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.
A 57-year-old Asian male had initial right eye cataract surgery in 1998 at the age of 40 in Singapore. Background history included asthma and allergic rhinitis. He had an ocular history of right-sided Fuchs’ heterochromic iridocyclitis and secondary glaucoma. In 2002, approximately 48 months after his right eye PCIOL implant, the patient developed intermittent right-sided ocular inflammation. On examination, his vision was 6/6 and was found to have an in-bag superonasally displaced PCIOL, rubbing against the posterior surface of the iris and causing inflammation. In 2013, the PCIOL dislocated inferiorly. The patient underwent right eye PCIOL removal with pars plana vitrectomy and removal of IOL with secondary ACIOL placement. Postoperatively, his acuity was 6/6−2.