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 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.