|Year : 2021 | Volume
| Issue : 3 | Page : 497-498
Misplaced and invisible intraocular lens
Madhusmita Behera1, Subrata Mandal2, Pankaj Rupauliha3
1 Department of Cataract, Orbit and Oculoplasty, Rotary Narayana Nethralaya, Kolkata, West Bengal, India
2 Department of Viteroretinal and Uvea, Narayana Nethralaya, Kolkata, West Bengal, India
3 Department of Cataract and Glaucoma, Rotary Narayana Nethralaya, Kolkata, West Bengal, India
|Date of Submission||02-Oct-2020|
|Date of Acceptance||07-Feb-2021|
|Date of Web Publication||02-Jul-2021|
Dr. Madhusmita Behera
Rotary Narayana Nethralaya, CN 5, Sector-5, Salt Lake, Kolkata - 700 091, West Bengal
Source of Support: None, Conflict of Interest: None
Traumatic dislocation of foldable posterior chamber intraocular lens (PCIOL) is very rare and an emergency condition. Again, intra-operative dislocation of foldable PCIOL is very rare. We are reporting a case of inadvertent intraoperative suprachoroidal dislocation of foldable PCIOL without any retinal detachment, irido-dialysis, zonular dialysis, or vitreous loss.
Keywords: Cataract, displacement, IOL, phacoemulsification
|How to cite this article:|
Behera M, Mandal S, Rupauliha P. Misplaced and invisible intraocular lens. Indian J Ophthalmol Case Rep 2021;1:497-8
Intraoperative dislocation of foldable posterior chamber intraocular lens (PCIOL) is very rare. In all previously reported cases, there was traumatic dislocation of posterior chamber intraocular lens (PCIOL) superiorly into suprachoroidal space, vitreous cavity, and subconjunctival space.,,, Posttraumatic dislocation of polymethyl methacrylate (PMMA) posterior chamber intraocular lens into the supra-choroidal space postcataract surgery (extracapsular cataract extraction) was reported by Foster et al. We are reporting a case of inadvertent intraoperative suprachoroidal dislocation of foldable PCIOL.
| Case Report|| |
A 50-year-old patient had come to us with complaints of diminution of vision in both the eyes Right eye > Left eye. On examination, his visual acuity was 6/24 in the right eye and 6/12 in the left eye. On slit-lamp examination he had cataract (Nuclear sclerosis grade 3+ in the right eye, nuclear sclerosis grade 2+ in the left eye) in both the eyes. On fundoscopy, Cup disc ratio was 0.3 in both the eyes with good foveal reflex and attached retina.
He was advised to undergo phacoemulsification with foldable intraocular lens in right eye. On the day of surgery, peribulbar block was given. After proper cleaning and draping, surgery was started. Cataractous lens was completely emulsified and was taken out. The bag was then completely inflated with visco-elastic substances. Then the foldable lens (Acriol IOL is a single-piece, foldable, hydrophobic acrylic posterior chamber IOL, with a biconvex optic of 6.0 mm diameter and overall length of 12.5 mm having a square edge optic) was inserted in the cartridge and engaged in the wound to inject PCIOL. While injecting, I could feel some kind of resistance but when I pushed the plunger a little more, the foldable PCIOL came in a great force and hit the iris root and I could see the leading haptic with 2/3rd portion of haptic vanished behind the iris. I could only see a very small portion of optic and trailing haptic in the anterior chamber. Very quickly I took a dialler to take out that intra-ocular lens (IOL) out, but before I could do anything the entire PCIOL got vanished into the supra-choroidal space. But to my surprise, there was no bleeding in the anterior chamber nor the pupil was irregular. There was no vitreous loss, bag was completely intact and no zonular dialysis. Retina consultant opinion was also taken intra-operatively. Thorough retinal evaluation was also done intra-operatively. Retina was within normal limits, there was no bleeding, no retinal detachment was there, however, there was shallow retinal indentation in the inferonasal quadrant of the eye. Then vitrectomy was done to find out the displaced foldable intraocular lens, but foldable intraocular lens was not found. So another foldable intra-ocular (AcryIOL) was placed in the bag and wound was closed. Next day on post-operative check-up, cornea was clear, anterior segment was quiet. Fundus examination was normal with visual acuity 6/9 in that eye. Patient was advised steroid antibiotic eye drop and topical NSAIDS. After 5 days, vision was 6/6 with minimal cylindrical correction. Anterior segment was quiet and fundus was normal. USG B-scan was done which showed highly reflective shadow in supra-choroidal space in inferonasal quadrant of the eye ball [Figure 1]. USG B-scan was repeated after 7 days and 1 month. On 1 month follow up, vision was 6/6, N6 with normal anterior segment [Figure 2] and posterior segment. The patient was followed us after 2 month, 3 months, 6 months, and after 2 years. In all of his visits patient had 6/6 vision, with normal anterior segment and posterior segment.
|Figure 1: Ultrasonography B Scan of the right eye shows suprachoroidal hypoechoic area in the superonasal quadrant suggestive of location of IOL (Arrow). Vitreous cavity is anechoic and retina is attached|
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|Figure 2: Slit lamp picture shows normal anterior segment post operatively|
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| Discussion|| |
Index case is an unusual case, where the PCIOL is there in the supra-choroidal space and there is no retinal detachment, no irido-dialysis, no zonular weakness and no vitreous loss. As of now, there is no similar reported case. There are few case reports on traumatic dislocation of IOLs in literature.
Anterior dislocation of a sulcus fixated PCIOL was reported in a high myopic patient following blunt trauma. In this case, a single-piece PMMA IOL was implanted in the sulcus, got dislocated completely into the anterior chamber without a wound dehiscence or an iris trauma. They have hypothesized that sudden positive pressure in the vitreous cavity following blunt trauma behind the iris in an enlarged globe of this high myope could have pushed the sulcus placed PCIOL into the anterior chamber through a large pupil. Alternatively, a lens-iris diaphragm retropulsion (LIDRS) type phenomenon might have occurred, with extreme dilation of the pupil when the cricket ball hit, followed by rebound of the PCIOL into the anterior chamber.
Inferior subconjunctival dislocation of posterior chamber intraocular lens after blunt trauma was described. Authors have reported an interesting variation of rare case of inferior subconjunctival dislocation of PCIOL in an elderly female following blunt trauma to her right eye with cow's head. Foster et al. treated a patient who had a posterior chamber intraocular lens that dislocated into the suprachoroidal space following trauma.
The dislocation of PCIOL is rare as compared to anterior chamber or iris fixation lens. There are many predisposing factors leading to traumatic dislocation of PCIOL such as severity of trauma, implant duration, and tensile strength of cataract wound. In comparison to anterior chamber intraocular lens (ACIOL), PCIOL usually tolerates minor to moderate trauma. However, this rare complication can happen because of faulty loading technique of IOL and accidental forceful insertion. So in cases of difficult in insertion of IOL, one can try by taking out the IOL outside the eye, then reload and reinsert the IOL in the second attempt.
| Conclusion|| |
Intraoperative suprachoroidal dislocation of foldable posterior chamber intraocular lens (PCIOL) without any retinal detachment, irido-dialysis, zonular dialysis, or vitreous loss is rare and is not reported in the literature to our knowledge.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]