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 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.