A 63-year-old male with history of retinal detachment and remote history of bilateral cataract surgery presented to the ED with blurry vision in his right eye. He described sudden-onset visual disturbance “like a curtain dropping” while walking earlier in the day. His vision transiently improved with bending over but would blur again when he stood upright. He denied any ocular trauma, eye pain or swelling, discharge, headache, or other focal neurological complaints. His past medical history included coronary artery disease, diabetes mellitus, hyperlipidemia, and hypertension.\nOn physical exam, pupils were equal and reactive to light bilaterally. Extraocular movements were intact. Visual acuity was 20/100 in the right eye and 20/30 in the left eye. Slit lamp exam of the right eye revealed a deep, quiet anterior chamber, but a lack of pupillary reflection and inability to visualize the retina.\nPoint-of-care ultrasound of the affected eye was performed in the sagittal and transverse anatomic planes using a high-frequency linear transducer. The prosthetic lens was visualized in the posterior chamber with the temporal side haptic still adherent to the lens capsule consistent with an IOL dislocation (, ), whereas an appropriately positioned prosthetic lens would appear as a hyperechoic curvilinear structure within the lens capsule posterior to the iris. The patient was then asked to perform the six cardinal positions of gaze to maximize visualization of the ocular structures. There was no evidence of retinal detachment, vitreous detachment, or vitreous hemorrhage. The case was discussed with his ophthalmologist, and the patient underwent urgent operative repair of the dislocated lens as an outpatient.
An 81-year-old Caucasian male presented with long-standing right-sided multifocal choroiditis and retinal vasculitis complicated by choroidal neovascularization with a macular scar and bilateral moderate glaucoma. He developed progressive anterior and posterior subcapsular cataract. Preoperatively, the patient’s uveitis was controlled with topical steroids only. He underwent uncomplicated phacoemulsification cataract extraction with a 19.0D Alcon SN60WF in-bag implant in 2000. Postoperatively, his vision was initially 6/36. Due to his choroidal neovascular membrane, the vision in his right eye progressively deteriorated to light perception only by 2009. He represented in 2013 at the age of 80, 165 months after his initial right eye IOL implant, with in-bag dislocation of his PCIOL. He was managed conservatively due to the poor visual potential.