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 65-year-old male was referred to the ophthalmology department by his optometrist after identification of an anteriorly dislocated posterior chamber IOL. The patient denied vision changes or other ocular symptoms. His past ocular history was significant for uncomplicated bilateral cataract surgery in 1993, twenty-three years prior to presentation. He denied any recent ocular or head trauma. Ten months prior to presentation, the patient underwent coronary artery bypass graft surgery which was complicated by postoperative cardiac arrest for which he required cardiopulmonary resuscitation, which included chest compressions.\nOn examination, the patient was noted to have an IOL dislocated into the anterior chamber of the right eye with inferior iris capture of the optic and a fractured inferior lens haptic as noted in Figure .\nOther findings included mild non-proliferative diabetic retinopathy in both eyes without macular edema. There was no evidence of pupillary block, intraocular inflammation, iris chafing, or vitreous prolapse. The patient’s visual acuity was 20/20 and the intraocular pressure was within normal limits. Given the lack of ocular symptoms and his unstable cardiac condition, observation with close follow up was recommended. The patient remained asymptomatic until five months later when he developed photophobia, hyperemia, and was found on examination to have intraocular inflammation with associated macular edema. Visual acuity in the eye at this time was 20/100. The implant's position had not changed since the previous visit. Due to his unstable cardiac status, surgical options were limited, and the patient was treated with three rounds of subtenon's triamcinolone acetonide (40mg) injections at six- to eight-week intervals along with topical prednisolone acetate 1% drops. Following cardiac clearance, the dislocated IOL was surgically explanted and the patient was left aphakic. The explanted lens was noted to be a three-piece flexible silicone lens with polyimide haptics. In the months following, the patient was noted to have complete resolution of intraocular inflammation and macular edema. His final best-corrected visual acuity was 20/20.