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 ().
A 71-year-old male presented with decreased visual acuity in the left eye for 2-month duration. On ocular examination, the best-corrected visual acuity in the right and left eyes was 20/20 (MR−, +0.50Ds -0.50Dc Ax90) and 20/60 (MR-error), respectively. On slit lamp examination, an empty capsular bag with anterior continuous curvilinear capsulorhexis (CCC) was found in the anterior chamber []. In addition, the slit lamp examination showed downward subluxation of a three-piece IOL and some vitreous strands in the anterior chamber in the mydriasis test []. The medical history of this patient was as follows. In 2009, he was diagnosed with a senile cataract (posterior subcapsular opacity type) in both eyes and underwent cataract surgery on both eyes in our clinic. There was no zonular weakness or pseudoexfoliation in the crystalline lens on the preoperative examination. The cataract surgery consisted of one-stitch, a 2.8-mm temporal clear corneal incision, phacoemulsification, and implantation of a three-piece hydrophobic acrylic IOL (TECNIS ZA9003, Abbott Medical Optics, Santa Ana, CA, USA) in the left eye and a one-piece hydrophobic acrylic IOL (TECNIS ZCB00, Abbott Medical Optics, Santa Ana, CA, USA) in the right eye. He denied accidental trauma before or after the cataract surgery. He also had no hereditary genetic diseases, including Marfan syndrome, homocystinuria, spherophakia, and retinitis pigmentosa. However, he stated that he had a habit of rubbing his eyes.\nThree years postoperatively, he presented with decreased visual acuity in the left eye and anterior dislocation of the capsular bag. The IOL was dislocated into the posterior chamber. We planned to reposition the IOL with scleral fixation of the existing lens. The dislocated capsular bag was extracted from the anterior chamber and spread on the corneal surface, and we observed a partial circumferential laceration along the equator of the capsular bag; that is, at the junction of the anterior and posterior capsular bags. The bag had an intact margin of anterior capsular curvilinear capsulorhexis [Fig. and ]. To reposition the IOL, two partial-thickness, limbal-based scleral flaps were created about 1.5 mm from the limbus, under which sclerotomies were performed. The IOL was repositioned through two 1-mm side punctures made using two 23-gauge end-gripping micro-capsulorhexis forceps (Micro Surgical Technology, Redmond, WA, USA), and both haptics were externalized under the scleral flap with Colibri forceps. The haptic ends were tucked into intralamellar scleral tunnels made with a 26-gauge needle. The scleral flaps and conjunctiva were closed with fibrin glue (Tisseel; Baxter, Deerfield, IL, USA; []). The surgery was completed with an anterior vitrectomy. This method, called a glued intrascleral fixation of the posterior chamber of the IOL, was introduced by Kumar et al.[] The uncorrected visual acuity recovered to 20/30 in the left eye [].