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.
A 45-year-old Caucasian male presented with right eye cataract secondary to previous bilateral uveitis in 2008 at the age of 39. Background history includes type 2 diabetes diagnosed in 2011. Ocular history included herpetic keratouveitis with bilateral acute retinal necrosis diagnosed in 2006 (now quiescent) and bilateral relapsing remitting macular oedema treated with multiple IVTA injections. His preoperative right eye vision was counting fingers, and he underwent an uncomplicated phacoemulsification with a 19.0D Alcon SN60WF PCIOL inserted into the bag. Postoperatively, the patient continued to have intermittent severe macular oedema and received three further right eye IVTA injections between 2008 and 2013. His right eye vision has improved to 6/9 by February 2013; however, some right eye PCIOL dislocation was noted. Sixty-four months after his initial PCIOL implant, the patient was found to have right eye in-bag PCIOL dislocation and a vision of 6/24−1 in June 2013. Two months later, he underwent a right-sided anterior approach IOL extraction and secondary anterior chamber IOL implantation. On last review, his right eye vision was 6/36.