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-76-year-old Japanese woman complained of blurred vision in her left eye. She reported that she had undergone cataract surgery with an implantation of an IOL without any complications 8 years earlier. She also reported that she had been diagnosed with presumed sarcoidosis 15 years earlier in another University Hospital based on the Japanese diagnostic criteria. Although mild iritis, vitreous opacities, and peripheral multifocal chorioretinitis were present, the iritis was under control by topical steroids. She had undergone pars plana vitrectomy (PPV) with cataract surgery in an eye with mild vitreous opacities, an epiretinal membrane (ERM), and macular edema (ME) in another eye 12 years earlier. Since then, the ocular inflammation has been stable in both eyes.\nWhen she was referred to our hospital, her best-corrected visual acuity (BCVA) was 20/20 in the eye with the inferiorly subluxed IOL in her left eye (). The intraocular pressure (IOP) was 9 mmHg in the right eye and 10 mmHg in the left eye. Slit-lamp examination revealed no cells in the anterior chamber (AC). Pseudoexfoliation was not observed, but multifocal hyperpigmented chorioretinal atrophy was present in both eyes. After an increase of blurred vison to 20/25, she underwent 25-gauge pars plana vitrectomy in January 2011 during which the 3-piece acrylic IOL was displaced into a bed of intravitreal perfluorocarbon liquid (PFCL). The IOL was then removed through a 7.0-mm corneal scleral incision. A constriction of the capsule of the lens was not observed intraoperatively. A fornix-based conjunctival peritomy was made at 270 degrees followed by the construction of a partial thickness triangular limbal based scleral flaps 180 degrees apart. Then, a one-piece P336UV (Bausch and Lomb, Rochester, NY) was placed in the posterior chamber (PC) using the ab externo method with PAIR-PAKTM needles (Alcon Laboratory). Then, 10–0 polypropylene sutures were passed through the haptic eyelets and sutured to the sclera. The suture knots were buried under the scleral flaps, and scleral flaps were sutured with 8–0 vicryl sutures to avoid suture-related complications. Thereafter, the IOL was stable with minimal cells in the AC, and the BCVA has remained between 20/20 to 20/16 for 8 years (). Confluent pigmented chorioretinal atrophy was clearly observed postoperatively (). The visual field was constricted ().