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 64-year-old Caucasian female presented with right-sided cataract in 2009 at the age of 59. She had a background history of rheumatoid arthritis treated with methotrexate. She had developed right herpetic retinitis in 2005. She underwent uncomplicated phacoemulsification with an Alcon SN60WF inserted in-bag. Loose zonules were noted at the time of the cataract surgery, and no capsular tension ring was inserted. Postoperatively, her acuity was 6/6. In May 2013, 47 months post-surgery review, there was no evidence of IOL instability; however, she represented 6 months later in November 2013 with right eye fluctuating vision and a right-sided in-bag IOL dislocation. Two months later, she underwent a right-sided anterior approach PCIOL explantation and anterior vitrectomy with anterior chamber intraocular lens (ACIOL). Postoperatively, her corrected visual acuity was 6/12.