the slit lamp examination showed downward subluxation of a three-piece IOL and some vitreous strands in the anterior chamber in the mydriasis test []. The medical history of this patient was as follows. In 2009, he was diagnosed with a senile cataract (posterior subcapsular opacity type) in both eyes and underwent cataract surgery on both eyes in our clinic. There was no zonular weakness or pseudoexfoliation in the crystalline lens on the preoperative examination. The cataract surgery consisted of one-stitch, a 2.8-mm temporal clear corneal incision, phacoemulsification, and implantation of a three-piece hydrophobic acrylic IOL (TECNIS ZA9003, Abbott Medical Optics, Santa Ana, CA, USA) in the left eye and a one-piece hydrophobic acrylic IOL (TECNIS ZCB00, Abbott Medical Optics, Santa Ana, CA, USA) in the right eye. He denied accidental trauma before or after the cataract surgery. He also had no hereditary genetic diseases, including Marfan syndrome, homocystinuria, spherophakia, and retinitis pigmentosa. However, he stated that he had a habit of rubbing his eyes.\nThree years postoperatively, he presented with decreased visual acuity in the left eye and anterior dislocation of the capsular bag. The IOL was dislocated into the posterior chamber. We planned to reposition the IOL with scleral fixation of the existing lens. The dislocated capsular bag was extracted from the anterior chamber and spread on the corneal surface, and we observed a partial circumferential laceration along the equator of the capsular bag; that is, at the junction of the anterior and posterior capsular bags. The bag had an intact margin of anterior capsular curvilinear capsulorhexis [Fig. and ]. To reposition the IOL, two partial-thickness, limbal-based scleral flaps were created about 1.5 mm from the limbus, under which sclerotomies were performed. The IOL was repositioned through two 1-mm side punctures made using two 23-gauge end-gripping micro-capsulorhexis forceps (Micro Surgical Technology, Redmond, WA, USA), and both haptics were externalized under the scleral flap with Colibri forceps. The haptic ends were tucked into intralamellar scleral tunnels made with a 26-gauge needle. The scleral flaps and conjunctiva were closed with fibrin glue (Tisseel; Baxter, Deerfield, IL, USA; []). The surgery was completed with an anterior vitrectomy. This method, called a glued intrascleral fixation of the posterior chamber of the IOL, was introduced by Kumar et al.[] The uncorrected visual acuity recovered to 20/30 in the left eye [].