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 Table of Contents  
PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 571-572

Double trouble - Explanting an unwanted extra intraocular lens


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Date of Submission08-Aug-2021
Date of Acceptance17-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Shorya V Azad
Dr R P Centre for Ophthalmic Sciences, AIIMS, New Delhi - 110029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2094_21

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  Abstract 


Keywords: Double IOL, endothelial decompensation, improvizing


How to cite this article:
Bhayana AA, Prasad P, Azad SV, Khokhar SK, Kaur M. Double trouble - Explanting an unwanted extra intraocular lens. Indian J Ophthalmol Case Rep 2022;2:571-2

How to cite this URL:
Bhayana AA, Prasad P, Azad SV, Khokhar SK, Kaur M. Double trouble - Explanting an unwanted extra intraocular lens. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 18];2:571-2. Available from: https://www.ijoreports.in/text.asp?2022/2/2/571/342925



We report a peculiar case of a 60-year-old patient presenting with high myopia due to “an extra IOL” (reason unknown-no records available). The ACIOL was well placed, but the PCIOL was hanging freely in the anterior vitreous, yet being in the visual axis. The patient was managed with least invasive procedure possible- explanting the PCIOL through a small corneal incision, leaving the ACIOL in situ. No perioperative or intraoperative complications were observed.

For preoperative clinical picture as shown [Figure 1]a and [Figure 1]b, the following procedure was done: a 25 gauge vitrectomy canula was inserted inferotemporally [Figure 2]a for vitrectomy back up in case of posterior dislocation of IOL. A 20 gauge Micro vitreo-retinal blade (sideport) entry was made at limbus and extended (2 mm). Anterior chamber was formed with viscodispersive agent. PCIOL was grasped at the haptic optic junction with a 23 gauge intravitreal forcep [Figure 2]b via the space between anterior chamber IOL (ACIOL) and pupillary margin. Posterior chamber IOL (PCIOL) was then maneuvered anteriorly with simultaneous support with a blunt Sinskey hook. The haptic of PCIOL was partly exteriorized [Figure 2]c and then held with Mcpherson forcep for a firmer grip [Figure 2]d. A 23 gauge vitrectomy cutter was inserted [Figure 2]e through limbal entry to cut any vitreous entrapping the PCIOL or the trailing haptic in the pupillary plane and below. Once free, PCIOL was explanted with a milking technique using a 2nd Mcpherson forceps [Figure 2]f and [Figure 2]g. Viscodipersive agent was washed off and residual vitreous in pupillary plane was cut. Intracameral pilocarpine was injected, ACIOL centered, and incision sutured [Figure 2]h. On first post-op day, corneal edema was present with unaided vision of 1/60. The patient was prescribed topical, systemic steroids, and topical hyperosmotic agents and advised to follow up.
Figure 1: (a) Slit-lamp photograph showing ACIOL (red arrow), PCIOL (blue arrow); (b) ASOCT showing ACIOL (red arrow), PCIOL (blue arrow)

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Figure 2: (a) Twenty-five gauge vitrectomy canula in situ; (b) microforceps holding the PCIOL; (c) PCIOL haptic exteriorized; (d) handed over to Mcpherson forceps; (e) limited anterior vitrectomy done; (f) PCIOL being pulled out through small incision with milking technique; (g) PCIOL explanted; and (h) surgery closed

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Corneal edema had reduced [Figure 3]a,[Figure 3]b,[Figure 3]c,[Figure 3]d at 2 weeks follow-up. Best-corrected visual acuity with manifest refraction of -5 dioptees was 20/80. Specular microscopy could not be captured due to corneal edema. Due to the ongoing COVID-19 pandemic (lockdown), the patient has not yet come for follow-up.
Figure 3: (a and b) Slit-lamp photograph 1 week postoperative; (c and d) slit-lamp photograph 2 weeks postoperative

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  Discussion Top


An alternate approach would have been complete vitrectomy with double IOL explant with a primary or secondary scleral fixated IOL, but it would have required a larger incision (ACIOL) and longer surgical time, both of which could have caused corneal decompensation for sure, considering the endothelial cell count of 670/mm2.[1] Long-term visual outcomes and endothelial cell loss are identical in ACIOL or scleral fixated IOLs.[2] So again there was no point explanting an already well centered ACIOL and putting an SFIOL instead. Our procedure was minimalistic and safest possible approach for this patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gupta K, Deng SX. Corneal endothelial decompensation. Klin Monbl Augenheilkd 2020;237:745-53.  Back to cited text no. 1
    
2.
Chan TC, Lam JK, Jhanji V, Li EY. Comparison of outcomes of primary anterior chamber versus secondary scleral-fixated intraocular lens implantation in complicated cataract surgeries. Am J Ophthalmol 2015;159:221-6.e2.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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