|Year : 2023 | Volume
| Issue : 2 | Page : 335-336
A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy
Kalluri Satya Srividya1, S Balamurugan2, Snigdha Mishra1, R Venkatesh3
1 Senior Resident, Aravind Eye Hospital, Pondicherry, India
2 Medical Consultant, Uvea Services, Aravind Eye Hospital, Pondicherry, India
3 Chief Medical Officer, Consultant, Glaucoma Services, Aravind Eye Hospital, Pondicherry, India
|Date of Submission||29-Oct-2022|
|Date of Acceptance||10-Jan-2023|
|Date of Web Publication||28-Apr-2023|
C/O Aravind Eye Hospital, Cuddalore Main Road, Thavalakuppam, Pondicherry - 605007
Source of Support: None, Conflict of Interest: None
Neodymium-ytrrium aluminium garnet capsulotomy is the gold standard for the treatment of posterior capsular opacification and is most commonly performed as an outpatient procedure. Here, the authors report a rare and probably the first encounter of a complication post laser capsulotomy seen in a 54 years old female who presented with defective vision and pain for 6 months after the procedure. Examination revealed one of the haptics of intraocular lens piercing through the iris into the anterior chamber, causing chronic inflammation leading to cystoid macular edema. The exact position of the intraocular lens and it's haptics were confirmed using anterior segment optical coherence tomography.
Keywords: Cystoid macular edema, laser capsulotomy, posterior capsular opacification
|How to cite this article:|
Srividya KS, Balamurugan S, Mishra S, Venkatesh R. A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy. Indian J Ophthalmol Case Rep 2023;3:335-6
|How to cite this URL:|
Srividya KS, Balamurugan S, Mishra S, Venkatesh R. A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 10];3:335-6. Available from: https://www.ijoreports.in/text.asp?2023/3/2/335/374993
Neodymium-ytrrium aluminium garnet (Nd:YAG) laser capsulotomy is the most common and widely acknowledged approach for disrupting the opacified posterior capsule. Although considered noninvasive and safe, it is not without any adverse effects. In this segment, we would linke to enlist an uncommon complication encountered as an aftereffect of this procedure.
| Case Report|| |
A 54-year-old female presented with blurring of vision in her right eye (OD) for the past 3 months. The best corrected visual acuity (BCVA) in OD was 6/36 and in the left eye (OS) was 6/18p. The OD showed pseudophakia with posterior capsular opacification (PCO) and the OS had immature cataract. Patient was advised Nd:YAG capsulotomy in OD. The size of opening done was 4 mm, with 26 spots of power 1.2 mJ/spot. Anti-inflammatory eye drops were prescribed with a 1-week follow-up. Patient failed to follow-up until 6 months and presented with pain in OD. There was no history of trauma after the procedure. A thorough anterior and posterior segment evaluation revealed one of the haptics of intraocular lens (IOL) piercing through the iris into the anterior chamber [Figure 1], causing chronic inflammation leading to cystoid macular edema (CME). The exact position of the IOL and its haptics were confirmed using anterior segment optical coherence tomography (AS-OCT) [Figure 2]. The patient was advised corrective surgery and was given a posterior subtenon steroid injection to reduce inflammation.
|Figure 1: Right eye slit-lamp image showing IOL haptic protruding through the iris marked by red arrow. IOL = intraocular lens|
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|Figure 2: Right eye AS-OCT image of the corresponding iris defect (marked as red arrow) showing haptic protrusion into the anterior chamber. AS-OCT = anterior segment optical coherence tomography|
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| Discussion|| |
Although complications including refractive alterations, IOL movement, damage to IOL, pupillary block glaucoma, retinal hemorrhage, endocapsular spreading of low-grade endophthalmitis, and secondary closure of capsulotomy aperture have been reported in isolation, to the best of our knowledge, this complication was encountered for the first time. It is not uncommon to see CME following IOL placement in sulcus, either accidentally or due to lack of support. A similar case of iris epithelial detachment has been reported; however, haptic protusion was not observed.
| Conclusion|| |
A thorough examination and suspicion for IOL position along with Anterior Segment OCT (AS-OCT) is necessary in cases of unexplained Cystoid Macular Edema (CME) and inflammation in post-operative cases.
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]