Traumatic anterior dislocation of capsular bag-posterior chamber intraocular lens complex into the anterior chamber

Madhu Shekhar; Suganya Babu; Kamatchi Nagu

doi:10.4103/ijo.IJO_383_22

PHOTO ESSAY

Year : 2022 | Volume : 2 | Issue : 3 | Page : 818-819

Traumatic anterior dislocation of capsular bag-posterior chamber intraocular lens complex into the anterior chamber

Madhu Shekhar, Suganya Babu, Kamatchi Nagu
Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission	07-Feb-2021
Date of Acceptance	25-Mar-2022
Date of Web Publication	16-Jul-2022

Correspondence Address:
Dr. Madhu Shekhar
Chief, Cataract and IOL Services, Aravind Eye Hospital and Post graduate Institute of Ophthalmology, Madurai, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_383_22

Abstract

Keywords: Anterior dislocation, capsular bag-posterior chamber intraocular lens complex, trauma

How to cite this article:
Shekhar M, Babu S, Nagu K. Traumatic anterior dislocation of capsular bag-posterior chamber intraocular lens complex into the anterior chamber. Indian J Ophthalmol Case Rep 2022;2:818-9

How to cite this URL:
Shekhar M, Babu S, Nagu K. Traumatic anterior dislocation of capsular bag-posterior chamber intraocular lens complex into the anterior chamber. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 11];2:818-9. Available from: https://www.ijoreports.in/text.asp?2022/2/3/818/351185

A 76-year-old male presented with sudden defective vision in the left eye (LE) associated with a history of trauma sustained during a fall to the ground. The patient underwent phacoemulsification with foldable intraocular lens (IOL) implantation for the LE 1 year ago. Anterior segment evaluation in the LE revealed variable anterior chamber depth; capsular bag-posterior chamber intraocular lens (PCIOL) complex was found to be dislocated anteriorly into the anterior chamber [Figure 1]a, with the inferior haptic of PCIOL touching the endothelium. Dilated fundus examination and intraocular pressure (IOP) were normal in the LE. IOL explantation via the sclerocorneal tunnel was done in combination with pars plana vitrectomy (PPV), and scleral fixation of a three-piece IOL was performed in the LE [Figure 1]b. On postoperative day 1 (POD 1), BCVA in the LE was hand movements with the B-scan showing dispersed vitreous hemorrhage. IOP was recorded to be 42 mm Hg. Antiglaucoma medications were added to routine postoperative medications. Following a gradual improvement in subsequent follow-up visits, BCVA of 6/9 and IOP of 16 mm Hg were recorded after 5 months.

Figure 1: (a) Slit-lamp photograph with diffuse illumination showing anterior dislocation of capsular bag-posterior chamber intraocular lens complex in toto in anterior chamber. (b) Slit-lamp photograph showing a postoperative picture of scleral fixated IOL

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Discussion

With a 0.2%–3.0% incidence rate, posterior chamber intraocular lens (PCIOL) dislocation is a rare and delayed complication of cataract surgery.^[1] Posterior dislocations are much more common than anterior dislocations. Although anterior dislocation is rare, delayed intervention in such cases may lead to corneal decompensation, glaucoma, uveitis, and cystoid macular edema.^[2] IOL repositioning with or without iris or scleral fixation, as well as IOL exchange, are all options for treating IOL dislocation. The technique used is based on the type of IOL implanted, surgeons' preference, and coexisting ocular pathology. The main postoperative complications are vitreous hemorrhage, post-inflammatory IOP spike, cystoid macular edema, recurrent IOL dislocation, and retinal detachment.^[3] Early intervention and regular follow-up in such cases can give a better outcome.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2.	Weng T, Chiang S-Y. Complete anterior dislocation of capsular tension ring-intraocular lens complex. Journal of Clinical & Experimental Ophthalmology 2017;08. https://www.longdom.org/open-access/complete-anterior-dislocation-of-capsular-tension-ringintraocular-lens-complex-51924.html.
3.	Clark A, Morlet N, Ng JQ, Preen DB, Semmens JB. Whole population trends in complications of cataract surgery over 22 years in Western Australia. Ophthalmology 2011;118:1055–61.