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 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